would you fill this?

[IlDestriero]

The reason he posted was because the guy asked for IV medication that he planned to use topically. That was the red flag. You like to harp on opiates as an example as they are widely abused and people have pill mills, however nobody is smoking 5FU for a high. You're comparing apples to oranges. One will cause you potential DEA troubles the other isn't even on the radar. The OP would have almost certainly filled the topical cream or solution for the same purpose, and I suspect you would as well.
You would really have denied topical 5FU cream written for this guy? That's a really odd place to draw your line in the sand.
It's not about semantics. It's about your partners above not recognizing that it's the same concentration of the same medication, pretending he's going to abuse it, not use it as he said, implying that the IV form used topically is significantly different and more dangerous than the topical solution, etc.
I was the one that said he probably did it to avoid copayments on an expensive cream. And that's probably true, and that's probably the best reason to deny filling it.
Carry on and deny whatever you want. Google all the MDs on the scripts and enforce your own "out of scope" rules on commonly used drugs with zero abuse potential. Hopefully it doesn't bite you on the ass.

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[Lnsean]

The reason he posted was because the guy asked for IV medication that he planned to use topically. That was the red flag. You like to harp on opiates as an example as they are widely abused and people have pill mills, however nobody is smoking 5FU for a high. You're comparing apples to oranges. One will cause you potential DEA troubles the other isn't even on the radar. The OP would have almost certainly filled the topical cream or solution for the same purpose, and I suspect you would as well.
You would really have denied topical 5FU cream written for this guy? That's a really odd place to draw your line in the sand.

Are you in the position to make that call though? Isn't that something that OP would make a judgement on. Why would you dismiss someone's concerns as "non sense" and then rationalize your double standard for pain prescriptions vs other scripts. So you can pick and choose apples or oranges and it's fine for your argument but when OP does it...he's being "non sense."

At the end of the day, can a pharmacist deny a script based on scope of practice? Yes. It's being done everyday. Everything else is just a debate on semantics.

 

[IlDestriero]

What properly MD written prescriptions for non drugs of abuse that don't have allergy conflicts, etc. are you denying for scope of practice concerns?
You saying OBs can't write hypertensive meds, surgeons can't write for birth control? What?
Apparently topical skin creams require dermatology level education?

 

[IlDestriero]

NPs with online advanced educations are writing for all of them already.

 

[Lnsean]

What properly MD written prescriptions for non drugs of abuse that don't have allergy conflicts, etc. are you denying for scope of practice concerns?
You saying OBs can't write hypertensive meds, surgeons can't write for birth control? What?
Apparently topical skin creams require dermatology level education?

Obviously, we have to exercise professional judgement just like those surgeons and opthamologists who are writing for birth control, chantix, and chemo agents for used in a way that is not supported by evidence. It's a two-way street. Prescribers should not be writing for anything and obviously pharmacists are mutually liable for refusing/dispensing everything. That is what we as healthcare providers are paid for. Otherwise, I can train a monkey to follow treatment guidelines.

I feel that you could have defended the opthamologist's stance in a much better way than condescending dismissing OP's concerns as if it has no bearing on his liability. The answer is that it does and this doesnt change just because you're here spewing your opinion. Again, when there comes a day when we're not mutually liable, I'll certainly dispense every script at face value.

 

[Rouelle]

Retired, cheap sob, ophthalmologist wants us to order and dispense Fluorouracil Injection 2.5gm/50ml(50mg/ml) for himself or wife for topical use not injection. I can find nothing that recommends topical use of this product. Yes, he ordered it but not sure that means a thing in this case if something goes south. He only wants it because its the very cheapest way to go. Personally uncomfortable with this. anyone have experience with using this topically? would you fill this?

Scope of practice isn't the issue here. A licensed MD/DO can prescribe whatever they want. The issue is that you're uncomfortable dispensing it. You shouldn't dispense it if , as a professional practitioner, you are uncomfortable doing so. The ability to use professional judgment is why you have a license and make the big bucks.

 

[wagrxm2000]

Two things, first what I'm getting from some of these responses is some people think an ophthalmologist should stick with their specialty but your typical family doctor can write for anything. How does that make sense to anyone? Just call the ophthalmologist ask what its being used for and if it seems legit fill it.

