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Out of state prescriptions

Discussion in 'Pharmacy' started by owlegrad, Aug 7, 2015.

  1. owlegrad

    owlegrad Uncontrollable Sarcasm Machine
    Staff Member Administrator Pharmacist 7+ Year Member

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    So on our last conference call it was said that FL requirements for prescriptions do not apply to out of state scripts. Specifically that if a PA or NP can write a controlled prescription in their home state we can honor it here in FL. Or if it doesn't have to be written on tamper evident paper in the home state we can still honor it here even though FL does require tamper evident paper. This is the opposite of what I have always heard before. Anyone have any insight?
     
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  3. zelman

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    There are laws about writing prescriptions and about filling prescriptions. You only need to worry about the latter in states where you don't know the former. It's super nitpicky to differentiate, and will probably require examining each regulation you question.
     
  4. ChalupaBatman86

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    Most state laws say the Rx is good if it is legal in the state where it was written. This is most common. Some states always go by their own laws. Some states only accept controls from contiguous states. Some states, like Hawaii, don't accept any controls from out of state doctors. Some states, like Alabama, say that their state laws supersede federal laws. I am not sure about Florida.
     
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  5. mtlam

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  6. txpharmguy

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    No out of state CII in Texas and no Ciii-v from NP or PA out of state
     
  7. BidingMyTime

    BidingMyTime Lost Shaker Of Salt
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    Even if is true, how can someone be expected to know the laws of all 50 states, in order to determine if the RX was legally written in the state it was written in? Even if not legally necessary, it only makes sense to go by the law of the state you are practicing in.
     
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  8. Sine Cura

    Sine Cura 10 seconds or less
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    The FAQ on counterfeit-proof prescriptions by the Florida Department of Health (http://www.floridahealth.gov/licensing-and-regulation/counterfeit-proof-prescription-pad-vendors/faq.html) says "If a controlled substance prescription is written outside the State of Florida, it is not subject to Florida law." The regulation on written prescriptions that includes the counterfeit-proof requirement for controlled substance prescriptions (http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0456/Sections/0456.42.html) refers to prescriptions written by "a health care practitioner licensed by law," and this is defined as someone licensed in Florida in section 456.00. Florida regulation permits dispensing of prescriptions by out-of-state prescribers. This would seem to allow dispensing of controlled substance prescriptions written by out-of-state mid-levels (NPs and PAs in Florida cannot prescribe controlled substances)... "may" is not "must."

    For the sake of comparison, I will describe what other states permit:

    Arizona: "medical practitioner" is defined as "any medical doctor, doctor of osteopathy, dentist, podiatrist, veterinarian or other person licensed and authorized by law to use and prescribe drugs and devices for the treatment of sick and injured human beings or animals or for the diagnosis or prevention of sickness in human beings or animals in this state or any state, territory or district of the United States." Therefore, out-of-state prescriptions for CII, CIII, CIV, and CV controlled substances written by anyone who is allowed to prescribe in another state can be filled in Arizona. There are no tamper-resistant form requirements in Arizona (aside from the Medicaid tamper-resistant form requirement). Whether prescriptive authority granted by other jurisdictions is circumscribed by Arizona statute is not addressed AFAIK.

    Massachusetts: written prescriptions for any prescription-only drug ("schedule VI" is any prescription drug not in the DEA schedules) must be on a tamper-resistant form that complies with Medicaid requirements for all prescribers, including out of state. (http://c.ymcdn.com/sites/www.mashp.org/resource/resmgr/Advocacy/Chapter_244-2012_Acts_(FAQ).pdf)

    California: unfortunately the FAQ on this topic is misleading (http://www.pharmacy.ca.gov/licensing/prescribe_dispense.shtml). It says dispensing of a prescription written by an out-of-state prescriber for CIII, CIV, or CV controlled substance to a patient in California is permissible given that "written controlled substance prescriptions must be on a form that meets the requirements for controlled substance prescriptions in the state in which it was prescribed," but that clause in quotes applies only to the mail-order context if you go literally by the written regulation (http://codes.lp.findlaw.com/cacode/HSC/1/d10/4/1/s11164.1). There is a clear distinction between the mail-order context and a pharmacy dispensing directly to a patient. In the latter, it seems that written prescriptions would still need to be on the California security prescription form (this can be bypassed via oral prescription). No CII prescriptions from out-of-state prescribers can be dispensed directly to a patient (but is allowed only for mail order).
     
    #7 Sine Cura, Aug 8, 2015
    Last edited: Aug 8, 2015
    HelpfulPharmer1 and owlegrad like this.
  9. HelpfulPharmer1

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    Update for California: (This is my ongoing research and contribution to the community....I would like to share this here to benefit all and hopefully others will contribute more insightful information. Thanks.)

    http://www.pharmacy.ca.gov/licensees/prescribe_dispense.shtml

    >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

    We got many different cases here so we must analyze each case carefully. Very hard to have universal 1 quick answer because we may have 8 different answers.

    Question 1: C2 ? or not?

    Question 2: Buyer receives in California ? or not?

    Question 3: Patient is ‘’California Resident while out of state’’? or not?

    >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

    Can a California pharmacy fill a controlled substance prescription written by an out of state prescriber for a patient that is a California resident?

    California Code of Regulations section 1717(d), in accordance with Business and Professions Code section 4005(b), in general, allows written and oral prescriptions from out-of-state prescribers. Health and Safety Code 11164.1 allows Schedule CIII-V written by an out of state prescriber to be dispensed, but CII may not unless delivered to the California resident while out of state. Written controlled substance prescriptions must be on a form that meets the requirements for controlled substance prescriptions in the state in which it was prescribed. Pharmacies must verify the prescription. The pharmacist should use his or her best professional judgment when filling out-of-state prescriptions.

    Updated 12/19/13.

    >>>>>>>>>>>>>>>>>>>>>>>>>>>>

    (Retrieved exactly on 01-26-2017)

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    Can a California pharmacy fill a controlled substance prescription written by an out of state prescriber for a patient that resides out of state?

    Health and Safety Code 11164.1 allows a California pharmacy to deliver the controlled substance to the patient in another state. The prescription must conform with controlled substance prescription form requirements of the state in which it was written. Schedule III, IV, and V controlled substances may be dispensed pursuant to Health and Safety Code 11164.1(b) but Schedule II must be delivered to the patient in another state per Health and Safety Code 11164.1(a)(1).

    Updated 12/19/13

    >>>>>>>>>>>>>>>>>>>>>>>>>>>>

    (Retrieved exactly on 01-26-2017)

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    Can a California pharmacy fill a prescription for a Schedule II controlled substance that was written by an out-of-state prescriber for an out-of-state patient? What about Schedule III thru V controlled substances?



    Yes, so long as the prescription conforms to the requirements for controlled substance prescriptions in the state in which the controlled substance was prescribed. The prescription must be delivered to the patient in the other state. Prescriptions for Schedule II controlled substances must be reported to CURES and effective January 1, 2005, prescriptions for both Schedule II and III must be reported to CURES.

    >>>>>>>>>>>>>>>>>>>>>>>>>>>>

    (Retrieved exactly on 01-26-2017)

    >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
     
  10. owlegrad

    owlegrad Uncontrollable Sarcasm Machine
    Staff Member Administrator Pharmacist 7+ Year Member

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    Just FYI, PAs and NPs can write controls in FL now. They have to have DEA numbers of course and there are day supply restrictions as well.

    Sent from my SAMSUNG-SM-G920A using SDN mobile
     

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