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What should a pharmacist do on a weekend when a patient needs a refill of a prescription for a maintenance drug that does not have any remaining authorized refills?The original prescriber is unavailable and the prescriber taking calls for the original prescriber cannot be reached.
- According to federal and Nebraska law, a phARMACIST CANNOT REFILL THE PRESCRIPTION WITHOUT AN AUTHORIZATION. However, a PHARMACIST CAN USE PROFESSIONAL JUDGMENT ON A CASE-BY-CASE BASIS TO GIVE THE MINIMUM AMOUNT NECESSARY (i.e., a partial filling which is not a refill) of a maintenance noncontrolled substance in order to take care of the patient until an authorization can be obtained the following week.
- In addition, a PHARMACIST CAN USE PROFESSIONAL JUDGMENT ON A CASE-BY-CASE BASIS IN A TRUE EMERGENCY SITUATION (which rarely occurs) to give the minimum amount necessary of a maintenance SCHEDULE III, IV, OR V controlled substance to take care of the patient until an authorization can be obtained the following week.
What should a pharmacist do on a weekend when a patient needs a refill of a prescription for a maintenance drug that does not have any remaining authorized refills, but the packaging of the drug product does not allow the dispensing of the minimum amount necessary (e.g., an ophthalmic drop or oral contraceptive)?
- Using professional judgment on a case-by-case basis, some pharmacists would dispense the item and obtain an authorization the following week.
- However, it may not be acceptable to do this according to the law in some states or according to some third-party contracts.
- For reimbursement that is submitted in most of these situations should reflect the date of the actual authorization and not the date of the partial filling in case the pharmacy is audited.
Can a prescription be filled at a central location and subsequently be dispensed to the patient at a different location?
- Yes, according to federal and Nebraska law.
- A central fill pharmacy cannot accept a prescription directly from a patient or prescriber or dispense the filled prescription directly to a patient.
- So, the central fill pharmacy must transport a filled prescription back to the retail pharmacy that initially received the prescription, and the filled prescription would then be dispensed to the patient at the retail pharmacy.
Prescriptions for Schedule II, III, IV, or V controlled substances may be transmitted electronically (including via facsimile) from a retail pharmacy to a central fill pharmacy. The retail pharmacy transmitting the prescription must:
- 1. Write “CENTRAL FILL” on the face of the original prescription and RECORD THE NAME, ADDRESS, AND DEA REGISTRATION number OF THE CENTRAL FILL pharmacy AND THE NAME OF THE PHARMACIST AT THE RETAIL PHARMACY THAT TRANSMITTED the prescription, and the DATE OF TRANSMITTAL;
- 2. MAINTAIN THE ORIGINAL PRESCRIPTION FOR A TWO YEARS from the date the prescription was last refilled;
- 3. KEEP A RECORD OF RECEIPT of the filled prescription, including THE DATE OF RECEIPT, THE METHOD OF DELIVERY (i.e., private, common, or contract carrier) and the NAME OF THE RETAIL PHARMACY EMPLOYEE ACCEPTING delivery; and
- 4. Indicate in the INFORMATION TRANSMITTED, the NUMBER OF REFILLS ALREADY DISPENSED and the NUMBER OF REFILLS REMAINING for a Schedule III, IV, or V controlled substance prescription.
A central fill pharmacy receiving the transmitted prescription must:
- 1. KEEP A COPY of the prescription (if sent via facsimile) or an electronic record of all the information transmitted by the retail pharmacy, INCLUDING THE NAME, ADDRESS, AND THE DEA REGISTRATION NUMBER OF THE RETAIL PHARMACY transmitting the prescription;
- 2. Keep a RECORD OF THE DATE OF RECEIPT of the transmitted prescription, the NAME OF THE PHARMACIST FILLING the prescription, and the DATES OF FILLING OR REFILLING OF THE PRESCRIPTION; AND
- 3. Keep a RECORD OF THE DATE THE FILLED PRESCRIPTION WAS DELIVERED to the retail pharmacy and the METHOD OF DELIVERY (i.e., private, common, or contract carrier).
- For electronic prescriptions __________________________________, _______________________at the retail pharmacy that transmitted the prescription, and the ____________________ must be added to the electronic prescription record.
- he name, address, and DEA registration number of the central fill pharmacy, the name of the pharmacist
- date of transmittal
Can a controlled substance be mailed to a patient?
- Yes. However, the "mailing” of an item is governed by United States Postal Service (USPS) regulations.
- Those regulations currently address the “mailing” of controlled substances (legend and nonlegend), but not the “mailing” of noncontrolled substances
Narcotic and nonnarcotic controlled substances (legend and nonlegend) and noncontrolled substances (legend and nonlegend) may be _______________________ (mailed or shipped) to patients today.
Can a controlled substance be mailed or shipped to persons in other countries?
- Such a delivery or shipment is considered an export and is usually prohibited
- Require proper authorization
The School Access to Emergency Epinephrine Act allows school to do what?
Stock and administer emergency supplies of epinephrine auto-injectors to treat life-threatening allergic reactions
Nebraska regulations also address the emergency response to life-threatening asthma or systemic allergic reactions (anaphylaxis). Under this rule, a Nebraska pharmacy can do what?
Provide an EpiPen or albuterol inhaler to a school for administration to a student in an emergency situation pursuant to a standing order signed by a minimum of one physician licensed to practice medicine in Nebraska
The EpiPen or albuterol inhaler does not have to be labeled for a specific patient, but must be labeled for "emergency use"
Can a pharmacist refuse to dispense a prescription?
- Federal law does not specifically address this matter
- Nebraska statute does: A pharmacist or pharmacist intern shall retain the professional right to refuse to dispense.
- A patient may claim he/she has been harmed if a pharmacist refuses to dispense a prescription.
A Jones v. Walgreen Co. established good reasons to refuse to fill or refill a prescription which included the pharmacist may:
- 1. not have the prescribed drug in stock
- 2. suspect that the prescription is forged
- 3. distrust his/her ability to fill the prescription (like compounding)
- 4. (in the case of a refill) know that the refilling of the prescription violates the law
- 5. believe that the prescription will be harmful to the patient due to an error on the part of the prescriber" (b)
- (T/F) It is imperative that the pharmacist refrain from making any comment to the patient as to the professional ability of the prescriber.
- True, you do not want to create slander, leading to a lawsuit
If a pharmacists refuses to fill a prescription, they should:
Explain their decisions in a friendly manner; cite professional judgment; and avoid making subjective statements about the patient and/or prescriber
South Dakota has a "conscience" law that provides pharmacists with:
The "legal right to refuse to fill prescriptions for drugs used in abortion, suicide, or euthanasia."
Is a partial filling of a prescription a refill of a prescription?
According to federal law "the partial filling of a prescription for a controlled substance listed in Schedule III, IV, or V is permissible, provided that:
- (a) Each partial filling is recorded in the same manner as a refilling,
- (b) The total quantity dispensed in all partial fillings does not exceed the total quantity prescribed, and
- (c) No dispensing occurs after 6 months after the date on which the prescription was issued.
Can diazepam 5 mg, #100, with 5 authorized refills be filled for a total of 12 partial fillings for 50 tablets within 6 months from the date of issue?
- As long as no more than 600 tablets are dispensed
According to federal law and Nebraska, you can refill a Schedule V controlled substance prescription forever as long as:
- You have authorizations
- However, according to federal law you cannot partially fill a Schedule V controlled substance prescription "after 6 months
- Not allowed in Nebraska, the six month window is applicable to refills and partial fillings of a Schedule III, IV, or V controlled substance prescription.