Q for pharmacist, Can I legally prescribe?

Started by Boopieness
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Boopieness

public health/pathologist
15+ Year Member
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Hello,

I read the pharmacy forums to get a good laugh. It educates me on what annoys you about us. So, here is more fodder I'm sure.

I just finished residency. My institutional DEA # is no longer valid from the residency program. I am a newly unrestricted license physician. I have no interest in ever prescribing schedule II drugs in my future.

I applied, in my state, for a controlled substance license (cost $5.00), which I now hold. It has on it IIN, II, III, IV, V, IIIN. However, I do not have a new DEA #. I am in a non-prescribing discipline (think radiology, pathology, etc.).

However, I want to be able to prescribe my family antibiotics or whatever non-schedule II, in the future when necessary. Do I need a DEA # to prescribe or is that only required for schedule II drugs?

I prescribed something at the end of my residency to a family member & the pharmacy student called me up asking what my DEA # was. I didn't know it off the top of my head, (but I had one.) I had left my NPI #. I said, I didn't need to list it because this was an antibiotic. (Which was my impression at the time.) The student was insistent. The pharmacist stepped in, & I guess either looked me up in some data bank for my DEA or just filled it.

I don't want to pay $550 to get a new DEA #, if I am not prescribing schedule II drugs and If I don't need it to legally prescribe antibiotics.

Can I legally prescribe antibiotics without a DEA#? or is the DEA required for all schedules?

Thanks,
 
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The DEA doesn't care about prescribing practices, as long as they're not controlled substances. You'll need a DEA number for anything, Schedule II-V, even if you have a state license.

Keep in mind, that if you're in a non-prescribing discipline and you prescribe antibiotics and the like, you'll be subject to some scrutiny. It's still technically legal, but I know that I would question a Z-Pak prescription from a pathologist (I'd question almost any prescription, to tell you the truth). You're also required to keep a full medical record on any prescriptions that you do write (depending on the state). A pharmacist will almost never ask if you're doing that, but you may run into a problem if the insurance company that was billed decides to run an audit.
 
Not to seem harsh, but I ALWAYS question what students tell me. That is why I requested a pharmacist answer.

Does your status on the left, like mine, need to be updated?
Are you a pharmacist?
 
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Shouldn't you also question information that comes from anonymous people over the Internet whether or not there is a pharmacist tag attached?
 
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With an unrestriced medical license in any of the 50 states or DC you can legally prescribe any non-controlled prescription medication. So nothing schedule II-V. There really is no doubt about that. That doesn't mean a pharmacist is going to fill any prescription you hand him, but you certainly have the authority.

Similarly, with an unrestricted medical license you can also legally perform open heart surgery. That doesn't mean anyone will let you, but you would have the authority. These are legal questions that have pretty cut and dry answers, but in the real world it gets grey pretty quick when you consider standards of practice and ethics.
 
Certainly, diastole. I agree.

"With an unrestricted medical license in any of the 50 states or DC you can legally prescribe any non-controlled prescription medication."

One has to at least hold an unrestricted license in that particular state, unless they work for the federal government. If a federal physician prescribes on base/post with a DEA #, a schedule II-V, but the patients walks off base/post to fill it at a civilian facility, is the prescription able to be filled? Since, the doc is not licensed in that state.

Can physicians call in a prescription to a patient in another state?
Or over the internet for a different state?
Is a prescription valid if someone attempts to fill just across the state line?

Will a pharmacist fill it?

I'm curious, since this is not my domain.
Sorry, I just wanted an answer from a pharmacist, but thank you students for taking the time to answer.
 
Boopieness said:
Can physicians call in a prescription to a patient in another state?
Or over the internet for a different state?
Is a prescription valid if someone attempts to fill just across the state line?

Will a pharmacist fill it?
Click to expand...

Yes, prescriptions can generally be filled across state lines. I see doctors in a different state (Indiana) and have their scripts filled in my home state all the time. I've had an RX from a West Coast doctor called in to a pharmacy in my home state (Kentucky).

Prescriptions need to follow the laws of the state in which they are written. For example, in KY all RXs for CS must be on a special "security blank." Indiana doesn't have "security blanks." I've had CS prescriptions from Indiana filled in KY, no problem b/c the prescriptions were consistent with the laws in the state in which they were written.

