When md writes for brand name concerta and the cvs computer wont let you change it to the generic you have in stock, do you call the md to write for generic?
State specific. I am in California and we are able to do this. From The Scripts July 2011...
Q. If a physician prescribes MS Contin 30mg qty 60 1 bid, can the pharmacist call the physician and request to change the prescription to Kadian 30mg qty 60 1 bid without requesting a new prescription? And if the physician authorizes this change over the phone and the pharmacist documents the conversation with the physician for this change on the original prescription, is all pharmacy law fulfilled?
A. The answer to both questions is yes. After you have discussed changing the prescription with the prescriber and received permission to do so, the change can be made on the prescription, and no new prescription is required. The Board recommends documenting the discussion with the prescriber, including the receipt of consent, on the prescription. (CCR 1716 and B&PC 4073)
The drug (active ingredient) is not being changed per se, but an "error" in the implied dosage form (Kadian implies capsules with ER beads).
CA regulations are frustratingly vague with respect to errors or omissions, and any guidance is also vague and inconsistent. Back in January 2001 there was guidance on what required elements on the old triplicate forms cannot be omitted (issue date, prescriber name, prescriber signature, patient name, and name of drug), but in the "The Scripts" newsletter from July 2011 cited above, the board notes that "Title 16, CCR 1716 and 1761, relating to deviating from the requirements of a prescription and errors/omissions on a prescription, do not address whether to send the prescription back to the physician for a new prescription in such instances. They do, however, require the pharmacist to obtain prior consent of the physician before making any change to the prescription. The Board recommends that the pharmacist note the conversation with the physician on the back of the prescription, and enter the changes on the front as one possible method of documentation."
The regulations are clear that a controlled substance prescription shall be signed and dated by the prescriber in ink on the controlled substance prescription form if a hard copy is issued.
The easy thing to do is to send it back and make the prescriber's office fix it. Otherwise the office will print the same error month after month after month
Jan 2001 The Script: http://www.pharmacy.ca.gov/publications/01_jan_script.pdf
July 2011 The Script: http://www.pharmacy.ca.gov/publications/11_jul_script.pdf
State specific. I am in California and we are able to do this. From The Scripts July 2011...
Q. If a physician prescribes MS Contin 30mg qty 60 1 bid, can the pharmacist call the physician and request to change the prescription to Kadian 30mg qty 60 1 bid without requesting a new prescription? And if the physician authorizes this change over the phone and the pharmacist documents the conversation with the physician for this change on the original prescription, is all pharmacy law fulfilled?
A. The answer to both questions is yes. After you have discussed changing the prescription with the prescriber and received permission to do so, the change can be made on the prescription, and no new prescription is required. The Board recommends documenting the discussion with the prescriber, including the receipt of consent, on the prescription. (CCR 1716 and B&PC 4073)
Partially true regarding the signature and date in ink. It is clear that both date and signature is required to be handwritten in ink for CII rx, but the handwritten DATE in ink is NOT CLEAR for CIII-CV.
If you can find reference that clearly states CIII-CV requires DATE in ink, let me know.
Do you guys call when the script doesn't specify caps or tabs? Another pharmacist did and it was busy as hell today and I just wanted to slap her for wasting time and not just putting it through for caps. One of the stores I float at calls every time to switch amoxicillin tabs to caps... So annoying
Wait pause, other pharmacist???Do you guys call when the script doesn't specify caps or tabs? Another pharmacist did and it was busy as hell today and I just wanted to slap her for wasting time and not just putting it through for caps. One of the stores I float at calls every time to switch amoxicillin tabs to caps... So annoying
There is no "future" rule yet (AFAIK) regarding changes to CIIs. Current DEA policy is to defer to the states. See below
http://www.deadiversion.usdoj.gov/faq/prescriptions.htm
Question: What changes may a pharmacist make to a prescription written for a controlled substance in schedule II?
Answer: On November 19, 2007, the DEA published in the Federal Register (FR) the Final Rule entitled Issuance of Multiple Prescriptions for Schedule II Controlled Substances (72 FR 64921). In the preamble to that Rule, DEA stated that "the essential elements of the [schedule II] prescription written by the practitioner (such as the name of the controlled substance, strength, dosage form, and quantity prescribed)…may not be modified orally."