Second, I was just skimming but do people think they are liable for denying a script? If I don't want to fill something that is my right and I am not liable.

 

[Old Timer]

Intersting topic. As a senior surgical resident, I'd be curious to know on what bases you are trained to reject a prescription? This thread seems to run the gamut from "scope of practice" (which several posters don't seem to understand) to "scope of training" (I'm not sure how that's even assessed) to "maybe I could get sued" to "you have to make me feel good that you know what you're doing."

Is it completely personal discretion? And are there no potential liabilities from refusing to fill a legally valid prescription because you don't feel good about it? I recall some controversy about birth control a few years ago that revolved around some of these issues.

You may refuse to fill a prescription for many reasons, included but not limited to:

• Prescribed out of the scope of practice. A dentist prescribing Anusol HC suppositories.
• Out of the normal dosage range. For example, more than 3,000 mg of Acetaminophen per day or more than 3200mg per day of Ibuprofen.
  
• Contraindicated drug combination such as Clarithromycin and a statin.
• Unsafe drug combination such as Soma plus a narcotic plus a benzodiazepine
• Inappropriate Drug Therapy such as Fentanyl in a narcotic naive patient.
• Something not prescribed properly. For example, when a clinic opens and every third patient gets Oxycodone 30 mg 180 tabs 1 every 4 hours.
• Rx not signed by the prescriber

I'm sure there are others. Not filling something just because you don't want to without valid cause could bring sanctions from the State Board or a law suit if your failure to dispense harms the patient by denying needed therapy.

 

[Old Timer]

Two things, first what I'm getting from some of these responses is some people think an ophthalmologist should stick with their specialty but your typical family doctor can write for anything. How does that make sense to anyone? Just call the ophthalmologist ask what its being used for and if it seems legit fill it.

Second, I was just skimming but do people think they are liable for denying a script? If I don't want to fill something that is my right and I am not liable.

So if Joe smith comes in for Pen VK for strep throat and you refuse to fill it because you don't fill prescriptions for people named Joe and the Mr. Smith gets SBE and needs open heart surgery to repair the valve, you wouldn't be liable? Think again. I picked a bizarre and extreme case, but it does point out that you cannot refuse to dispense just because. You have to have a valid reason.

 

[Ackj]

So if Joe smith comes in for Pen VK for strep throat and you refuse to fill it because you don't fill prescriptions for people named Joe and the Mr. Smith gets SBE and needs open heart surgery to repair the valve, you wouldn't be liable? Think again. I picked a bizarre and extreme case, but it does point out that you cannot refuse to dispense just because. You have to have a valid reason.

If you give him the rx back and tell him to go elsewhere, I don't think you would be liable. What if you're legitimately out of stock? Or maybe Joe Smith has been previously hostile and disruptive, and you no longer accept his business. You direct him to another pharmacy and he is on his way to treatment.

I can see your argument if you're holding onto the rx or are doing something to delay the therapy like "come back tomorrow, no Monday, try again tomorrow." In that case, you are definitely preventing his treatment. However, in most realistic cases, he doesn't need to get it from your pharmacy. You simply tell him you're not filling it, and he needs to go somewhere else.

 

[BenJammin]

Not filling something just because you don't want to without valid cause could bring sanctions from the State Board or a law suit if your failure to dispense harms the patient by denying needed therapy.

This isn't true at all. Nothing in federal law or even state law (at least here in Texas) forces an obligation to fill a prescription on my license. You are so wrong when it comes to scope of practice and you're more wrong when it comes to pharmacy law. When will your madness end?

 

[Corpseman]

You may refuse to fill a prescription for many reasons, included but not limited to:

• Prescribed out of the scope of practice. A dentist prescribing Anusol HC suppositories.
• Out of the normal dosage range. For example, more than 3,000 mg of Acetaminophen per day or more than 3200mg per day of Ibuprofen.
  
• Contraindicated drug combination such as Clarithromycin and a statin.
• Unsafe drug combination such as Soma plus a narcotic plus a benzodiazepine
• Inappropriate Drug Therapy such as Fentanyl in a narcotic naive patient.
• Something not prescribed properly. For example, when a clinic opens and every third patient gets Oxycodone 30 mg 180 tabs 1 every 4 hours.
• Rx not signed by the prescriber

.

