New Pharmacy Law in Texas.

[MountainPharmD]

I love it when the State Board shows up for an inspection on a busy day when you have tons of **** to do! Amazingly enough I had my first perfect State Board inspection. They usually find something to write you up for so I am pretty happy.

Anyway, I was chatting with the inspector at the end and he asked me if I knew about the new law going into effect June 1st. I did not so he explained. The Texas Board of Pharmacy now requires the Pharmacist who counsels the patient on a new prescription to initial the hard copy or sign electronically that they performed the counseling. Texas has had a law on the books since 1993 that states all patients will be counseled on all new prescriptions. A technician cannot ask the patient if they have any questions for the Pharmacists nor can you put up a sign that says if you have questions ask the Pharmacist. This is nothing new. OBRA 90 mandated counseling for all patients receiving government assistance and most states followed suit with their own laws supplementing this.

Ok, ok all of you retail Pharmacists stop laughing. Yes, we all know it is absolutely absurd for us to even try to counsel every patient on every new prescriptions. Hell with the current staffing levels we are lucky to get the prescriptions filled and verified with out killing someone. Think about what this law means for the retail Pharmacists in Texas. I will see if some of you can grasp the implications of this new law before I chime in. Its a game changer and that's all I will say for now.

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[Jeddevil]

Ok, ok all of you retail Pharmacists stop laughing. Yes, we all know it is absolutely absurd for us to even try to counsel every patient on every new prescriptions.

It isn't absurd. In AZ we have to do this. I work at a wags that averages 400 a day and we either counsel every new one or have the pt decline counsel to us for a new one. Then we have to document it on a counsel log with rx number and initials of who did the counsel. The techs are taught that on anything marked new, they can't release it. They ring them up and send them to the counsel window until the rph comes over and either counsels or accepts the pt's right to deny counsel. The techs have the rx numbers jotted down on the log and you just check wether counsel was accepted or denied and initial it. The pt's can't deny counsel to the techs. The rph has to accept it.

Everytime the board comes in, they always pull the counsel logs and write you up if any line is not initialed. Every complaint to the board, they pull the logs to see if the pt was counseled.

I know that some rph's decide to not counsel and risk getting in trouble with the board. I don't think it is worth risking my license to cheat people by not doing my job to counsel, so at my store, we do it. Make it a priority and you will find a way to get it done.

 

[type b pharmD]

Very, very interesting. 👍

Also congrats on the successful audit. We just had our first "perfect" audit in years last month too!


Side note:
Are you a manager?

 

[Sparda29]

I love it when the State Board shows up for an inspection on a busy day when you have tons of **** to do! Amazingly enough I had my first perfect State Board inspection. They usually find something to write you up for so I am pretty happy.

Anyway, I was chatting with the inspector at the end and he asked me if I knew about the new law going into effect June 1st. I did not so he explained. The Texas Board of Pharmacy now requires the Pharmacist who counsels the patient on a new prescription to initial the hard copy or sign electronically that they performed the counseling. Texas has had a law on the books since 1993 that states all patients will be counseled on all new prescriptions. A technician cannot ask the patient if they have any questions for the Pharmacists nor can you put up a sign that says if you have questions ask the Pharmacist. This is nothing new. OBRA 90 mandated counseling for all patients receiving government assistance and most states followed suit with their own laws supplementing this.

Ok, ok all of you retail Pharmacists stop laughing. Yes, we all know it is absolutely absurd for us to even try to counsel every patient on every new prescriptions. Hell with the current staffing levels we are lucky to get the prescriptions filled and verified with out killing someone. Think about what this law means for the retail Pharmacists in Texas. I will see if some of you can grasp the implications of this new law before I chime in. Its a game changer and that's all I will say for now.

So just sign it but don't counsel?

 

[Its Z]

I think it's a great thing.

 

[jinga]

This, to me, is a good thing. I'm sure WAGS will screw it up somehow, if they haven't already. A modest expansion of pharmacist's "clinical" role in the retail setting? I hope so. This is why we work so hard in school...

 

[jinga]

I think it's a great thing.

Yo Stavi...JINX!

 

[genesis09]

Counseling is required on all new prescriptions in WI. I do it, and manage to stay afloat. Also, the techs cannot offer to counsel, and so, I ask every single person. I am at a store which averages about 350/day. I've done it at pharmacies which do twice that amount.
In Walgreens, for states which require a log book, at POS the register will prompt you to input whether counseling was accepted or not. It is connected to a electronic log.