Oh and as this is the S T U D E N T Doctor Network, you are probably going to get replies/feedback from students. Just sayin' 🙂
 
Boopieness said:
Certainly, diastole. I agree.

"With an unrestricted medical license in any of the 50 states or DC you can legally prescribe any non-controlled prescription medication."

One has to at least hold an unrestricted license in that particular state, unless they work for the federal government. If a federal physician prescribes on base/post with a DEA #, a schedule II-V, but the patients walks off base/post to fill it at a civilian facility, is the prescription able to be filled? Since, the doc is not licensed in that state.

Can physicians call in a prescription to a patient in another state?
Or over the internet for a different state?
Is a prescription valid if someone attempts to fill just across the state line?

Will a pharmacist fill it?

I'm curious, since this is not my domain.
Sorry, I just wanted an answer from a pharmacist, but thank you students for taking the time to answer.
Click to expand...

A pharmacist can fill a rx from any state.

I am unsure of your internet question as you cant send a RX over the internet. If you mean E-prescribing, yes.. we can fill it.

The prescription is valid if someone attempts to fill it across the state line.
 
Boopieness said:
One has to at least hold an unrestricted license in that particular state, unless they work for the federal government. If a federal physician prescribes on base/post with a DEA #, a schedule II-V, but the patients walks off base/post to fill it at a civilian facility, is the prescription able to be filled? Since, the doc is not licensed in that state.
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If a physician holds a medical license by a valid government authority within the USA, then he/she may prescribe medication/practice medicine anywhere. You can't do it permanently but it is allowed on a limited basis.

Boopieness said:
Can physicians call in a prescription to a patient in another state?
Click to expand...
Yes.

Boopieness said:
Or over the internet for a different state?
Click to expand...
You'll have to be more specific about what "over the internet" means.

Boopieness said:
Will a pharmacist fill it?
Click to expand...
As long as it's a "normal" Rx and isn't for some oddball med then I'm sure they will.

All4MyDaughter said:
Prescriptions need to follow the laws of the state in which they are written. For example, in KY all RXs for CS must be on a special "security blank." Indiana doesn't have "security blanks." I've had CS prescriptions from Indiana filled in KY, no problem b/c the prescriptions were consistent with the laws in the state in which they were written.
Click to expand...
This is an important concept that I'm afraid is not very well known in my experience.

I actually had to print out the relevant section of the pharmacy law book in CA so that a buddy of mine could get his wife's OOS CII Rx filled. The CA pharmacist initially rebuffed. Pharmacists can be real pansies sometimes. 🙂

Oh, also, if you are prescribing for a patient that has Medicaid or Medicare the prescription generally must be on a tamper-proof prescription pad.
 
What is the problem with the Michael Jackson case? Dr. Conrad Murray although licensed in CA did not have a DEA # for California.

Although, he had DEA #s for Texas & another state. Why would a physician need different state DEA #s, if they can be filled anywhere?

What I meant by over the internet, is that Patients are sending off their prescriptions to online pharmacies to be filled, wherever that pharmacy is at.
 
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I don't have a clue what is happening in the MJ case and I'm not sure I want to know. You generally only get one DEA#. The DEA# is a federal registration number with the Drug Enforcement Administration allowing you to prescribe addictive substances with abuse potential in order to practice medicine. It literally has nothing to do with your legal ability to practice medicine, other than allowing you unrestriced prescribing authority. A medical license is issued by state governments and allows the holder to practice medicine.

From what I remember, Murray is in trouble because of malpractice, not because of the fact that he was using propofol. As a licensed physician & surgeon in California he had full legal authority to administer anesthetics for medical indications.
 
Boopieness said:
What I meant by over the internet, is that Patients are sending off their prescriptions to online pharmacies to be filled, wherever that pharmacy is at.
Click to expand...

Sending off prescriptions how? Email? I was under the impression that most online pharmacies utilize 5 minute consults over the phone to meet legal standards. But I really have no idea how they work because most of them are shady as hell.
 
I just googled it. Multiple DEA#s from same physician are required to track inventory from different clinical sites where scheduled drugs are stored & dispensed (samples, even). The pharmacist would never need to be concerned with that aspect. Just check whether it is a valid DEA #.
 
