The Basics of Veterinarian Prescriptions in Florida
Veterinary prescriptions in Florida are subject to specific rules and regulations. In general, Chapter 474, Florida Statutes, governs the practice of veterinary medicine in Florida. Under §474.203, which is the subsection prohibiting things like delegating the practice of veterinary medicine or practicing through an agent or employee, it is a violation for the holder of a license to practice veterinary medicine "to permit an unlicensed person to practice veterinary medicine." The term also includes "dispensing of veterinary legend drugs," which makes this section relevant to the dispensing or distributing of veterinary prescriptions. Pursuant to the Florida Administrative Code and Rules , Rule 61G18-18.002(4), the word "dispense" means to "furnish a veterinary legend drug in accordance with a prescription to a patient of the practitioner who issued the prescription."
It is important to remember that this Rule expressly limits the scope of dispensing to patients of the practitioner who wrote the prescription. This is not something that all other states necessarily require, so if you are writing a prescription, its important to make sure that your particular state even requires a prescription at all. Most do, but Florida’s is slightly different.
Who Is Authorized to Prescribe for Animals?
Florida is a leader in progressive veterinary medicine and has very clear laws regarding the prescription of drugs for animals. A veterinarian with an active license issued by the State of Florida is clearly authorized to write prescriptions for animals in Florida. Florida Statute § 474.203 specifically states "Only a veterinarian who holds an active license issued under this chapter may prescribe or issue a prescription for any drug for an animal patient." There is an exception to this statutory language in the area of compounding.
A pharmacist however, may only dispense a drug for an animal based on a prescription from a licensed veterinarian. Florida Statute §465.0276 specifically states "Unless otherwise directed by a veterinarian licensed under chapter 474, a pharmacist filling a prescription may not prepare (i.e. compound) a drug in excess of a 96-hour supply." This overwhelming majority of compounding done for animals with great success is done by veterinarians and not pharmacists.
Other professionals who enjoy prescribing authority for animals are veterinarians licensed in other states with a supervisory relationship with a doctor in Florida. Veterinarians licensed in other states can be eligible for licensure in Florida through endorsement. The basic premise of endorsement is that the veterinarian’s license in the other state has not lapsed, been suspended or revoked; the veterinarian has a clean record on the National Practitioner Data Bank; and has passed an examination equivalent to Florida’s Board exam.
Doctors of osteopathic medicine, physician assistants, nurses, chiropractors, and dentists also have limited authority to prescribe certain drugs for animals in Florida as part of their active practice. The Florida Board of Osteopathic Medicine, Florida Board of Medicine, Florida Board of Nursing, Florida Department of Health, Florida Board of Chiropractic Medicine and Florida Board of Dentistry promulgated rules to allow certain classes of drugs to be prescribed for animals by their licensees as part of their act.
The most common myth regarding who can prescribe medication for animals in Florida is regarding retail business owners who also have license to practice medicine in other states. Physicians licensed to practice medicine in other states as retail business owners do not have license to prescribe for animals in Florida. These physicians will only have authority to prescribe for animals in their primary state of license.
Rule 64B-18.0021, Florida Administrative Code and Florida Statute § 474.213 detail the requirements with regard to issuing a written prescription for animals in Florida.
What Do Veterinarians Need to Know About Prescribing?
Veterinarians must abide by several laws and ethical principles when prescribing medication for pets. For example, the Florida Veterinary Practice Act mandates that veterinarians may only prescribe drugs after they have established a veterinarian-client-patient relationship (VCPR). This relationship requires that the veterinarian (1) assume responsibility for the animal’s medical care; (2) possess sufficient knowledge of the animal to provide at least a general diagnosis; and (3) issue a medical treatment plan or referral to a specialist to ensure the care of the animal.
Once certified, licensed veterinarians can only fill potentially dangerous drugs at an approved pharmacy. Under federal law, veterinarians are permitted to dispense or prescribe prescription drugs -primarily those regulated by the federal Controlled Substances Act ("CSA")- so long as they do so in the normal course of business and only in limited quantities for use by the patient. CSA-defined drugs, which include tranquilizers like diazepam and certain sedatives, require veterinarians to register annually with the U.S. Drug Enforcement Administration ("DEA") in order to be permitted to dispense these drugs. Although veterinarians can administer these potentially dangerous drugs in their offices, under the current state law, veterinarians are generally not permitted to dispense this type of drug from their offices. Under the Florida Pharmacy Act, veterinarians who dispense prescription drugs must register with the Florida Department of Health ("DOH"). The DOH is authorized to issue rules and regulations "reasonably necessary for the . . . professional discipline and regulation of the practice of veterinary medicine. . . ." Notably, the Florida Veterinary Medical Association ("FVMA") warned in its 2015 Legislative Bulletin that its members should "be cautious about dispensing dangerous drugs from their office in lieu of having a counter prescription logbook in place."