 

[Lnsean]

So if Joe smith comes in for Pen VK for strep throat and you refuse to fill it because you don't fill prescriptions for people named Joe and the Mr. Smith gets SBE and needs open heart surgery to repair the valve, you wouldn't be liable? Think again. I picked a bizarre and extreme case, but it does point out that you cannot refuse to dispense just because. You have to have a valid reason.

Dude, you are throwing out unrealistic scenarios in order to appear right. Obviously, use your professional judgement and common sense. That's what you're paid for. Yes, you can refuse for scope of practice. Walgreens pharmacists do this every day and they say it straight to the prescriber. They even send out letters.

Oldtimer, I'm still waiting for you to quote the laws to me. Just don't inject your personal biased interpretation. I'm looking for direct quotes preventing pharmacists from refusing for scope of practice. Very simple. You ask others to quote you laws all the time; I would think it would be easy when it's your turn. I guess not.

 

[Old Timer]

This isn't true at all. Nothing in federal law or even state law (at least here in Texas) forces an obligation to fill a prescription on my license. You are so wrong when it comes to scope of practice and you're more wrong when it comes to pharmacy law. When will your madness end?

In Pennsylvania, you would be wrong. I won't engage you on scope of practice. You have presented less than no evidence to back up your assertion that ophthalmologists have a different license than a GP or that scope of practice applies to anything other than the license. And if you can't, you should just shut up.

 

[Old Timer]

If you give him the rx back and tell him to go elsewhere, I don't think you would be liable. What if you're legitimately out of stock? Or maybe Joe Smith has been previously hostile and disruptive, and you no longer accept his business. You direct him to another pharmacy and he is on his way to treatment.

I can see your argument if you're holding onto the rx or are doing something to delay the therapy like "come back tomorrow, no Monday, try again tomorrow." In that case, you are definitely preventing his treatment. However, in most realistic cases, he doesn't need to get it from your pharmacy. You simply tell him you're not filling it, and he needs to go somewhere else.

Not having it in stock and not filling it because his name is Joe Smith are two different things. If you don't have it, you are not refusing, you are unable. There is a difference.

In PA you can by law refuse to fill:

A pharmacist may decline to fill or refill a prescription if the pharmacist knows or has reason to know that it is false, fraudulent or unlawful, or that it is tendered by a patient served by a public or private third-party payor who will not reimburse the pharmacist for that prescription. A pharmacist may not knowingly fill or refill a prescription for a controlled substance or nonproprietary drug or device if the pharmacist knows or has reason to know it is for use by a person other than the one for whom the prescription was written, or will be otherwise diverted, abused or misused. In addition, a pharmacist may decline to fill or refill a prescription if, in the pharmacist’s professional judgment exercised in the interest of the safety of the patient, the pharmacist believes the prescription should not be filled or refilled. The pharmacist shall explain the decision to the patient. If necessary the pharmacist shall attempt to discuss the decision with the prescriber.

Just because is not in the list and therefore prohibited by Pennsylvania Law.

 

[Deja]

Just because is not in the list and therefore prohibited by Pennsylvania Law.

im not a lawyer but somehow i don't think that's how it works lol

I feel like people on here are starting to argue about a bunch of non issues now because nobody want to hear anyone elses opinion lol

 

[Ackj]

Not having it in stock and not filling it because his name is Joe Smith are two different things. If you don't have it, you are not refusing, you are unable. There is a difference.

In PA you can by law refuse to fill:



Just because is not in the list and therefore prohibited by Pennsylvania Law.

So customers who have threatened your staff and had to be removed by police, you continue to fill their rx time and time again and get continuously harassed, because PA says you can only turn down the rx for reasons XYZ?

 

[pillpharmer14]

I cannot believe I just read every post in this thread. I just couldn't stop.

I believe scope of practice is important, but only in extreme circumstances would it affect my decision to fill the script or not. Ophthalmologist writes for Tamiflu for his wife, sure dude knock yourself out. Pretty sure I'm not going to pharmacy jail for that one. Use your best judgement instead of trying to mindlessly police the entire healthcare system by slapping the hands of MDs.

 

[Old Timer]

So customers who have threatened your staff and had to be removed by police, you continue to fill their rx time and time again and get continuously harassed, because PA says you can only turn down the rx for reasons XYZ?

