The Oklahoma Attorney General ("OAG") recently opined that Oklahoma law does not require out-of-state medical practitioners to possess an Oklahoma license prior to treating Oklahoma residents outside of Oklahoma. Further, no Oklahoma license is required for an out-of-state practitioner to prescribe medication to Oklahoma residents when the patient care occurs outside of Oklahoma, nor is an out-of-state practitioner required to register with the Oklahoma Bureau of Narcotics and Dangerous Drugs ("OBNDD") before sending a prescription for a controlled drug to an Oklahoma pharmacy.
Recently, the Oklahoma State Board of Osteopathic Examiners ("OSBOE") had issued interpretive guidance asserting that an out-of-state osteopathic physician could not prescribe controlled substances to an Oklahoma resident if the physician did not possess an Oklahoma license to practice, although the patient encounter did not occur in Oklahoma. This interpretation disrupted a long-standing practice under which it was assumed that no Oklahoma license was required in such circumstances. In response, the OBNDD indicated that it did not interpret the uniform Controlled Dangerous Substances Act to require an out-of-state practitioner to register with the OBNDD prior to sending a prescription to an Oklahoma pharmacy.
The OAG disagreed with the OSBOE's guidance. Instead, he indicated that Oklahoma professional licensing boards require licenses prior to rendering patient care if the patient is in Oklahoma when receiving health care. This would include practitioners physically present or providing care via telemedicine. The opinion covers doctors practicing allopathic medicine (MDs), doctors practicing osteopathic medicine (DOs), physician assistants (PAs), Advanced Practice Registered Nurses (APRNs), dentists, and veterinarians.
Additionally, the OAG confirmed the position of OBNDD that no Oklahoma registration is required to prescribe a drug or to send a prescription to be filled in Oklahoma for an out-of-state practitioner seeing an Oklahoma patient outside of the state.
The opinion is significant because many Oklahomans live in rural areas near a state border. As many of these areas are designated as Health Professional Shortage Areas, the closest healthcare may be in a neighboring state. Requiring practitioners who practice exclusively out of state to be licensed or registered in Oklahoma would no doubt reduce the number of practitioners who would accept Oklahoma residents as patients in areas that are already underserved.
In a footnote, the OAG raised an issue an issue outside the scope of the inquiry that was implicated by the inquiry: whether a pharmacist licensed by the Oklahoma Pharmacy Board may fill a prescription written or issued by a practitioner (other than an APRN or PA) licensed in another state but not in Oklahoma. While suggesting that such practice may be permitted under the Oklahoma Pharmacy Act as written, the OAG encouraged the Legislature to examine Oklahoma laws regarding prescribing and dispensing authority and provide unambiguous direction.
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