The instructions contained in the Rule's preamble are in opposition to DEA's previous policy which permitted the same changes a pharmacist may make to schedules III-V controlled substance prescriptions after oral consultation with the prescriber. DEA recognizes the resultant confusion regarding this conflict and plans to resolve this matter through a future rulemaking. Until that time, pharmacists are instructed to adhere to state regulations or policy regarding those changes that a pharmacist may make to a schedule II prescription after oral consultation with the prescriber [emphasis mine]. (Policy Letter)
Therefore, when information is missing from or needs to be changed on a schedule II controlled substance prescription, DEA expects pharmacists to use their professional judgment and knowledge of state and federal laws and policies [emphasis mine] to decide whether it is appropriate to make changes to that prescription.
We already went over this. Most pharmacists would not change the active ingredient due to professional judgment but the DEA language is clear. Some states specify issue date can't be changed, some allow it. Post-dating is strictly illegal, so someone exercising professional judgment wouldn't even touch the issue date (where allowed), refuse the script, and contact the prescriber office letting them know post-dating is illegal, where the arrogant employees will then state they don't give a ****. Some states are stricter than others. Some pharmacists will wonder why the federal standards for CIII-CV are stricter than for CII and not unreasonably apply the federal standards for CIII-CV to CII prescriptions regardless of what the state they are in allows.
Do you guys call when the script doesn't specify caps or tabs? Another pharmacist did and it was busy as hell today and I just wanted to slap her for wasting time and not just putting it through for caps. One of the stores I float at calls every time to switch amoxicillin tabs to caps... So annoying
Apparently you don't know what an inline url is (to the DEA FAQ that I referenced). There is even a dea policy letter referenced on the FAQ page: http://www.deadiversion.usdoj.gov/faq/multiple_rx_clarification_ltr_102010.pdf
What the DEA does or does not allow for modifications is not ensconced in the controlled substance act but stated by policy. Many states, following the policy I quoted, have enforced stricter requirements either as guidance/policy or regulations already stated explicitly what is allowed
http://www.deadiversion.usdoj.gov/faq/prescriptions.htm#rx-7Question: What changes may a pharmacist make to a prescription written for a controlled substance in schedules III-V?
Answer: The pharmacist may add or change the patient's address upon verification. The pharmacist may add or change the dosage form, drug strength, drug quantity, directions for use, or issue date only after consultation with and agreement of the prescribing practitioner. Such consultations and corresponding changes should be noted by the pharmacist on the prescription. Pharmacists and practitioners must comply with any state/local laws, regulations, or policies prohibiting any of these changes to controlled substance prescriptions.
The pharmacist is never permitted to make changes to the patient's name, controlled substance prescribed (except for generic substitution permitted by state law) or the prescriber's signature.
http://www.deadiversion.usdoj.gov/faq/prescriptions.htm#rx-7Question: What changes may a pharmacist make to a prescription written for a controlled substance in schedule II?
Answer: On November 19, 2007, the DEA published in the Federal Register (FR) the Final Rule entitled Issuance of Multiple Prescriptions for Schedule II Controlled Substances (72 FR 64921). In the preamble to that Rule, DEA stated that "the essential elements of the [schedule II] prescription written by the practitioner (such as the name of the controlled substance, strength, dosage form, and quantity prescribed)…may not be modified orally."
The instructions contained in the Rule's preamble are in opposition to DEA's previous policy which permitted the same changes a pharmacist may make to schedules III-V controlled substance prescriptions after oral consultation with the prescriber. DEA recognizes the resultant confusion regarding this conflict and plans to resolve this matter through a future rulemaking. Until that time, pharmacists are instructed to adhere to state regulations or policy regarding those changes that a pharmacist may make to a schedule II prescription after oral consultation with the prescriber. (Policy Letter)
Therefore, when information is missing from or needs to be changed on a schedule II controlled substance prescription, DEA expects pharmacists to use their professional judgment and knowledge of state and federal laws and policies to decide whether it is appropriate to make changes to that prescription.
When you apply DEA rules for CIII-CV (because clearly that clause applies to CIII-CV and this clause comes AFTER the FAQ about CII) to CII, that is using your professional judgment (the DEA says it is permissible to use your professional judgment).
I already said it is "not unreasonable" to use your professional judgment (within the bounds of federal and state policy and/or regulation), but that is different than the DEA saying you must do so (that is, recognize that you can't change the drug name for CIII-CV so why should you even consider it for CII despite the policy letter deferring to state regulations or policy).
