What defines a practitioner?
- physician, dentist, vet, podiatric physician who holds a license to practice his profession in this state
- advanced practitioner of nursing certified by state board of pharmacy/nursing authorizing him to dispense and/or prescribe CS
- scientific investigator, pharmacy, hospital, other institution licensed
- euthenasia tech licensed by NV state board of Vet Medical examiners
- physician who holds license from board of medical examiners and authorized by board
- PA
- optometrist, within his scope of practice
Limitations of an optometrist
can prescribe if
has seen the pt and examined for the med
medication should only be for 72 hours
unable to refill
cannot prescribe analgesic of hydrocodone, codeine, or propoxyphene
directions for use
specify dosage
frequency
manner it is to be taken or applied
Registration
every practitioner who dispenses any CS
NOT required:
employee of registered dispenser
warehouse/man
ultimate user
physician (DO) who has a temp license and is registered with the DEA at another location
sales office who only displays
lawful distribution only for sample, not sale
need separate registrations for these:
- manufacturing
- distributing
- dispensing, prescribing, conducting research, etc from CII-V
- conducting research with any narcotic for rehab purposes
- research and instructional activities with any CI
- conducting chemical analysis of any schedule
certificate must have:
- name, address, reg #
- schedules of CS authorized to handle
dispensing of controlled substances
- record keeping
- record keeping of CII
records must contain:
- name of pt
- address if not RA
- name, strength, quantity dispensed
- date dispensed
- name of PP and classification of license
- DEA # of PP
- initials of dispensing practitioner (DP) of not the same as PP
- directions for use
- sig of PP
- CII files must be kept separate from other CS and dangerous drugs
- locked/secured
- clearly labeled packaging container of dispensed CS
- package complies w/ all state and federal law
dispensing CII in emergency
oral authorization from prescribing practitioner if
-ltd to amt to treat pt during emergency period
pharmacist then:
- reduces rx to writing, contains all info minus the signature
- “authorization for emergency dispensing” and date of the oral order
- within 72 hours: prescribing practitioner must give a written rx to dispensing rph. rph then attaches this to the oral emergency rx
- rph reports if doctor fails to give this written rx
restrictions on CS rx
not for office use in large quantity
not issued for dependent pt for dependence
administering or dispensing is ok if for clinical trial or weening off addiction
III, IV, V – can all be faxed
ICD-10
tells you what the medication is for (indication)
ie: back pain
unlawful acts
- only dispense for who its for
- can request proper ID from person requesting CS
- must not fill of shows evidence of alteration
- A pharmacist shall not fill a prescription for a controlled substance classified in schedule II unless it is tendered on or before the 14th day after the date of issue.
the day following
ex: if today is the 5th, it is good through the end of day on the 19th
content of rx
- name of prescribing practitioner
- ^ address
- date prescription was issued MM/DD/YYYY
- full name and DOB of pt
- ^ address if not immediately available to RPh or pharmtech
- name, strength, and quantity
- directions for use
- day supply (fewest number of days necessary to consume, determined by dr)
- ICD-10 that corresponds to diagonosis
- classification license of prescribing dr
- DEA # of dr
a pharmacist cannot change or add on CII
The name of the patient;
The name of the controlled substance prescribed, may change the name to reflect the generic name of the controlled substance if the pharmacist substituted; or
On a written prescription, the signature of the prescribing practitioner.
the pharmacist CAN change or add to CII
Initial any addition or change made under 7a; and
Make a notation on the prescription of:
The date and time that the prescribing practitioner approved the addition or change; and
The reason for the addition or change.
what can a pharmacist change on a written rx of CS?
- strength
- quantity
- directions for use;
- date that the prescription was issued;
- days supply of the drug prescribed;
- ICD-10 code that corresponds to the diagnosis for which the drug is prescribed; and
- date of birth of the patient
a pharmacist CANNOT change or add on CII
-name of the patient;
-drug name of the controlled substance prescribed
( may change the name to reflect the generic name of the controlled substance if the pharmacist substituted); or
-on a written prescription, the signature of the prescribing practitioner.
