CALIFORNIAN law question, for a change

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CetiAlphaFive

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So, apparently there's this wannabe Mark Zuckerberg that has a healthcare startup that is basically just another mailorder pharmacy.

However, we've started getting profile transfer requests from them out of the blue.

Here's the part that made me really apprehensive:
The people handling and faxing all of these transfers are "clerks" acting as the one single pharmacist's agent.
They're not techs.
They're not pharmacists.
They're "clerks", whatever that means.
Is there such a thing as a "clerk" in Californian pharmacy law?

So, naturally, I'm thinking, "How the heck is this legal?"

In my state, transfers must be started and finished from one pharmacist to another.

Any thoughts from Californian pharmacists?

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Definitely not legal. It has to be between pharmacist or interns here in California.
 
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Definitely not legal. It has to be between pharmacist or interns here in California.
That's what I figured.

I checked their pharmacy license, and the RPh listed on all of the faxes wasn't there when I called to grill them, even though they'd put that name as the RPh
 
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In California, you don't need to be licensed as a pharmacy technician to do data entry, initiate refills, or access and maintain patient profiles. Transfers may be done by fax as long as the transfers are done by "direct communication" between pharmacists (or even interns since they are allowed to do all the functions of a pharmacist under RPH supervision)

Pharmacists in California achieve this by addressing the receiving pharmacist on the fax transmission, i.e., have someone write "to RPH Bob."

Q. Can a pharmacist transfer a prescription for a Schedule III, IV, or V controlled substance by faxing a copy of the computer-generated label to another pharmacy without talking to the receiving pharmacist?

A. Again, as stated in the answer above, there is no authority under existing law for a prescription label to be used for the purpose of transferring a prescription. However, if a computer-generated Schedule III, IV, or V prescription is faxed to another pharmacy, section 1306.25(b)(1) of the Code of Federal Regulations and section 1717 of 16 CCR require the transfer to be “communicated directly” between the sending and receiving pharmacist. The common understanding of “communicating directly” is actual contact where the sending and receiving pharmacists:
  • Speak directly to each other;
  • Communicate via e-mail; or
  • Communicate by use of a facsimile transmission directed to the pharmacist involved in the transfer.

The Board recommends that pharmacists use one of the above methods of direct communication.

Source: http://www.pharmacy.ca.gov/publications/13_mar_script.pdf (page 7 of 28)

(e) A pharmacist may transfer a prescription for Schedule III, IV or V controlled substances to another pharmacy for refill purposes in accordance with Title 21, Code of Federal Regulations, section 1306.25.
Prescriptions for other dangerous drugs which are not controlled substances may also be transferred by direct communication between pharmacists or by the receiving pharmacist's access to prescriptions or electronic files that have been created or verified by a pharmacist at the transferring pharmacy.

Source: View Document - California Code of Regulations
 
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[QUOTE "Sine Cura, post: 19154291, member: 310012"]In California, you don't need to be licensed as a pharmacy technician to do data entry...." /QUOTE]

Thank you for your research and for quoting the law. I would like to focus on a section of the law you quoted:

"require the transfer to be “communicated directly” between the sending and receiving pharmacist.....Communicate by use of a facsimile transmission directed to the pharmacist involved in the transfer."
Above is the quote from law authority and here is my friendly discussion:
This means to me pharmacist can print prescription record and then fax. The record is faxed as legal script like physician's order. No mistake can happen here.
Why can't I delegate the time consuming task of faxing a hardcopy to my assistant to fax ? I have reasonable trust that asking a clerk to fax a hardcopy will maintain the integrity of the hardcopy to the other fax machine.
What is so hard about faxing a hardcopy that my assistant can not handle?
This is the same assistant, the non-licensed clerk, that the law allows to touch and count my money, type scripts, pick drug from database to generate labels. If this assistant picks wrong drug from database, the patient may die if I don't catch the mistake. The law allows this clerk to pick drug from database to make label that may kill someone and we don't like to ask this same clerk to fax my hardcopy? I was clerk in California for 2 year before becoming pharmacist and as a clerk who had no license, I could do nearly everything like a licensed technician except the law did not allow clerk to do 1 special action, the law did not allow clerk to manipulate or package drug. Law book states that only "pharmacy technician may perform packaging". The law does not allow clerk to package drug which was interpreted as: clerk is not allowed to count drug at retail pharmacy (not making IV bag at hospital or compound drug at compounding pharmacy.)

