Legal Requirements of a Prescription

All prescriptions must have the same information

Prescriber’s information: Name, address, telephone number, and other information identifying the prescriber; NPI and DEA numbers; and sometimes, the state license number

Date: Date on which the prescription was written; this date may differ from the date on which the prescription was received

Patient’s information:

• Patient’s name: Full name (first and last name); initials alone are not acceptable

• Patient’s Birth Date and Sex: Identifying information, often required by third-party insurance billing. Knowing age and sex helps the pharmacist evaluate the appropriateness of the drug, its quantity, and the dosage form prescribed.

• Patient’s address, telephone number(s): Federal law requires a verifiable physical address for controlled substances. Phone numbers assist in any follow-up needed with patient.

Rx: Symbol Rx, from Latin verb recipere meaning “to take”

Inscription: Medication prescribed-medication name (brand or generic), strength, and amount. If generic is filled the name, strength and manufacturer need to be printed on the label.

Subscription: Instructions to the pharmacist on dispensing the medication. Includes: Refill information (NR and PRN), compounding and labeling instructions, and notes about dispensing drug equivalents (DAW Codes)

Signa: Directions for the patient to follow (commonly called the sig)

Additional Information: Any additional instructions that the prescriber deems necessary

Signature: The prescriber’s signature must be handwritten in ink for written prescriptions. No rubber stamp signatures are allowed. Faxed prescriptions must be signed before transmission. Must have an electronic signature for e-prescriptions.

Any Clarifications for a prescription must be documented on the prescription along with the name of the provider representative who clarified the issue, the date and the initials of who made the changes

Physician’s DEA Number

A physician’s DEA number (DEA Registration Number) is an identifier assigned to a health care provider by the United States Drug Enforcement Administration allowing providers to write prescriptions for controlled substances. The DEA number must be on all prescriptions for controlled substances. Though there is no legal basis for preventing its use as a general prescriber identification number, for security reasons the DEA prefers that DEA registration numbers only be used for authenticating and tracking prescriptions for controlled substances. The agency prefers that the National Provider Identifier be used for general identification purposes.

National Provider Identifier

A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers, mandated by HIPAA and administered by the National Plan and Provider Enumeration System.

Providers must use an NPI when transmitting any electronic health information in connection with a transaction.

Necessary for a healthcare provider to get reimbursed for services provided.

Dispense as Written Codes (DAW) or “Brand Name Medically Necessary”

DAW: Brand name medically necessary; codes are entered into the computer and billed to insurance to clarify the choice of drug prescribed/dispensed

DAW 0: No product selection indicated, generic ok

DAW 1: Brand name required by MD; substitution not allowed by the prescriber

DAW 2: Substitution is allowed, however, patient request brand name (often results in higher copay)

DAW 3: Substitution allowed-pharmacist selected product dispensed

DAW 4: Substitution allowed-generic drug not in stock

DAW 5: Substitution allowed-brand drug dispensed as generic

DAW 6: Override

DAW 7: Substitution not allowed-brand drug mandated by law

DAW 8: Substitution not allowed-generic drug not available in marketplace

DAW 9: Other

Path of a New Prescription

The pharmacy technician selects the appropriate medication → The pharmacy technician prepares the medication → The pharmacy technician packages medication in appropriate container → The pharmacy technician affixes the medication level to the prescription container →The pharmacy technician prepares the filled prescription for pharmacist to make final check → The pharmacist checks the prescription and may initial label and prescriptions → The pharmacists bags approved prescription and attaches the medication information sheet → The pharmacist technician returns the stock bottle to drug shelf and delivers packaged prescription to cash register area → The pharmacy technician verifies that the correct patient is picking up the medication → The pharmacy technician collects payment for the medication

Computer Communications and Efficiencies

Database Management System (DBMS):

• Computerized

• Interoperability

• E-prescriptions

Database Management System (DBMS): Pharmacy oriented computerized information system that integrates and interfaces (communicates) with the many different software programs needed for pharmacy operations and online transmissions and networking.

Pharmacy Software Interoperability: The ability to exchange and process information between various internal and external databases, software, and technology. Creates the possibility of working together between different pharmacy functions and out-of-pharmacy stakeholders; prescriber and insurance representatives.

Types of Prescriptions

• E-prescriptions

• Written prescriptions

• Telephone

• Fax Orders

• Prescriptions on file

• Refill requests

• Partial fill

• Emergency Refills

• Transfer prescriptions

E-Prescriptions

• Approximately 70% of prescriptions are communicated from the prescriber to the pharmacy digitally via the internet

• Prescriptions are transferred to the pharmacy computer through a healthcare interface network (Surescripts and RxHub)

(+):

• Speed

• Accuracy

• Improved billing

• Minimizes risk of medication errors; handwriting, misinterpretation of abbreviations, decreased wait time for patients

CS e-prescribing: reduced forgeries; must have a DEA number and state eligibility for prescribing, controlled-substance identity authentications and a protected software program

Written Prescriptions

• Always call if clarification is needed

• Hard copy of prescription will be scanned into the computer

Medicaid Prescriptions and Tamper Resistant Prescriptions

• CMS (The Center for Medicare and Medicaid Services) requires all medicaid scripts be written on tamper resistant prescription pads

• TRP (Tamper-Resistant Prescription) is specifically designed to prevent copying, erasing or alteration

• If an audit reveals that scripts were not written on TRP or authenticated by pharmacy personnel, claim for reimbursement can be denied

Telephone Prescriptions

Telephone prescriptions must be taken by the pharmacist over the telephone. The pharmacist transcribes the telephone order onto a prescription pad and will verify it for accuracy.

Partial Fills

A partial fill refers to dispensing only a portion of the prescribed quantity of a medication at one time, with the intention of dispensing the remaining quantity at a later date

Partial fills are often used for various reasons, such as

• Medication shortages

• Insurance limitations

• When the patient does not need the full quantity immediately

Before a partial fill, the pharmacy must communicate with the patient to determine if a partial fill is acceptable and appropriate for the medication in question. The patient’s consent is essential before proceeding with a partial fill.

Then, the pharmacy team documents the partial fill in the patient’s medication profile and dispenses the medication noting the quantity dispensed and the remaining quantity that is available for future refills.

Patient Profile Database

The patient profile is the confidential data file in the pharmacy software that contains the customer’s demographic and insurance information. The profile lists all the prescriptions that have been dispensed at that particular pharmacy for that particular patient.

Every pharmacy patient must have a current, updated profile to have a prescription filled.

Essential Components of the Patient Profile:

• Patient demographics

• Insurance and billing information

• Medical and allergy history

• Medication and prescription history

• Prescription preferences

• HIPPA confidentiality

HIPAA Requirements

Patients must be given a copy of the pharmacy’s personal information privacy policies to comply with the Health Insurance Portability and Accountability Act (HIPAA). Patients will need to sign off that they have received the notice and this is usually scanned into the computerized patient profile.