Again, no. You are being a fool. This is a straw man. As a pharmacist you take an oath to help people. You don't refuse to give people needed medication because you feel like it. You better have a reason. Chances of them going to the state board when there is store down the street is almost zero, but if they do, you will be sanctioned. It's also just wrong. But if this is the level of thinking that goes on today in pharmacy, it's easy to see why the profession is circling the bowl......

 

[VA Hopeful Dr]

Interestingly, not once in the physician or pharmacy code of laws in my state is "scope of practice" mentioned. Both boards only care about "licensed practitioners".

That being said, I wouldn't dispense IV chemo at an outpatient pharmacy ever - that just seems like a terrible idea.

 

[wagrxm2000]

So if Joe smith comes in for Pen VK for strep throat and you refuse to fill it because you don't fill prescriptions for people named Joe and the Mr. Smith gets SBE and needs open heart surgery to repair the valve, you wouldn't be liable? Think again. I picked a bizarre and extreme case, but it does point out that you cannot refuse to dispense just because. You have to have a valid reason.

Huh???? What are you smoking? If a person drops a script off and by my judgement I won't fill it that is my call and its under our good faith dispensing guidelines.

Let me guess after this hypothetical person gets his script back instead of going elsewhere he decides well I guess I can't get this filled?

How about a new scenario, a black homosexual male comes to your pharmacy with atripla but you decide not to fill it for obvious reasons. Depressed, the man goes to a strip club where an enormous orgy breaks out with men cheating on theirs wives because he forgets he has hiv. Those men later go back home and infect their wives soon everyone brings atripla to your pharmacy but you reject them all for the same obvious reason and instead of going elsewhere your entire city dies from aids. Are you liable?

Anyways, be realistic on your scenarios I wouldn't reject most scripts without a reason so no I'm not liable

 

[BenJammin]

Interestingly, not once in the physician or pharmacy code of laws in my state is "scope of practice" mentioned. Both boards only care about "licensed practitioners".

That being said, I wouldn't dispense IV chemo at an outpatient pharmacy ever - that just seems like a terrible idea.

Not sure why you brought up the physician code. I'm a pharmacist. I don't follow the board of medicine code because they do not license me. What matters the most is what the pharmacy code says because that's what I'm licensed to practice. Sometimes you can get discrepancies among codes and I have to defer to mine by default. Great example is controlled substance prescribing to family members. I used to work in a state whose board of medicine had no limit on prescribing to a wife for example while the board of pharmacy said prescriptions to 1st degree relatives by blood or marriage are not valid. Of course you default to the pharmacy code.

 

[Corpseman]

Not sure why you brought up the physician code. I'm a pharmacist. I don't follow the board of medicine code because they do not license me. What matters the most is what the pharmacy code says because that's what I'm licensed to practice. Sometimes you can get discrepancies among codes and I have to defer to mine by default. Great example is controlled substance prescribing to family members. I used to work in a state whose board of medicine had no limit on prescribing to a wife for example while the board of pharmacy said prescriptions to 1st degree relatives by blood or marriage are not valid. Of course you default to the pharmacy code.

But the doctors can write for whatever they want.

 

[BidingMyTime]

My medical license doesn't limit my practice nor does it require me to not use off label drugs, etc.

No......BUT....the fact is, doctor's cant just prescribe anything for anyone....they can only prescribe medication to treat a legitimate medical condition, and they can only prescribe when there is a legitimate doctor/patient relationship. If a pharmacist feels that a doctor is not prescribing a medication for a legitimate medical treatment, or that there is not a legitimate doctor/patient relationship, then the pharmacist has the legal responsibility to refuse to fill the prescription.

Now in the OP's case....it doesn't not sound like either of these conditions are being met (the doctor wants to prescribe it for "either himself or his wife"......well, if he doesn't even know which one of them has the legitimate medical condition requiring treatment, then NO he does not have a legal right to prescribe the drug.)

"Prescribing outside of scope of practice" may not be the right terminology to describe what the doctor is doing, but their is no evidence that the doctor is legitmately prescribing this, so I would refuse to fill it.

Now, the chemotoxic issue is another whole issue, and I would refuse to fill it for that reason alone, even if the doctor were legitimately prescribing it (being retired, the doctor presumably does not have access to a chemo hood.)