 

[Carboxide]

So just sign it but don't counsel?

Everyone take a drink...

 

[diastole]

I did my IPPE at Sav-on this year and they had that requirement for new prescriptions. They built it into to the software. When counseling was required, the pharmacist had to do a fingerprint scan so there was no way for a tech to just say they refused it. A patient could refuse counseling but it still required the pharmacist's fingerprint. They ended up doing the counseling and not just pretending they did but it was a pretty slow store with just 75 scripts per day.

If the law goes into effect on June 1st and you are just hearing about it now, it sounds like your store management doesn't intend to comply.

 

[AC1997]

This is a good start but for some reason, pharmacy laws are not enforce as much as they should.

 

[pharm B]

Wal-Mart has really tailored their policies so that if a mistake occurs, you can pinpoint who handled the bag at that time. They now have a special screen that requires the pharmacist to indicate whether the patient received or rejected counseling. The main place it slows the pharmacy down is when the patient is getting a new Lisinopril refill (new Rx number). The pharmacist has to get pulled from what they're doing to say "You've had this before? Great. <bags it up> Have a good day," then pull it up on his computer and indicate the patient accepted the counseling.

It's slowed the pharmacy down and just provides one more distraction for the pharmacist. (the refills, mind you. of course new rx's have to be counseled.)

Anyway, I was chatting with the inspector at the end and he asked me if I knew about the new law going into effect June 1st. I did not so he explained. The Texas Board of Pharmacy now requires the Pharmacist who counsels the patient on a new prescription to initial the hard copy or sign electronically that they performed the counseling. Texas has had a law on the books since 1993 that states all patients will be counseled on all new prescriptions. A technician cannot ask the patient if they have any questions for the Pharmacists nor can you put up a sign that says if you have questions ask the Pharmacist. This is nothing new. OBRA 90 mandated counseling for all patients receiving government assistance and most states followed suit with their own laws supplementing this.

Ok, ok all of you retail Pharmacists stop laughing. Yes, we all know it is absolutely absurd for us to even try to counsel every patient on every new prescriptions. Hell with the current staffing levels we are lucky to get the prescriptions filled and verified with out killing someone. Think about what this law means for the retail Pharmacists in Texas. I will see if some of you can grasp the implications of this new law before I chime in. Its a game changer and that's all I will say for now.

 

[MountainPharmD]

I think it's a great thing.

It is a great thing but why?

It is also surprising since this link below is the best the Texas State Board of Pharmacy could do concerning adverse working conditions.

http://www.tsbp.state.tx.us/files_pdf/Working Conditions.pdf

The Texas State Board of Pharmacy (TSBP) has received numerous letters and telephone calls from pharmacists regarding the inadequate conditions and environment in the pharmacies in which they work. Frequently, the comments involve the following issues:

• a pharmacist's inability to take periodic breaks, such as a breaks for meals and basic human needs, especially when working long hours; and

• the inability of a pharmacy manager or pharmacist-in-charge (who is not the owner of the pharmacy) to make decisions about the operation of the pharmacy, such as the employment of a sufficient number of trained, support staff to meet the needs of the pharmacy's patients.
TSBP recognizes that unsatisfactory working conditions in a pharmacy may involve a two-fold problem"

There response at he end is the best!

In summary, TSBP encourages pharmacists to be valuable employees and pharmacy owners to be good employers.
Rev. 08/03

Wow that has sure help things alot!

 

[SELDANE]

Like most people I'm all for patients receiving counseling on their prescriptions. The intent of OBRA 90 was to insure that counseling was occurring. If a misfill occurred and counseling did not occur the offending pharmacist was culpable for not only the misfill but also for failure to counsel. If a pharmacy was reported to the board for failure to counsel without a misfill then the pharmacy (ie., the chain) was held liable and had to pay the fine and have their name and address published in the boards newsletter. The passage of the new law begs the question, is it intended to increase patient counseling or is it designed to shift culpability from the chain to the pharmacist. Considering the number to retail corporate pharmacists that serve on states board of pharmacy the latter seems more plausible.
One can argue that culpability for failure to counsel rests with the pharmacists, if that is the case then the pharmacists should have predominate input with respect to how tech hours are utilized. At present that is not the case in most retail settings.