Some veterinarians who oppose the prohibition on in-office dispensing argue that filled prescriptions are not available 24 hours a day, which creates accessibility issues. Regulators, however, have consistently delayed any proposed change to the current law. In an effort to appease interested parties, the FVMA facilitated collaborative discussions between veterinarians and pharmacies since 2010 to reach a consensus in opening up a path to the in-office dispensing of potentially dangerous drugs. However, no consensus has been reached thus far. Another concern is that in-office dispensing creates the potential for veterinarians to overprescribe medications and to sell medications to pet owners for profit. Florida law prohibits veterinarians from engaging in professional misconduct. These prohibitions include: the failure to maintain a medical record for each patient, failing to preserve confidential communication, and violating standards of medical and surgical competency. Under the Florida Veterinary Practice Act, prohibitions against discussing the professional confidence of the veterinarian-client-patient relationship include selling unnecessary services and items to the client and accepting any compensation for referring clients to a person competent to furnish those goods, facilities, or services. Despite these safeguards, however, veterinarians’ ethical obligations to keep a medical record and preserve communications with their patients are sometimes violated in cases of "continuing prescriptions." The FVMA warned its members that billing clients yearly for continuing drugs and posting "signs around your office" to call clients for drug refills may violate the law.
Requirements and Record Keeping
The Florida Veterinary Practice Act requires that veterinarians issue a written prescription for any drug or medication they determine is required, as an element of the veterinarian-client-patient-relationship, except in those circumstances where it would be impractical or impossible to do so (for example, when providing an animal with emergency care). The veterinarian is required to provide this written prescription to the client or responsible party, upon request. The Office of the Attorney General Appendix provides examples of what constitutes compliance in the issuance of this prescription. The prescription requirements are typically satisfied by initialing the signature line of a blank prescription pad and writing the necessary information on the balance of the pad.
The Florida prescription laws also require the veterinarian to maintain a copy of the issued prescription for two years after it has been issued.
Controlled Drugs and Florida Law
Much like medications issued to humans, there are strict rules when it comes to the obtaining and dispensing of controlled substances. When it comes to pain management, veterinarians are aware of the myriad of options on the market for animals of all types (dogs, cats, horses, etc.). There is a variety of options available whether they be oral, topical, injectable, infra-nasal, etc.) that the animals can benefit from because of the level at which they function and pain relief they provide. However, not all pain medications are equal or are suitable for the type or severity of condition that would require their use. Therefore, there are strict requirements for the distribution of certain medications.
Only licensed veterinarians are permitted to prescribe medication for animals and even though there may be a variety of medications available for the treatment of a condition , veterinarians must follow the guidelines set forth by the regulators of prescription medications. State veterinarian boards, medical board of each state and federal entities regulate the use of controlled substances and there are certain types of drugs that are only permitted for use by veterinarians as an approved "veterinary compound" or cannot be used for animal purposes. It is best to check with the respective agencies to determine what is permissible under the laws that govern your practice as a veterinarian.
State and federal regulations guide the distribution and use of controlled substances and, of course, there are no exceptions to these regulations and penalties may include fines and ineligibility to receive a prescription permit.
Risky Business: Common Pitfalls and Legal Issues
A significant challenge veterinarians face with respect to Florida’s veterinary prescription laws is access to a suitable "office use" labeled product that is not available for pets from an outside pharmacy. In this case, the veterinarian must prepare a prescription in compliance with the Florida Veterinary Practice Act and Rules as if a valid veterinarian-client-patient relationship existed. While the office use prescription requirements under the law are readily accessible on the online version of the Florida Veterinary Practice Act (see Section 474.203 (9) and Fla. Admin Code Rule 61G18-33.004), as discussed above, Florida Board of Veterinary Medicine (BVM) Board Counsel has also advised that in such circumstances it is the practice of the Veterinary Board not to require an "actual" VCPR to exist and instead the pharmacist should rely on the veterinarian’s written assurances in the medical record or otherwise even where an actual VCPR does not exist. Notably, the BVM has now included a sample office use prescription available to download and incorporate into your practice’s medical record and you can access it here: (sample office use prescription).