 

[Dr Wario]

Since we have beaten the original example to death, I have another issue that came up that has nothing to do with scope of practice but could be considered insurance fraud. Had a NP (midwife?) write a rx for nystatin cream in the name of an infant with sig "apply to mother's nipples after feeding". I called the NP asking to change the named patient to the mother (since she would be the one using it) and the NP said that it was put in the infant's name because it was being used to prevent fungal infection in the infant. This really did not sound reasonable to me, and after some more digging, I found out that the mother did not have insurance but the infant had been provided state medicaid.

I somewhat understand the NP's argument, but with that logic she could bill a vaccine in Paul's name and give it to Sally because that would help to prevent infection in Paul. I ended up filling the script as written, but not 100% sure what I would do if the same situation came across again.

 

[VA Hopeful Dr]

Not sure why you brought up the physician code. I'm a pharmacist. I don't follow the board of medicine code because they do not license me. What matters the most is what the pharmacy code says because that's what I'm licensed to practice. Sometimes you can get discrepancies among codes and I have to defer to mine by default. Great example is controlled substance prescribing to family members. I used to work in a state whose board of medicine had no limit on prescribing to a wife for example while the board of pharmacy said prescriptions to 1st degree relatives by blood or marriage are not valid. Of course you default to the pharmacy code.

Mainly to prove that the 2 legal bodies involved in this interaction don't care what type of physician you are. I don't expect you to follow what the board of medicine says, but I think its further evidence that this "scope of practice" thing y'all keep talking about isn't something that my state (at least) cares about.

 

[Lnsean]

Since we have beaten the original example to death, I have another issue that came up that has nothing to do with scope of practice but could be considered insurance fraud. Had a NP (midwife?) write a rx for nystatin cream in the name of an infant with sig "apply to mother's nipples after feeding". I called the NP asking to change the named patient to the mother (since she would be the one using it) and the NP said that it was put in the infant's name because it was being used to prevent fungal infection in the infant. This really did not sound reasonable to me, and after some more digging, I found out that the mother did not have insurance but the infant had been provided state medicaid.

I somewhat understand the NP's argument, but with that logic she could bill a vaccine in Paul's name and give it to Sally because that would help to prevent infection in Paul. I ended up filling the script as written, but not 100% sure what I would do if the same situation came across again.

Yea, that's insurance fraud. Low chance of you getting audited though...If the mom couldn't really afford the cost of the medication, I'd taken a chance on it too and maybe have the NP change the directions to "use as directed" to cover you legally. Morally speaking, I think you made the right decision...just remember to protect yourself too.

 

[rxlea]

Not appropriate to therapy? You're not trained to diagnose...how do you know it's not appropriate therapy? That'll open up some lawsuits...I hope you're not going around telling doctors it's not appropriate therapy. You're not trained enough nor involved enough in the patient's treatment to even make that call.

The other day I told an MD what he was prescribing was not appropriate for a patient, in my professional opinion. After a professional discussion, he agreed.

As pharmacists, it's not our job to just blindly dispense or verify what a physician prescribes. It's our job to ensure the appropriateness and safety of a medication. I assure you, there have been numerous times that MDs thanked me for insight and for saving their ass (especially from an attending).

It's OK to inquire and communicate with the provider when something is off. You don't have to know how to diagnose for that.

 

[rxlea]

How about a new scenario, a black homosexual male comes to your pharmacy with atripla but you decide not to fill it for obvious reasons.

What are those obvious reasons? And how do you know he's homosexual?

 

[BidingMyTime]

What are those obvious reasons? And how do you know he's homosexual?

I was wondering the same thing....what "obvious" reasons would someone have for not filling that prescription? And are we to assume this guy was wearing a T-shirt that says "I'm a homosexual!"....this would be unusual, but I suppose it could happen, I'm not sure how else the pharmacist would know he's homosexual. (Maybe I don't work enough retail, but I've never, not even once, had a patient come in and say "hey, I'm homosexual, will you fill my prescription?"