 

[MountainPharmD]

Like most people I'm all for patients receiving counseling on their prescriptions. The intent of OBRA 90 was to insure that counseling was occurring. If a misfill occurred and counseling did not occur the offending pharmacist was culpable for not only the misfill but also for failure to counsel. If a pharmacy was reported to the board for failure to counsel without a misfill then the pharmacy (ie., the chain) was held liable and had to pay the fine and have their name and address published in the boards newsletter. The passage of the new law begs the question, is it intended to increase patient counseling or is it designed to shift culpability from the chain to the pharmacist. Considering the number to retail corporate pharmacists that serve on states board of pharmacy the latter seems more plausible.
One can argue that culpability for failure to counsel rests with the pharmacists, if that is the case then the pharmacists should have predominate input with respect to how tech hours are utilized. At present that is not the case in most retail settings.

Good answer! Someone is using their head and thinking about this. I think this is a very good explanation of why this is happening.

If you practice in Texas the question is what are we going to do? Are we going to let the chains continue to ruin our profession or can we use something like this to take it back.

 

[Got Em]

I think they are delaying it until January 1st of 2011....or at least this is what my store manager told me.

 

[ahimsel]

i work for kroger pharmacy in in Texas and as of TODAY 6/9/2010, our pharmacist has to electronically sign off on all new prescriptions being counseled or declined counsel when it is release. =( bummer our pharmacists are bouncing around the pharmacy like a pingpong ball now.

 

[Got Em]

i work for kroger pharmacy in in Texas and as of TODAY 6/9/2010, our pharmacist has to electronically sign off on all new prescriptions being counseled or declined counsel when it is release. =( bummer our pharmacists are bouncing around the pharmacy like a pingpong ball now.

That really stinks. For us (Walgreens), it's until December 1st, 2010. We have two pilot programs right now to see which one is working. The state board knows about this, so we're good until then.

 

[DAW2]

first off, most people dont wanna be counseled anyways. just gimme my stuf and let me get out of here!

second, when we had an audit and she heard a tech go have you taken this before? she said you cant do that, you have to ask if they have any questions. guess it depends on which inspector you ask to see how to ask?

 

[MountainPharmD]

first off, most people dont wanna be counseled anyways. just gimme my stuf and let me get out of here!

second, when we had an audit and she heard a tech go have you taken this before? she said you cant do that, you have to ask if they have any questions. guess it depends on which inspector you ask to see how to ask?

Not in Texas. The law specifically states a technician asking a patient if they have any questions does not meet the counseling requirement. It has to be asked by a pharmacist.

I think it is great the State Board is enforcing patient counseling. I think it is ****ty they are placing the burden on the individual pharmacist and not on the ****ty retail chain that does not allow enough staff or time to counsel. Counseling is one of the most valuable services we can offer our customers. Unfortunately, the business model for retail pharmacy today does not allow the staffing or the time to do it. Counseling interferes with getting the prescriptions out the door as quickly as possible with as little labor as possible.

 

[MountainPharmD]

i work for kroger pharmacy in in Texas and as of TODAY 6/9/2010, our pharmacist has to electronically sign off on all new prescriptions being counseled or declined counsel when it is release. =( bummer our pharmacists are bouncing around the pharmacy like a pingpong ball now.

The last two days have been an absolute disaster. Don't you love how Kroger just throws this out without thinking about how it will effect the business. The labor model we currently work under does not allow the staffing to counsel. Hell it is total inadequate for just getting prescriptions filled and out the door.

Now every single new prescription hard halts at the register until the pharmacist comes over and enters a note and overrides it. Running around like a chicken with its head cut off does not even begin to describe it.

What a joke. Kroger had their head up their ass just like CVS and Walgreens.

 

[Rebel78]

Not in Texas. The law specifically states a technician asking a patient if they have any questions does not meet the counseling requirement. It has to be asked by a pharmacist.

AZ has had that law for several years now. The WAG I worked at did about 700/day. It can be done, just a lot more work. I used to let them pile up at the window about 5 deep before I'd go and counsel, saved time walking back and forth. Get a mic for the drivethru near where you verify scripts or you'll wear a hole in the floor going back and forth.

 

[Plan B]

A technician cannot ask the patient if they have any questions for the Pharmacists nor can you put up a sign that says if you have questions ask the Pharmacist.

I was trying to find the answer to this exact question (about technicians) and this helped me get to the official source for the rule, so thanks.

However, the last part of this sentence is wrong. Actually, a sign is mandated with just about that exact wording.