TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING

BOARD OF MEDICINE

Proposed Regulation

Title of Regulation: 18VAC85-50. Regulations Governing the Practice of Physician Assistants (amending 18VAC85-50-160).

Statutory Authority: § 54.1-2400 of the Code of Virginia.

Public Hearing Information:

April 3, 2026 - 8:31 a.m. - Department of Health Professions, Perimeter Center, 9960 Mayland Drive, Suite 201, Richmond, VA 23233-1463.

Public Comment Deadline: May 8, 2026.

Agency Contact: Erin Barrett, Director of Legislative and Regulatory Affairs, Department of Health Professions, Perimeter Center, 9960 Mayland Drive, Suite 300, Henrico, VA 23233, telephone (804) 750-3912, fax (804) 915-0382, or email erin.barrett@dhp.virginia.gov.

Basis: Section 54.1-2400 of the Code of Virginia authorizes the Board of Medicine to promulgate regulations that are reasonable and necessary to administer the regulatory system.

Purpose: This regulatory change is essential to protect the health, safety, and welfare of citizens because the change will help expedite prescriptions being filled and improve speed of care.

Substance: The amendments remove the requirement that the patient care team or podiatrist name appear on prescriptions issued by physician assistants for Schedules II through V drugs.

Issues: The primary advantage to the public is ensuring quick and efficient access to care. There are no disadvantages to the public. There are no primary advantages or disadvantages to the agency or the Commonwealth.

Department of Planning and Budget Economic Impact Analysis:

The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Code of Virginia and Executive Order 19. The analysis presented represents DPB's best estimate of the potential economic impacts as of the date of this analysis.¹

Summary of the Proposed Amendments to Regulation. Following a petition for rulemaking,² the Board of Medicine (board) proposes to remove the requirement that the name of the patient care team physician or podiatrist must appear on prescriptions issued by physician assistants for Schedules II through V drugs.

Background. This regulation currently requires that the prescriptions issued by physician assistants (PAs) for Schedules II through V drugs disclose the name of the patient care team physician or podiatrist supervising the PA. However, according to the Department of Health Professions (DHP), this requirement has been causing some unnecessary procedural delays in filling prescriptions. Although the collaborative practice agreements allow PAs to write prescriptions for Schedules II through V drugs without the direct knowledge of the patient care team physician or podiatrist, inclusion of this information has been known to generate calls to supervisors about patients they have not seen, causing unnecessary delays. This issue has been brought to the attention of the board through a petition for rulemaking and the board feels the requested change would help expedite prescriptions being filled and improve speed of care. Accordingly, the board proposes to no longer require that the name of the PA supervisor appear on prescriptions written by a PA.

Estimated Benefits and Costs. The removal of the name of the supervising patient care team physician or podiatrist from the prescriptions written by PAs is expected to eliminate delays deemed unnecessary by the board in filling prescriptions and benefit PAs, supervisors, and patients. DHP is not aware of any potential unintended adverse consequences.

Businesses and Other Entities Affected. According to DHP, there are currently 7,274 licensed PAs in the Commonwealth.³ No PA appears to be disproportionately affected. The Code of Virginia requires DPB to assess whether an adverse impact may result from the proposed regulation.⁴ An adverse impact is indicated if there is any increase in net cost or reduction in net benefit for any entity, even if the benefits exceed the costs for all entities combined.⁵ The proposal does not raise costs or reduce benefits for any entity. Thus, no adverse impact is indicated.

Small Businesses⁶ Affected.⁷ The proposal does not appear to adversely affect small businesses.

Localities⁸ Affected.⁹ The proposed amendment does not create costs or other effects for localities.

Projected Impact on Employment. No significant impact on employment is expected.

Effects on the Use and Value of Private Property. No significant effect on the use and value of private property nor on real estate development costs is expected.

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¹ Section 2.2-4007.04 of the Code of Virginia requires that such economic impact analyses determine the public benefits and costs of the proposed amendments. Further the analysis should include but not be limited to: (1) the projected number of businesses or other entities to whom the proposed regulatory action would apply, (2) the identity of any localities and types of businesses or other entities particularly affected, (3) the projected number of persons and employment positions to be affected, (4) the projected costs to affected businesses or entities to implement or comply with the regulation, and (5) the impact on the use and value of private property.

² https://townhall.virginia.gov/L/viewpetition.cfm?petitionid=388.

³ https://www.dhp.virginia.gov/about/stats/2026Q1/04CurrentLicenseCountQ1FY2026.pdf.

⁴ Pursuant to § 2.2-4007.04 D: In the event this economic impact analysis reveals that the proposed regulation would have an adverse economic impact on businesses or would impose a significant adverse economic impact on a locality, business, or entity particularly affected, the Department of Planning and Budget shall advise the Joint Commission on Administrative Rules, the House Committee on Appropriations, and the Senate Committee on Finance. Statute does not define "adverse impact," state whether only Virginia entities should be considered, nor indicate whether an adverse impact results from regulatory requirements mandated by legislation.

⁵ Statute does not define "adverse impact," state whether only Virginia entities should be considered, nor indicate whether an adverse impact results from regulatory requirements mandated by legislation. As a result, DPB has adopted a definition of adverse impact that assesses changes in net costs and benefits for each affected Virginia entity that directly results from discretionary changes to the regulation.

⁶ Pursuant to § 2.2-4007.04, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

⁷ If the proposed regulatory action may have an adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include: (1) an identification and estimate of the number of small businesses subject to the proposed regulation, (2) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the proposed regulation, including the type of professional skills necessary for preparing required reports and other documents, (3) a statement of the probable effect of the proposed regulation on affected small businesses, and (4) a description of any less intrusive or less costly alternative methods of achieving the purpose of the proposed regulation. Additionally, pursuant to § 2.2-4007.1 of the Code of Virginia, if there is a finding that a proposed regulation may have an adverse impact on small business, the Joint Commission on Administrative Rules shall be notified.

⁸ "Locality" can refer to either local governments or the locations in the Commonwealth where the activities relevant to the regulatory change are most likely to occur.

⁹ Section 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

Agency Response to Economic Impact Analysis: The Board of Medicine concurs with the economic impact analysis prepared by the Department of Planning and Budget.

Summary:

In response to a petition for rulemaking, the proposed amendments remove the requirement that the patient care team or podiatrist name appear on prescriptions issued by physician assistants for Schedules II through V drugs.

18VAC85-50-160. Disclosure.

A. Each prescription for a Schedule II through V drug shall bear the name of the patient care team physician or podiatrist and of the physician assistant.

B. The physician assistant shall disclose to the patient that he is a licensed physician assistant, and also the name, address, and telephone number of the patient care team physician or podiatrist. Such disclosure shall either be included on the prescription or be given in writing to the patient.