A common challenge is that some outside pharmacies, such as local chains like Walgreens, CVS, Rite Aid, etc., do not fill such office use prescriptions for pet owners and the veterinarian must contact another pharmacy in the State of Florida to ensure that such office use prescriptions may be filled. Certainly, this is very time consuming and cumbersome on your staff and in those cases, the practical solution may be to either stock the labeled product in your office or refer your clients to a compounding pharmacy that can take on the burden of creating the labeled medication.
Another challenge vets encounter is determining whether the "off label" use of a drug requires VCPR compliance. To assist veterinarians and their staff, these circumstances have been organized into a chart that is available to download and print and can be found here: (office use prescription requirements).
Finally, there’s the issue of record keeping. Florida’s law and rules are expansive in ensuring that accurate records are maintained and readily accessible by the requesting party without delay. Texting, emailing and good old fashion handwritten notes between staff members is not sufficient nor is failing to protect the confidentiality of your client’s information. A comprehensive recordkeeping protocol should include the ability to not only quickly produce the requested records, but do so in a way that methodically organizes the information in a predictable and convenient manner. For example, no matter how you choose to format and group your records, you should ensure that the following key information for each patient is clearly identifiable: (1) medical record date and time stamps, (2) medical record containing all diagnoses, medications and treatments recommended or performed, (3) radiology reports, (4) laboratory tests and tests results, (5) charts, graphs, and the like, (6) details of all consultations provided by others, (7) identify staff members who contributed to the record in a way that is readily understandable and (8) any other information the Florida BVM may require. While the Florida Veterinary Practice Act does not dictate how such information must be stored, keeping the information in a searchable and quantifiable format will save you time responding to audit letters.
Penalties for Non-Compliance
Veterinarians who do not comply with prescription requirements may be deemed unprofessional under Florida law. The law protects the public from veterinarians who engage in unprofessional, unsatisfactory or improper conduct in the practice of veterinary medicine. A veterinarian may be deemed unprofessional under the relevant statute (the Veterinary Medicine Practice Act, Section 474.214, Florida Statutes (2016)) if he/she violates, among others: The types of prescription violations that may result in disciplinary action include, but are not limited to, the following: A veterinarian found to have committed any of the above can be subject to license suspension or permanent revocation in addition to a civil penalty.
FAQs on Veterinary Prescription Laws in Florida
1. Can I get a written prescription from my veterinarian to fill at an off-site pharmacy?
Generally speaking, a veterinarian’s medical record is subject to the legal doctrine of "practitioner-patient privilege", Florida Statutes Section 456.057. As the Florida Board of Veterinary Medicine has stated in its letter dated April 27, 2017, the "Florida Veterinary Practice Act does not require veterinarians to provide prescriptions" or "to create a written prescription upon client’s request." This is not to say a veterinarian cannot do so voluntarily, if he or she so chooses.
2. My veterinarian will provide a written prescription, but will not forward it to a different pharmacy for me. Is this legal?
Yes. In a case decided in 2016, the Florida First District Court of Appeals held a veterinarian does not owe a legal duty to fill or forward a prescription to a pharmacy. When a veterinarian writes a prescription for a client, he or she is not legally obligated to fill or forward a prescription to a pharmacy.
3 . My veterinarian says his office or hospital has to be licensed in order to stock on-site prescribed medications. Is that so?
Veterinary practices dispensing prescribed medications are required to be licensed as a "Veterinary Medicine Establishment" with Florida’s Agency for Health Care Administration (AHCA). The AHCA and Florida Department of Health conduct inspections. If your veterinarian is dispensing medications on-site, without an establishment license, they are in violation of law.
4. Can I report my veterinarian dispensing prescribed medications on-site without a license?
Yes. You can file a complaint with the AHCA’s Bureau of Health Care Practitioner Regulation.
To summarize Florida law on veterinarians dispensing prescribed medications, the veterinarian must be in a licensed veterinary standards facility and licensed as a veterinarian in the State of Florida, be an employee of and working under supervision of a licensed veterinarian, and the premises must have passed inspection within the past 24 months and be operating under the Structural Pest Control Act.