Fundamentals of Pharmacy Practice: Spring 2025 Overview

Premium

Amount individuals pay for health insurance every month

Deductible

Out-of-pocket payment BEFORE insurance coverage

Copay

A fixed out-of-pocket payment after deductible is met

Formulary

List of drugs covered by insurance plan

Pharmacy Benefit Managers (PBMs)

Companies that manage prescription drug benefits on behalf of health insurers, Medicare Part D, large employers, and other payers.

Examples of PBMs

CVS Caremark, Express Scripts, Prime therapeutics

Rx BIN

Bank Identification Number

Rx PCN

Processor Control Number, Number/letters assigned for routing claims

Rx Group

Identify plan

ID number

Unique number assigned to each member in the plan, which is used to verify coverage

Person Code

01: card holder, 02: spouse, 03: child #1, 04: child #2

Mismatched Patient Information

Ensure correct information entered, Insurance expired? Patient's info, Double-check Full name and DOB, Correct person code?

Refill Too Soon

Calculate days from last fill, Inform patient when they can refill their medication

Drug Regimen Review (DRR)

Rejection related to MRPs or formulary substitutions

Prior Authorizations (PA)

Rejections from insurance companies to ensure that prescribed medications are medically necessary

Reasons for PA rejection

Lower cost associated with alternative therapy, Medication is high risk, Physician is prescribing medication for off-label use, Prescribed dose exceeds max daily limit

Prior Authorization Timeline

Not specified in the notes

Discount cards

Ask patient for discount cards info in Data Entry

Pharmacist's Role in Patient Safety

The role of the pharmacist is to dispense and offer expertise in safe use of prescriptions

Goal of Pharmacists

DO NO HARM!

Right patient

Ensuring the medication is given to the correct individual.

Right drug

Administering the correct medication as prescribed.

Right dose

Giving the appropriate amount of medication.

Right route

Administering the medication via the correct method (e.g., oral, intravenous).

Right time

Providing the medication at the correct scheduled time.

Institute for Safe Medication Practices (ISMP)

An organization that advances patient safety through reporting adverse events, providing education, and advocating for change to prevent medication errors.

2006 Preventing Medication Errors report

A report from the Institute of Medicine (IOM) showing that 51.5 million errors per 3 billion prescriptions occur annually.

Patient Information

Key element for patient safety that includes health conditions and allergies.

Drug Information

Key element for patient safety that includes knowledge about drug-drug interactions.

Communication of Drug Orders/Information

The process of clearly conveying prescription details to avoid errors.

Drug Labeling, Packaging, and Nomenclature

Ensuring medications are clearly labeled to prevent confusion, including look-alike names and bottles.

Drug Standardization, Storage, and Distribution

The organization and management of medications to ensure safety and efficiency.

Medication Device Acquisition, Use, and Monitoring

The process of obtaining and properly using medical devices for medication administration.

Environmental Factors, Workflow, and Staffing

Elements that influence the safety and efficiency of medication administration.

Staff Competency and Education

Ensuring that healthcare staff are properly trained and knowledgeable about medication safety.

Patient Education

Informing patients about their medications to enhance safety and adherence.

Quality Processes and Risk Management

Strategies to minimize errors and maximize patient safety.

Corresponding Responsibility

The shared responsibility between the prescribing practitioner and the pharmacist for the proper prescribing and dispensing of controlled substances.

C-II Prescriptions Dispensed in Texas

Generally should be dispensed to an electronic prescription (ePrescribe) that meets DEA requirements.

Electronic prescribing

A method of prescribing that needs to meet DEA requirements for C-II prescriptions.

Texas Official Prescription Form

Must be written on the Texas Official Prescription Form

30 days of issuance

Must be filled within 30 days of issuance; Date written counts as Day 0 (zero)

No Refills

No refills are allowed

Official Prescription Form (C-II)

No Longer Valid; Valid (as of June 1, 2019); Triplicate; Issued by DPS; Really old

Official Form before Sep 1, 2016

Issued by DPS

Official Form after Sep 1, 2016

Issued by TSBP after Sep 1, 2016 but before Sep 1, 2018

New Official Form

Only New Official Form issued after Sept 1, 2018; Issued by TSBP

C-II Rx days

The physical C-II Rx days are numbers

Control Number

Unique number which gets submitted to PMP

Pantograph

Void appears several times if copied or scanned

Thermochromic Ink

New: Red Rx on front

Watermark

Seal of State of Texas printed on face of Rx; 2nd watermark embedded in Rx paper

Forms are not transferrable

Forms are not transferrable ... Just for that prescriber

One C-II med per form

One C-II med per form (prescription)

Non C-II meds

Not intended for other - Non C-II meds

Faxing prescriptions

Can only be faxed in rare cases

C-II Rxs & APRN or PA

Can only write for C-II if authorized to do so and working in hospital-based practice for patient of hospital (admitted or ER visit) or terminally-ill patient

Official Form requirements

Official Form must have name and DEA number of supervising physician in addition to APRN / PA's name and DEA number