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I'm not sure how a z-pack for a pathologists family falls within the "scope of normal practice".
 
ForcedEntry said:
I'm not sure how a z-pack for a pathologists family falls within the "scope of normal practice".
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Well it doesn't take an infectious disease doctor to diagnose sinusitis, so it seems perfectly legitimate to me for any licensed physician to prescribe for that. Although to be fair pathologists are the only medical specialty that does not perform an intern year in medicine or surgery and goes straight into pathology. On the other hand, maybe he personally took a sputum sample and did a gram stain and coag panel and other lab tests. In that case he's doing better than most empirical diagnoses!

If he wanted a few alprazolam 2mg on a Friday night though...
 
Boopieness said:
Not to seem harsh, but I ALWAYS question what students tell me. That is why I requested a pharmacist answer.

Does your status on the left, like mine, need to be updated?
Are you a pharmacist?
Click to expand...

More importantly, why didn't you call your local pharmacists (a different one then the one who filled it)? You've got the hospital staff, clinical pharmacists, and community pharmacists, and maybe even some consultants in your area. It might be a good idea to establish a relationship with one or two of them so that you can have more direct answers and they will be more likely to look out for you. Whereas here anyone might say anything.
 
meister said:
Well it doesn't take an infectious disease doctor to diagnose sinusitis, so it seems perfectly legitimate to me for any licensed physician to prescribe for that. Although to be fair pathologists are the only medical specialty that does not perform an intern year in medicine or surgery and goes straight into pathology. On the other hand, maybe he personally took a sputum sample and did a gram stain and coag panel and other lab tests. In that case he's doing better than most empirical diagnoses!

If he wanted a few alprazolam 2mg on a Friday night though...
Click to expand...


I said what I said for a reason. You may want to check your Federal law. True, most pharmacists will fill it out of professional courtesy or the fact it isn't normal for a retail pharmacist to check the pedigree of every prescriber they encounter. It still isn't legal. And yes, woeful blindness is not a legal defense...though who is going to chase you down for a z-pack.
 
I have had problems where insurance providers required a DEA on antibiotics and the like. Luckily, there was an override available for the one rejection that I got in regards to a missing doctor DEA# ... idk tho maybe the tech was just dumb.
 
ForcedEntry said:
I said what I said for a reason. You may want to check your Federal law. True, most pharmacists will fill it out of professional courtesy or the fact it isn't normal for a retail pharmacist to check the pedigree of every prescriber they encounter. It still isn't legal. And yes, woeful blindness is not a legal defense...though who is going to chase you down for a z-pack.
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I might want to check my federal law? :laugh:

Here's a newsflash: the federal government does not regulate the practice of medicine. It is regulated by the states. So please, take your intern pharmacist condescension down a peg or two. While your state may have a regulation that physicians may not prescribe for themselves or immediate family, that is most certainly not the case in every state.

And since I'm feeling generous, why don't I offer you some assistance in truly understanding this issue. Let's take Montana as an example.
Q. “Is it illegal or illicit for me to be prescribing controlled substances for my spouse?”
A. No, not under current Montana law. Counter questions the physician should consider, however, include: “ Even though it is not illegal, is it wise?” “Is it possible the risks to the patient and the physician outweigh the benefits.
Click to expand...

Now, isn't that interesting? Before you go spouting off in smug self-assurance perhaps you should properly educate yourself about issues. Though it may be silly of me to expect such a thing from someone who said this regarding novel H1N1 vaccination programs:
ForcedEntry said:
The thought of this makes my skin crawl.
Click to expand...

Ttennis31590 said:
I have had problems where insurance providers required a DEA on antibiotics and the like. Luckily, there was an override available for the one rejection that I got in regards to a missing doctor DEA# ... idk tho maybe the tech was just dumb.
Click to expand...

Here's the DEA#: AB1111119
 
Wow, you are a smart guy. Who regulates the drugs?

Oh and you may want to educate yourself about what happened back in February with Baxter Healthcare and their test run of "novel" vaccinations before you cast your ******** dispersions.
 
ForcedEntry said:
Wow, you are a smart guy. Who regulates the drugs?
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What does that have to do with anything? The point of the story is that it is not illegal anywhere that I know of for a physician to prescribe non-scheduled medications to a family member or even to himself. You were wrong.

