Indiana Standards, Saction, and CS Prescribing

main goal of the BoP

protecting the public

what is a sanction

states discinplinary action

license taken away permanently

revocation

license taken away temporarily

suspension

can practice but with limits or additional requirements

probation

written expression of disapproval

letter of reprimand

written expression of disapproval

letter of reprimand

verbal expression of disapproval

censure

up to $1000 for each violation

fine

can NOT practice

suspension usually indefinite

license taken away permanently - you can NOT practice

revocation

not a sanction becuase it is done my practioner

surrender

clear and immediate danager to public health and safety

emergency suspension

ability to practice is at issue board my mandate

physical and mental exam

what can the BoP impose for a probationary licensure

report regularing to the board
limit practice
contune or renew professional education
community service
perform or refrain for an act the board consdiers apprpriate to public interest

CS prescription format

electronic format only

who is required to send CS prescriptions in an electronic format

everyone except veterinarians and medical residents

who is exempt from electronic prescribing (excemptions not exceptions)

technology failure
issues prescription to be filled outside indiana
prescriber is licensed in another state
prescriber is the pharmacist
legal requirement or public health emergency
waiver from the board
electronic prescription would cause a delay and adversely impact the patient
impractical for the patient to obtain electronic prescription and delay would adversely impact the patient

who can provide telehealth care

most healthcare workers

who can provide telehealth prescriptions

physician
physician assisstant
advance practice reigstered nurse
optometrist
podiatrist
dentist
veterinarian

what counts as telehealth modalitites

secure videoconferencing
store and foward technology
remote patietn monitoring technology

what requirements must be met to write a prescription via telehealth for a patient who have not previously been examined by prescriber before

meets standards of care
issued within scope of practice
not an abortion inducing drug
if a medical device, technology is sufficient to allow for an informed diagnosis and treatment plan

what requirements must be met to write a CS prescription via telehealth

valid IN CSR
follows federal law
issued for a real medical purpose
conducting using audiovisual, real time, tow-way interactive communication system
meets INSPECT program requirement
may NOT prescriber an opioid unless it it a partial agonist that is used to treatm or manage opiod dependence

what indiana limitations on put on opioid prescribing

may NOT be written for 7 days:
IF the prescription is for an adult being prescribed an opiod for the first time by a prescriber
IF the prescription is for a child less than 18 years old
IF the prescription is for an animal for the first time by a veterinarian

when doe shte 7 day opioid prescribing limit not apply

cancer
palliative care
medication-assissted treatment for SUD
a conditional that is expemted by the medical licensing board
prescriber’s professional judgement that a patient requires more

partial fill for opioids - pharmacists can if

patient requests
representative of the patient
guardian of the patient

requirements for partial filling upon request

fill within 30 days of prescription written (federal)
document that a request for a partial fill was amde by one of the people listed above

what is a drug order

inpatient institiution wrriten order

what is a prescription

outpatient written order

who is able to prescribe in indiana

physicians
veterinarians
dentists
podiatrist
optometrist licensed in IN
APRNs
PA

requirements on a drug order

name and bed number of patient
name and strength/size of drug
amount ot be dispensed in quantity or days
adequate direction for the proper use of the drug
name of prescriber (no signature)

requirements of prescription

name and address of patient
name and strength/size of the drug or device
amount to be dispensed
adeqaute directions for use
name of practioner
written or electronic signature of prescriber

requirements on a prescription label

name, address, phone number of dispensing pharmacy
date filled
prescription number
name of practitioner
name of the patient (if animal species too)
direction for use
if opium containing, statment saying that drug is an opioid
name of the drug (trade or generic or both)
if an animal, owners name

directions for practioner label (dispensing directly from office)

directions for use of the drug
name and address of the practitioner
name of the patient
prescribered for the for animal - species included

when can you prescribe anabolic steroids

if they have a valid legitimate medical purpose

where can mechanical storage devices be held

pharmacy holds a permit issued by IN BoP
remote location under the jurisdiction of the IN BoP
licensed health care facility

what can IN BoP do

may carry a firearm during official dutites
exectue and severe warrants/subpoena
make arrests without warrant for suspected CS felony
seize property
perform other enforcement dutities

samples and coupon requirements

bans sale, purchase, or trade of a drug sample or coupon and counterfeiting of drug coupons
practitioners must ask for drug samples in writing
community pharmacies may not have drug samples at any time
established recordkeeping, storage, and handling requirements for drug samples
Cannot remove a sample from its original packaging, repackage it, then sell/exchange it
cannot deliver a drug sample to someone after its expiration date

what is not defined as a drug sample`

OTC and starter packs

who can you not substitute a generic for if the prescription is written for the brand

veterinarians

writtne prescription requires 2 signature lines. what are the

left line: dispense as written
right line: may substitute

what insurance companies must you substitute for the cheaper version despite where the prescriber signs

Medicaid and CHIP

how do you override medicaid/CHIP generic switch

must write (or type) brand meidcally necessary in own handwriting
if orally stating - must forward a covering prescription that has “brand medically necessary”

if swapping generic from brand - what must you include on prescription label

both names
_______ generic for _______

when can you switch biosimilar products

determined interchangable by purple book
prescriber signs “may substitute”
pharmacist informed customer of substitution
prescriber is informed of the name and manufactuer of the biologic product dispensed

requirements for a pharmacist or enetity to dispense naxolone

register annually with the state or health department
instruct the individual to call 911 immediately
provide education and training on drug overdose treatment
provide drug addition treatment and referral information