C-II Partial Fills

If a RPh cannot issue full quantity of C-II, balance must be dispensed within 72 hours of first partial dispensing

RPh notes on Rx

RPh notes on face of Rx (or electronically if ePrescribed) the quantity supplied

After 72 hours

No further amounts can be dispensed; RPh must notify prescriber to get a new prescription

Exceptions for partial fills

Exceptions exist if patient is resident of LTCF or terminally-ill

Multiple C-II prescriptions

Practitioner can issue multiple C-II Rx on same day for a med if up to 90-day supply for all Rx's issued that day

Legitimate medical need

Practitioner must determine there is legitimate medical need

Earliest fill date

Writes on each prescription (after 1st), the earliest fill date

What RPh Can't Change

RPh cannot change the name of patient, name of drug, name of prescribing physician, or date the prescription was issued

What RPh Can Add or Clarify

RPh can add or clarify notification alone, notification and permission, dosage form, drug strength, drug quantity, directions for use, correct obvious issuance date errors, and add missing date of issuance

Modify earliest fill date

RPh can modify earliest fill date on multiple issuance prescriptions

Without notification

Without notification a RPh, at professional discretion, can correct patient name (misspelling) and add patient address to prescription

Electronic Controlled Substance Prescribing

Mandatory electronic prescribing of controlled substances (C-II to C-V) in effect as of Jan 1, 2021

Opioid Rx for Acute Pain

Opioid Rx (C-II to C-V) for Acute Pain limited to 10 days with no refills

Safe Disposal of Controlled Substance

Requires RPh dispensing C-II to provide written notice on safe disposal of CS to patient unless pharmacy is a take-back location or provides no-cost means of CS destruction to patient

Notice on safe disposal

Notice must include info on safe disposal locations, or a website specified by TSBP with searchable data of safe disposal locations

DEA 222 Form

Used to order C-II meds; also used to transfer C-II between registrants but 5% Rule applies

Signers of DEA 222 Form

Only signer of most recent DEA registration or those granted Power of Attorney may order or complete 222

Electronic orders

Electronic orders allowed since 2005; Pharmacist may now electronically sign the data entry attestation

DEA 222 Form

A form used for ordering controlled substances that requires only one medication per line and must be completed with specific details.

Zero Reporting

A requirement for pharmacies to notify TSBP if no controlled substances are dispensed for 7 consecutive days.

PMP Access & Use

Regulations regarding the access and use of the Prescription Monitoring Program by pharmacists and pharmacy technicians.

Mandatory PMP Look-up Start Date

The date, set to March 1, 2020, when it became mandatory to look up the PMP for all opioid prescriptions.

ePrescribing of Controlled Substances

The process of electronically prescribing controlled substances, which must comply with DEA requirements.

Authentication for Prescribers

Prescribers must obtain authentication or a digital signature from a private credential service to ePrescribe.

Prescriber Authentication Options

Prescribers must choose 2 from: something you have (e.g., hardware token), something you know (e.g., username & password), or something you are (e.g., biometrics).

Compliance Audits

Prescriber and pharmacy systems must be audited by a third party for compliance at least every 2 years.

Exceptions to Mandatory Electronic Prescribing

Situations where electronic prescribing is not required, such as written prescriptions by veterinarians or due to technological failures.

Prescriber Waivers for Electronic Prescribing

A process for prescribers to request a waiver from electronic prescribing requirements by demonstrating specific circumstances.

Waiver Duration

A waiver for electronic prescribing can be issued for a period of 1 year.

Permanent Ink Requirement

DEA 222 Form must be filled out in permanent ink or typewriter, with no erasures or alterations allowed.

Last Line Completed

A requirement on the DEA 222 Form to indicate the last line that was completed.

Controlled Substance Prescriptions

Prescriptions for drugs classified as C-III to C-V under DEA regulations.

Health and Safety Code 481.075

The section of the Health and Safety Code that was amended to include zero reporting of controlled substance dispensing.

Health and Safety Code 481.076

The section of the Health and Safety Code that was amended to address PMP access and use.

Pharmacy Technician Trainee

A pharmacy technician who is in training and may access PMP records under the direction of a registered pharmacist.

Public Health Emergency Prescriptions

Non-patient specific prescriptions that may be issued during a public health emergency.

Research Protocol Drugs

Drugs prescribed under a research protocol that may not follow standard electronic prescribing rules.

Economic Hardship Waiver

A waiver request that must demonstrate economic hardship as a circumstance for not complying with electronic prescribing.

Technologic Limitations Waiver

A waiver request that must demonstrate technological limitations not reasonably in control of the prescriber.

Exceptional Circumstances Waiver

A waiver request that must demonstrate other exceptional circumstances as determined by the prescriber.

TSBP Clarification 2021

Clarification from TSBP that mandatory PMP look-up only applies to outpatient prescriptions.

Class A Pharmacies

Pharmacies that are subject to specific DEA and TSBP rules regarding the issuing and dispensing of controlled substance prescriptions.