Latvia to Tighten Control Over Paper Prescriptions, Expand Prescriber Pool

Latvia's National Health Service (NVD) is set to implement stricter controls on the distribution of paper prescription forms to medical institutions. New regulations approved by the government aim to limit the quantity of forms issued, a measure prompted by violations discovered by the NVD and the Health Inspectorate (VI).

These violations included instances where individuals without proper authorization issued prescriptions, narcotic and psychotropic drugs were prescribed under another person's name, medical documentation lacked information on all prescribed medications, or drugs were prescribed without justification and in excessive amounts. The Ministry of Health (VM) stated that the changes are intended to make prescription practices safer and more transparent, improving the detection of violations and reducing the risks associated with errors, fraud, and the misuse of dangerous medications.

The NVD will calculate the number of forms based on the previous quarter's issuance, applying a coefficient of 0.7, or by assessing the institution's justification. The NVD can review these quantities if unjustified demand, significant discrepancies, or changes in the institution's activity level are detected. Despite efforts to transition to e-prescriptions, paper prescriptions remain significant, with approximately 418,000 redeemed in pharmacies in 2025, making them harder to control.

Paper prescriptions will now be reserved for specific situations, such as during prolonged E-health system disruptions, when a patient urgently needs medication, or for use in countries with which Latvia does not have cross-border e-prescription exchange. Narcotic and psychotropic drugs, as well as those recognized as narcotic analgesics by the State Agency of Medicines, must be prescribed via a special e-prescription. This electronic system allows for the identification of the prescriber, verification of previously prescribed medications, control of dosages and frequency, and quicker detection of suspicious cases.

The new regulations also expand the scope of prescribers. Dentists can issue prescriptions within their professional competence, and residents and intern doctors can do so under the supervision of a certified specialist. Psychiatrists, narcologists, addiction psychiatrists, neurologists, algologists, and general practitioners can prescribe psychotropic drugs and narcotic analgesics for treatment courses up to three months, regardless of whether the drugs are reimbursed. Doctors and physician assistants not working in a medical institution but holding a valid professional registration can prescribe medications for themselves through the "Recipe pro me" system. Doctors can issue up to 50 regular prescriptions per 12-month period, while physician assistants have a limit as well.