ForcedEntry said:
Oh and you may want to educate yourself about what happened back in February with Baxter Healthcare and their test run of "novel" vaccinations before you cast your ******** dispersions.
Click to expand...
What the hell are you talking about?
 
it is not illegal for a physician to prescribe even controlled substances to a family member.

even as a radiologist, you are a licensed physician and should be able to prescribe ABX, prostate drugs, whatever you want.
 
Baxter has shortened the manufacturing process of influenza vaccines by half, 26 to 13 weeks, by developing the Vero cell culture process and abandoning the egg-based predecessor. It is also free of adjuvants. They've been working on this technology for years, but the recent outbreak of H1N1 allowed for it to be fast tracked.

In order to validate this procedure, they ran trials with something they know very well, H3N2, and from what I can gather (yes, I am a former and happy Baxter R&D employee) the FDA said no, not here. The EC wasn't so cautious (they usually aren't). During December 2008, they shipped this new product to 18 countries. The problem is it was contaminated with live H5N1 and it wasn't discovered until February when they tested it in ferrets and they all died (ferrets don't die from H3N2). Baxter maintains no humans received the contaminated vaccine. In hasty effort to meet an accelerated time line, a simple mistake occurred.

So yes, it makes my skin crawl to think forced vaccinations for H1N1 are a good thing. Government agencies are allowing the manufacturers to skimp on research and testing while running around claiming the sky is falling. They need to slow the **** down and make sure they don't create and actual pandemic in hopes of averting a perceived one.
 
meister said:
What does that have to do with anything? The point of the story is that it is not illegal anywhere that I know of for a physician to prescribe non-scheduled medications to a family member or even to himself. You were wrong.
Click to expand...

My small brain was applying CSA law to non-schedules. Yes, it was a mistake.

1306.04a- A prescription for a controlled substance to be effective must be issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice. The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription. An order purporting to be a prescription issued not in the usual course of professional treatment or in legitimate and authorized research is not a prescription within the meaning and intent of section 309 of the Act (21 U.S.C. 829) and the person knowingly filling such a purported prescription, as well as the person issuing it, shall be subject to the penalties provided for violations of the provisions of law relating to controlled substances.

Write whatever you want, for whomever you want, whenever you want. Like I said before, most people will fill it out of professional courtesy, but they don't have to. If I feel your actions are in contradiction with the above LAW, your family member will have to get it filled elsewhere.

Oh and how is this for intern pharmacist condescension? There's nothing you can do about it. 😛
 
ForcedEntry said:
My small brain was applying CSA law to non-schedules. Yes, it was a mistake.
Click to expand...
Even then, the CSA says nothing about self-prescribing or prescribing for family members. All it does is classify drugs into categories and grant the DEA and FDA certain regulatory authority. The states themselves regulate who may prescribe and what they may prescribe. Some states really don't have any regulation on what physicians may prescribe at all.

Of course simple legality does not necessarily mean it's ethical, and physicians can and do lose their licenses for legal actions that are unethical. And of course when you are a registered pharmacist, at least in California, you are well within your rights to refuse to fill any prescription. Of course you could be liable for unduly hindering access but for the most part you'd be ok.
 
ForcedEntry said:
So yes, it makes my skin crawl to think forced vaccinations for H1N1 are a good thing.
Click to expand...
They are undoubtedly a good thing. There is no scientific evidence-based reason to oppose widespread forced vaccination when it comes to public health.

ForcedEntry said:
They need to slow the **** down and make sure they don't create and actual pandemic in hopes of averting a perceived one.
Click to expand...
Create a pandemic via vaccination...ooooooooooook.

Do you have a source for any of your concern trolling regarding the novel H1N1 vaccine?
 
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Interestingly enough searching for "h1n1 vaccine baxter contamination" gives me a bunch of links to websites related to conspiracy theories and autism. Not going to waste my time knee-deep in the sewage of the internet if you won't deign to provide us with sourced information.
 
meister said:
Interestingly enough searching for "h1n1 vaccine baxter contamination" gives me a bunch of links to websites related to conspiracy theories and autism. Not going to waste my time knee-deep in the sewage of the internet if you won't deign to provide us with sourced information.
Click to expand...

Teaching a doctor how to use a search engine...classic

Try "baxter avian flu" for starters
 
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