Miscellaneous

Question 1

What is required for a facility, such as a school, to obtain epinephrine?

Answer 1

1. A physician, ARNP, or a PA may issue a prescription for one or more epinephrine auto-injectors in the name of the facility, school district, or accredited nonpublic school.
2. The prescription shall be issued in the name and address of the facility, the school district, or the accredited nonpublic school in lieu of the name and address of a patient.
3. IAC 8.19

Question 2

Can a pharmacist dispense a medication provided to a patient via telemedicine?

Answer 2

1. Pharmacist shall not dispense a prescription medication if the patient received the prescription solely on the basis of an Internet-based questionnaire, an Internet-based consultation, or a telephonic consultation, and without a valid pre-existing patient-practitioner relationship.
2. Per the Board of medicine rules, telemedicine does not include the provision of medical services only through an (1) audio-only telephone (2) e-mail messages (3) facsimile transmission (4) US mail or other parcel service (5) or any combination thereof.
3. IAC 657 8.19 and IAC 653 13.11

Question 3

Does Iowa allow medication repository/donation programs?

Answer 3

1. Yes, an individual of at least 18 years of age may donate non-controlled prescription medications that were dispensed in unit-dose dispensing systems; are in original, tamper-evidence sealed packaging; have been stored properly; do not appear to be tampered, misbranded, or adulterated; and contain the expiration date of the enclosed medication.
2. Controlled substances may not be returned/reused.
3. IAC 641.109

Question 4

Can medications returned from a patient med pack be returned to stock or re-dispensed to a different patient?

Answer 4

1. Under no circumstances shall a medication within a container of a patient med pack be retruned to the pharmacy stock or returned to an automated medication distributino system component unless: the medication was dispensed as a single dose and was not commingled with other patient medications in a single package or contaienr.
2. Review Board Position on:”The Repackaging of Prescription Drugs Already Dispensed by Another Pharmacy”

Question 5

How does a pharmacist determine what biological products the FDA determines to be interchangeable biosimilars?

Answer 5

1. The FDA maintains the “List of Licensed Biological Products with Reference Product Exclusivity and Biosimilarity or Interchangeability Evaluations” also known as the “Purple Book.”
2. Lists biological products, including any biosimilar and interchangeable biological products licensed by FDA under the Public Health Service Act (PHS Act).
3. The Purple Book will clarify whether a biological product has been determined by FDA to be biosimilar to or interchangeable with a corresponding trade product and indication.
4. Biosimilar and interchangeable biological products will be listed under the reference product to which biosimilarity or interchangeability was demonstrated.

Question 6

Can a generic medication that is not listed in the FDA Approved Drug Products with Therapeutic Equivalence Evaluations book (“Orange book”) be substituted for a brand name product when the prescriber has not prohibited substitutions

Answer 6

1. No.
2. the pharmacist may exercise professional judgment in changing brand to generic medications only when:
   a. Bioavailability has been demonstrated
   b. It is in the interest of the patient or public funds,
   c. The prescription does not designate “dispense as written”

Question 7

May a prescription issued by an out-of-state practitioner be lawfully filled by an Iowa pharmacist?

Answer 7

1. Prescriptions issued by out-of-state practitioners who would be authorized to prescribe if they were practicing in Iowa may be filled by licensed pharmacists operating in a licensed Iowa Pharmacy.
2. IAC 155A.30

Question 8

Are Iowa pharmacies allowed to provide therapeutic shoes and inserts to patients?

Answer 8

1. Yes.
2. The Iowa Board of Pharmacy has given informal guidance that this is within the scope of pharmacy practice, and the Board of Podiatry has agreed.
3. A guidance letter was co-written by these Boards on June 24, 2014 allowing this practice, but official regulations have not been written yet to reflect this statement.

Question 9

Is medical cannabidiol legal in Iowa?

Answer 9

“Medical cannabidiol” meaning:

1. Any pharmaceutical grade cannabinoid found in the plant Cannabis sativa L., or Cannabis indica, or any preparation thereof
2. That has a tetrahydrocannabinol (THC) level of no more than three percent,
3. And is delivered in a form recommended by the medical cannabidiol board,
4. Approved by the board of medicine,
5. And adopted by the department pursuant to rule,
6. Is legal in the state of Iowa for use by patients who meet the requirements and are issued a Medical cannabidiol registration card.
7. To note, federal law considers cannabidiol products to be Schedule I substances.
8. In iowa, dispensaries that meet certain requirements (not pharmacies) are able to dispense cannabidiol.
9. See Iowa Code 124E

Question 10

What is the Impaired Pharmacy Professionals (IMP3) program?

Answer 10

1. IMP3 is a program that provides support, evaluation, and monitoring of licensees who are impaired as a result of
2. alcohol or substance use disorder, dependency or addiction, or by mental or physical disorder or disability

Question 11

Who may enroll in the Impaired Pharmacy Professionals (IMP3) program?

Answer 11

1. A pharmacist, pharmacist intern, or pharmacy technician registered with the board that self-reports or is referred by the board based on a complaint or investigation may enroll.
2. Several factors may disqualify a professional, including but not limited to:
   a. Diversion for others or personal profit
   b. Tampering with medications intended for a patient
   c. Provide misleading or fraudulent information to the IMP3 committee,
   d. was unsuccessful in a similar program
   e. failed to sign an agreement provided by the IMP3 committee.
3. The ultimate decision is upon the discretion of the IMP3 committee.

Question 12

How long may an individual be enrolled in the Impaired Pharmacy Professionals (IMP3) program?

Answer 12

1. The duration of enrollment is upon the discretion of the IMP3 committee
2. but is a minimum of three years for substance abuse.
3. The duration may change at the discretion of the committee.
4. IAC 657-30(272C)

Question 13

What is the difference between a wholesale distributor, a limited distributor, and a third-party logistics provider?

Answer 13

1. A wholesale distributor distributes and/or receives a drug to a person other than the consumer or patient.
2. A limited distributor operates or maintains a location, regardless of the location, where prescription drugs or devices are manufactured, repackaged, distributed at wholesale, or distributed to a patient pursuant to a prescription drug order, who is not eligible for wholesale distributor license or a pharmacy license.
3. A third-party logistics provider coordinates the or provides the warehousing and other logistics services on behalf of a manufacturer, wholesale distributor, or dispenser of a product, but does not take ownership of the product nor have responsibility to direct the sale or other disposition of the product.