Here is the link to get law book, the clerk is called "non-licensed person", page 298, quoted here, law book included below:

"1793.3. Other Non-Licensed Pharmacy Personnel.
(a) In addition to employing a pharmacy technician to perform the tasks
specified in section 1793.2, a pharmacy may employ a non-licensed person to
type a prescription label or otherwise enter prescription information into a
computer record system,
but the responsibility for the accuracy of the
prescription information and the prescription as dispensed lies with the
registered pharmacist who initials the prescription or prescription record."

See? non-licensed person can type script into computer and make label which can be wrong which can kill and non-licensed person can not fax a hardcopy from computer?

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjR4rep7K7VAhUDslQKHeMAD5MQFghZMAA&url=http://www.pharmacy.ca.gov/laws_regs/lawbook.pdf&usg=AFQjCNFzVQ4kr2Rft9ZoLxMj9DM7iW7cXg

How can faxing a hardcopy kill someone? I am sure picking wrong drug makes wrong label which has 50 percent chance of killing someone if I don't catch the mistake.

One thing to support your stand though: the law keeps mentioning about "direct supervision" of pharmacist meaning, pharmacist must be within near distance of same physical area, not far in different building. For the other pharmacy to employ clerk to fax without pharmacist in near proximity, the pharmacy may violate pharmacy law. That's the possible violation I am thinking about.

Still, please tell me what's so hard about faxing a hardcopy that a pharmacist must fax to a pharmacist? I still prefer delegating that to my assistants. Please tell me, dear pharmacy board inspector, I am curious.
 

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  • California Law Book, version 2017, free from website of Board of Pharmacy_1.pdf
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  • California Law Book, version 2017, free from website of Board of Pharmacy_2.pdf
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  • California Law Book, version 2017, free from website of Board of Pharmacy_3.pdf
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Since when do laws have to make sense? You can point out countless ways that pharmacy laws make zero sense or even seem to contradict each other.
 
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Since when do laws have to make sense? You can point out countless ways that pharmacy laws make zero sense or even seem to contradict each other.

I can't imagine having non techs type up scripts, but I guess that was the norm not too long ago
 
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Do pharmacists get fined for having a non-pharmacist prepare all the paperwork for a transfer and do the faxing with the pharmacist verifying the transfer info is accurate?
 
Do pharmacists get fined for having a non-pharmacist prepare all the paperwork for a transfer and do the faxing with the pharmacist verifying the transfer info is accurate?

I guess the pharmacist at the place I dealt with is gonna find out real soon
 
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Since when do laws have to make sense? You can point out countless ways that pharmacy laws make zero sense or even seem to contradict each other.

Who decided that c3-5s have a max refill day supply of 120? So if original script is for 90 days, then the patient can have a total of 1 refill and 180 day supply. But if the original script is for 30 days, then only 4 refills are allowed and a total of 150 days.
 
Is that some state specific law? I am not aware of any such max day supply law.
California for sure.
Refills has limit, based on 1 of 2 rules:

Refills can happen until you can count total 5 refills done, then script is done.
or
Refills can happen until refills give 120-days-supply of drug, then script is done.
Of those 2 rules, whichever happens first, that rule wins, script is done.

Law quote is here, from page 374 of 2017 version:

"Article 4. Refilling Prescriptions

11200. Restrictions on Dispensing or Refilling
.....
(b) No prescription for a Schedule III or IV substance may be refilled more
than five times and in an amount, for all refills of that prescription taken
together, exceeding a 120-day supply."
 

Attachments

  • California Law Book, version 2017, free from website of Board of Pharmacy_1.pdf
    1,014 KB · Views: 27
  • California Law Book, version 2017, free from website of Board of Pharmacy_2.pdf
    1 MB · Views: 30
  • California Law Book, version 2017, free from website of Board of Pharmacy_3.pdf
    243.2 KB · Views: 32
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