There is a discrepancy with respect to federal policy about oral modifications to schedule II controlled substances, including name of drug by implication, because the DEA freakin' acknowledged it. Rules for oral modifications on all controlled substances are not addressed in the CSA but a matter of DEA policy. DEA policy is clear on CIII-V, and for CII the current policy is to defer to state regulations/laws, federal law (oral modifications are NOT addressed in the CSA) and professional judgment. Again go ahead and use your professional judgment, who cares.
http://www.deadiversion.usdoj.gov/fed_regs/rules/2007/fr1119.htmThe original rule is actually "In a Q&A section [on the DEA Diversion website], the website instructed regarding CIIs that a 'pharmacist may change or add the dosage form, drug strength, drug quantity, direction for use, or issue date only after consultation with and agreement of the prescribing practitioner.'" http://deadiversion.usdoj.gov/mtgs/drug_chemical/2011/gallagher.pdf (This the DEA's presentations on the policy update in question in this thread).
The new rule (based on the policy on multiply issued prescriptions) is "In addition, because the CSA states that prescriptions for schedule II controlled substances must be written (21 U.S.C. 829(a)), the essential elements of the prescription written by the practitioner (such as the name of the controlled substance, strength, dosage form, and quantity prescribed, and--in the case of multiple prescriptions under this Final Rule--the earliest date on which the prescription may be filled) may not be modified orally." http://www.deadiversion.usdoj.gov/fed_regs/rules/2007/fr1119.htm
The DEA did not say "there is a conflict regarding policy on changing only dosage form, drug strength, and drug quantity." (These are the only 3 things that are explicitly cited that are common to both "rules.")
The DEA said: "DEA recognizes the resultant confusion regarding this conflict and plans to resolve this matter through a future rulemaking. Until that time, pharmacists are instructed to adhere to state regulations or policy regarding those changes that a pharmacist may make to a schedule II prescription after oral consultation with the prescriber." By "conflict" DEA really means conflict between the rules in general, not conflict between rules on changing only dosage form, strength, or drug quantity.
In other words "neither rule applies so do what the states permit within federal regulations" is the official policy. And you can't say "can't change name is federal law" because to be truly adherent, federal regulation says CIIs must be written, so oral modification of ANYTHING contravenes the law because the practitioner didn't write it, yet the DEA allows pharmacists to adhere to state regulations until the future rule is created.
"no controlled substance in schedule II, which is a prescription drug as determined under the Federal Food, Drug, and Cosmetic Act [21 U.S.C. 301 et seq.], may be dispensed without the written prescription of a practitioner, except that in emergency situations..." => prescription must be written. Nothing permitting modification..
If it's written for 10 mg oxycodone daily can you just change it to 2 oxycodone 5 mg daily. I've seen pharmacists do that a lot. I guess technically your not changing the drug...???
Question: What changes may a pharmacist make to a prescription written for a controlled substance in schedules III-V?
Answer: The pharmacist may add or change the patient's address upon verification. The pharmacist may add or change the dosage form, drug strength, drug quantity, directions for use, or issue date only after consultation with and agreement of the prescribing practitioner. Such consultations and corresponding changes should be noted by the pharmacist on the prescription. Pharmacists and practitioners must comply with any state/local laws, regulations, or policies prohibiting any of these changes to controlled substance prescriptions.
The pharmacist is never permitted to make changes to the patient's name, controlled substance prescribed (except for generic substitution permitted by state law) or the prescriber's signature.
This is where your understanding of law and reading comprehension fail you miserably. It is a not a NEW RULE that replaces the old rule. This is a NEW rule about the ability to issue multiple prescriptions to one patient at a single time. In that rule they foolishly said you could not do something you could do before. However, there is no rule any time, anywhere that says you can change the drug to be dispensed. They don't say the whole rule is null and void. They say the items in question are what is at stake. This does not suddenly give the pharmacist the right to change the item ordered. It is strictly forbidden and I have enough friends who are lawyers and enough real world experience to know your interpretation is way off. You are free to do what you want. I would never swap kadian for MS Contin. Feel free to do it of you wish..
When md writes for brand name concerta and the cvs computer wont let you change it to the generic you have in stock, do you call the md to write for generic?
Varies by state.Can we dispense Concerta for Rx written for methylphenidate ER upon pt request?