Module 4

Rx transmission and records; Rx information

Types of Rx prescription forms

• electronic

• written

• faxed

• oral

what are faxed prescriptions considered as?

Written

Schedule 2 FAX Rx are acceptable as original Rx only if at least one of these applies…

1. Patient is in LTCF - any C-IIs

2. compounded for direct parenteral administrations - narcotics only

3. patient is in hospice certified by medicare or licensed in WI - narcotic only

Narcotic = opioid or cocaine

if a FAXED Rx does not comply with the C-II criterias of being an OG rx, what must be done in order to dispense the faxed rx?

must receive original written/electronic Rx and have it verify by a pharmacists

what are the requirements for electronic rx transmission?

• pharmacists' responsibility to ensure the security, integrity, and confidentiality of orders

• must be sent to patients choice of pharmacy

• secure validation, including electronic signature of prescriber

• DEA requires prescribers and pharmacy applications to have detailed secuirty anf retrievability to process electronic CS Rx

requirements for oral rx transmission

• must be immediately reduced to writing or entered into a comp system and filed accordingly

• must document pharmacists responsible for ensuring accuracy

• any alterations to an Rx - must document pharmacists ID and the practitioner/delegate authorizing the alteration

when can C-IIs be oral rx transmissions?

• may be oral in case of emergency!!

Oral rx can be transmitted from who to who? And via what?

from: prescriber or agent

to: pharmacists, students, intern, or technician

by: direct convo, telephone answering device or VM

All mediations profiles and rxs must be kept for how long since the date of the LAST fill?

5 years

• if computerized record system used, printout must be available within 48 hrs

what must patient profiles have?

• all info that is within each rx must also be recorded in the patient profile

  • name, DOB and address

  • strength, quanity, directions, and dosage form of dispensed products

• dates of dispensing and refills

• names of providers

• attempt to obtain allergies, medical conditions and adverse drug reactions or idiosyncrasies

  • profile records must be kept for at least 5 years after last dispensing

what are the required info on a rx so that it can be filled??

• patient name and address

• date of issue

• practitioner name and address

• direction for use

• drug name, strength, quantity

• signature of practitioner

what are the required info on a standing order?

• patient name and address

• date of issue

• practitioner name and address

• drug name, strength, quantity

• directions for use

• first and last name of delegate

• indication for standing order user

What is the required information for a veterinary Rx

• client (owner) name and address + species and name of animal

• date of issue

• veterinarian name and address

• drug name, strength, quantity

• directions for use

• signature of veterinarian (if written)

• withdrawal time (for food-producing animal)

What information is required for CS rx?

• everything a non-CS rx has PLUS"

• prescribers DEA #

CS II

• expirations

• refills

• quantity

expirations: None

refills: 0

quantity: no rx has quanity or days supply limits (per pharmacy and insurance policy may differ)

CS III-IV

• expirations

• refills

• quantity

expirations: 6 mo

refills; max 5

quantity: no rx has quanity or days supply limits (per pharmacy and insurance policy may differ)

CS V

• expirations

• refills

• quantity

expirations: None

refills: no limits

quantity: no rx has quanity or days supply limits (per pharmacy and insurance policy may differ)

Non-CS

• expirations

• refills

• quantity

expirations: None

refills: no limits

quantity: no rx has quanity or days supply limits (per pharmacy and insurance policy may differ)

Can pharmacists change information on a CS III-V rx?

Yes - the rx can be prescribed orally, so info may be clarified on consultation by creating a new Rx

Can pharmacists change information on a CS IIrx?

NO

• changes can not be made

• must get a new Rx for any missing/erroneous info

corresponding responsibility

both:

• the prescriber who writes the prescription and

• the pharmacist who fills it

are independently responsible for making sure the prescription is valid, appropriate, and lawful.

when are CS rx’s invalid/not allowed to be dispensed??

• general dispensing/ “office use.”

• prescribing CS for self (II-IV)

• C-II not written or electronic

• C-II with missing or wrong information

• CIII-IV for more than 6 mo or greater than 5 refills

other general scenario where Rx’s are invalid

• practitioner prescribing outside scope of practice

• practitioner in another state who would not have prescribing privileges in WI

• practitioner from outside the US

To have multiple C-II Rx for a single person, what must be on the Rx?

• each rx must be signed and dated on the day written and issued

• each ex must have written instructions as to earliest date of filling permitted

T/F someone can have multiple, sequential rx for up to a total of 90 days supply to be written at the same time?