-DEA
the pharmacist SHALL change or add to CII
- initial any addition or change allowed; and
- make a notation on the prescription of:
- the date and time that the prescribing practitioner approved the addition or change; and
- the reason for the addition or change.
Do Not Fill Until CIIs
only have 30 days from date written to get partial fills
- date indicated must not be later than 3 months from date prescription was written
- rx must be tendered to on or before 14th day after date indicated
- may not exceed 90 day supply
- cannot be combined rx w/ another CS or dangerous drug
prescriptions for schedule II CS
- rx blank can have more than one CII, other CS, other dangerous drugs
- if multiple, must make copies of rx for each drug – must include serial number of rx CII and attached all serial numbers onto the first CII prescription
pseudoephedrine
amount to be dispensed
3.6 - for 1 day
7.5 - by mail order
9 - for 30 day supply
partial filling of CS rx
pharmacist may partially fill rx for CII if
and must keep on record of
may refuse to fill or partially fill any rx for a CS listen in;
- requested by pt or PP and total quantity of CS dispensed does not exceed total quantity prescribed
- remaining portion may be filled within 30 days of the day the rx was written
- in emergency: remaining portion must be filled within 72 hours after rx was issued
- if LTCP or terminally ill
- pt is LTC pt or terminally ill
- date of partial filling
- quantity of med dispensed
- remaining quant authorized to be dispensed
- signature or initials of RPh must be recorded on back of rx
- CII more than 30 days after the date the prescription was written
- CIII, IV, V more than 6 months after the date the prescription was written
partial filling of CS rx
pharmacist may partially fill rx for CII if
and must keep on record of
may refuse to fill or partially fill any rx for a CS listen in;
- requested by pt or PP and total quantity of CS dispensed does not exceed total quantity prescribed
- remaining portion may be filled within 30 days of the day the rx was written
- in emergency: remaining portion must be filled within 72 hours after rx was issued
- if LTCP or terminally ill
- pt is LTC pt or terminally ill
- date of partial filling
- quantity of med dispensed
- remaining quant authorized to be dispensed
- signature or initials of RPh must be recorded on back of rx
- CII more than 30 days after the date the prescription was written
- CIII, IV, V more than 6 months after the date the prescription was written
A doctor has checked a pre-printed box on a prescription that states “Dispense as Written”. The prescription is faxed to the pharmacy for a non-controlled medication. Is the pharmacist required by law to dispense the generic if it is less expensive than the brand name medication prescribed the doctor?
yes, if the pt is informed that the generic is being dispensed
yes, if the pt is part of government program
( checking a box means nothing in nevada )
partial filling of CS rx
pharmacist may partially fill rx for CII if
and must keep on record of
may refuse to fill or partially fill any rx for a CS listen in;
- requested by pt or PP and total quantity of CS dispensed does not exceed total quantity prescribed
- remaining portion may be filled within 30 days of the day the rx was written
- in emergency: remaining portion must be filled within 72 hours after rx was issued
- if LTCP or terminally ill
- pt is LTC pt or terminally ill
- date of partial filling
- quantity of med dispensed
- remaining quant authorized to be dispensed
- signature or initials of RPh must be recorded on back of rx
- CII more than 30 days after the date the prescription was written
- CIII, IV, V more than 6 months after the date the prescription was written
-partial filling of CII does not count as a refill until the fill has been completed
NARCOTICS:
do not dispense until 11/06/2018
when is the last possible date the pt can tender this rx to a pharmacy?
11/20/2018
When is it required by law that a pharmacist dispense the brand name product and not its generic equivalent?
When the patient requests it
When the doctor writes “brand medically necessary” on a precription
When an electronic prescription has the words “Dispense as written” on it
When the doctor orally requests brand name for the patient over the phone