TRUE

What conditions must ALL be present for a pharmacist to be able to extend a rx? (7)

• There are no instructions by the prescriber saying we can’t extend

• You cannot reach the prescriber/office

• judge that if there is an interruption in therapy, there could be undesirable consequences “essential or life”

• pt is on a consistent drug therapy

• has had rx filled at your pharmacy or chain before

• NOT a CS

• a previous extension has NOT been provided for that drug within a year

What is the max DS for Rx extension that can be granted?

7 days

after your extend a Rx, what must you do?

notify prescriber ASAP

Can you provide partial fills on initial non-CS meds?

You may not dispense different quantity than written UNLESS
- pt has had the same med filled for the quantity in the past 2 years

Can you provide partial fills on refill non-CS meds?

may dispense any quantity (up to 90 days) in a single fill

• per pharmacists judgement and patients request

Can you provide partial fills on CS III-IV meds?

WI may dispense partially for CS III-V

DEA;

• Each partial fill is recorded in the same manner as a fill

• total quantity dispensed does not exceed total quantity prescribed

• 6 mo exp data applies to CS-III, IV AND V Rx

Can you provide repeated partial fills on CS II meds?

yes only for LTCF or terminally ill pts

• LTCF or terminally ill must be on the face of rx

• and terminally ill must be documented in patients med profile

must record date, quantity, remain quantiy, and RPh ID for each fill

Expires after 60 days!! (unlike other CS-II rx)

IN what situtaion may a pharmacist partially fill a CS-II for an ambulatory outpatient (not LTCF/terminally ill)?

• pharmacists are unable to supply total quantity called for in the Rx OR

• patient requests partial dispensing OR

• prescribing practitioner request partial dispensing

ONE TIME partial fill

After partially filling a CS-II Rx, what must the pharmacists do?

• note quantity dispensed on face of Rx

• dispense remainder within 72 hr or notify prescriber if this doesn’t happen

• DEA position: remainder must be filled and ready for dispensing, not necessarily delivered to the patient

for emergency oral C-II rx, what must be all met? (3)

• immediate administration necessary

• no appropriate alternative (non-CII) txt available

• not reasonably possible to provide a written or electronic rx

T/F an agent of the prescriber may call in an emergency C-II rx

False

• must be the prescriber personally

what must a pharmacists do/have after approving emergency oral C-II rx?

• quantity prescribed in limited to an emergency period (no 30-day supply)

• reduce rx to writing and contain all info needed for c-II rx

• make a reasonable effort that prescriber is authorized to prescribe (if not known to pharmacists)

• ensure covering Rx is received within 7 days and attached to a copy of emergency rx (can be written or electronic)

  • info local DEA if it does not arrive

what information does the transferring pharmacists need? (non-CS)

• write VOID on transferring Rx

• name/address of receiving pharmacy

• name of transferring pharmacists (first and last name)

• date of transfer

What information do the receiving pharmacists need?

• write TRANSFER on transferring rx

• date of issue of OG Rx

• date of OG dispensing

• OG Rx number

• refills

  • OG

  • remaining (or total quantity remaining - only for non-CS)

  • date of last fill

• name/address of transferring pharmacy

• name of transferring pharmacists (first and last)

• name of receiving pharmacists (first and last)

What information do the transferring pharmacists need? (CS)

• write VOID on transferring Rx

• name/address of receiving pharmacy

• name of transferring pharmacists (first and last name)

• date of transfer

• DEA# of receiving pharmacy

What information do the receiving pharmacists need? (CS)

• write TRANSFER on transferring rx

• date of issue of OG Rx

• date of OG dispensing

• OG Rx number

• refills

  • OG

  • remaining (or total quantity remaining - only for non-CS)

  • date of last fill

• name/address of transferring pharmacy

• name of transferring pharmacists (first and last)

• name of receiving pharmacists (first and last)

• DEA # of

  • practitioner

  • transferring pharmacy

  • OG pharmacy (if different)

• dates and location of previous fills)

what are the Rx transfer limits?

• non-CS

• CS II

• CS III-V

non-CS

• up to allowable # of refills

CS II

• no refills = no transfers

CS III-V

• ONE TIME

• unless pharmacies share common real-time, online database = may transfer more than once, up to # of authorized refills

only REFILLS may be transferred for CS

• not the OG (so like a first fill)