 

[Deja]

Yea, that's insurance fraud. Low chance of you getting audited though...If the mom couldn't really afford the cost of the medication, I'd taken a chance on it too and maybe have the NP change the directions to "use as directed" to cover you legally. Morally speaking, I think you made the right decision...just remember to protect yourself too.

using the use as directed as direction is asking to be audited... why didn't the NP just write apply to affected area once a day or some bs like that for the baby... seems like a simple solution lol samething as when doctor call in script for simple blood pressure med as 1qd but patient is actually taking half qd... get more pills for the bucks lol

 

[wagrxm2000]

I was wondering the same thing....what "obvious" reasons would someone have for not filling that prescription? And are we to assume this guy was wearing a T-shirt that says "I'm a homosexual!"....this would be unusual, but I suppose it could happen, I'm not sure how else the pharmacist would know he's homosexual. (Maybe I don't work enough retail, but I've never, not even once, had a patient come in and say "hey, I'm homosexual, will you fill my prescription?"

Did you read what I responded to? Oldtimer was making some ridiculous situation where the person declined to fill a script and is liable for whatever happens to the person. I was simply going over the top.

The point was people should only decline a script if they have a justified reason and are not liable.

 

[Lnsean]

What are those obvious reasons? And how do you know he's homosexual?

Guys, he's trying to win an argument. So logic isn't going to be a part of this.

 

[Old Timer]

Did you read what I responded to? Oldtimer was making some ridiculous situation where the person declined to fill a script and is liable for whatever happens to the person. I was simply going over the top.

The point was people should only decline a script if they have a justified reason and are not liable.

I was certainly being hyperbolic. When you become a pharmacist you are taking an oath morally, if not legally to help people. You should only refuse to fill a prescription for a valid reason. If you refuse for no reason and the patient is injured, you can be sued. I refuse to fill things all the time. But not just because I feel like it.....

 

[Old Timer]

Not sure why you brought up the physician code. I'm a pharmacist. I don't follow the board of medicine code because they do not license me. What matters the most is what the pharmacy code says because that's what I'm licensed to practice. Sometimes you can get discrepancies among codes and I have to defer to mine by default. Great example is controlled substance prescribing to family members. I used to work in a state whose board of medicine had no limit on prescribing to a wife for example while the board of pharmacy said prescriptions to 1st degree relatives by blood or marriage are not valid. Of course you default to the pharmacy code.

Well don't practice in PA. You are beholden to every law. You can only fill valid prescriptions and it's the laws and regulations governing doctors, PA's and NP's that determine what is or is not a valid prescription. All scope of practice laws relate to the bodies that govern the prescriber. The PA pharmacy act does not mention PA's. The law regulating PA's does that. That law limits C-II rxs to 3 days for initial therapy and up to 30 days if they write ongoing therapy on the rx. While nothing about this appears in the PA pharmacy act, I am bound by it. I would bet not one mention of the word scope of practice as it applies to doctors, dentists or ancillary prescribers appears in the pharmacy act in your state. Please show me I am wrong. You might be able to, I don't know where you practice. You can't on the one had say out of scope of practice and on the other hand say I don't have to follow the law that defines scope of practice. Also, in PA you need a hazardous waste license to take back prescription medication so we can't take part in those drug bring back days the DEA does, even though the Pharmacy Act says nothing about this except it can't be resold.

So let's recap:

• Scope of practice has nothing to do with specialization. There is NO state that I am aware of that licenses doctors by specialty (except maybe anesthesiology). All physicians have a physicians license and they are entitled to exercise all of the rights and privileges of any other person who holds that license.
• Physicians are free to prescribe anything they want.
• Pharmacists have the duty to make sure any order written by any physician complies with all laws of the jurisdiction in which they practice and is medically appropriate and safe for the patient to take.
• Pharmacists may refuse to fill any order they want as long as they comply with the laws of their jurisdiction.

 

[Lnsean]

Well don't practice in PA. You are beholden to every law. You can only fill valid prescriptions and it's the laws and regulations governing doctors, PA's and NP's that determine what is or is not a valid prescription. All scope of practice laws relate to the bodies that govern the prescriber. The PA pharmacy act does not mention PA's. The law regulating PA's does that. That law limits C-II rxs to 3 days for initial therapy and up to 30 days if they write ongoing therapy on the rx. While nothing about this appears in the PA pharmacy act, I am bound by it. I would bet not one mention of the word scope of practice as it applies to doctors, dentists or ancillary prescribers appears in the pharmacy act in your state. Please show me I am wrong. You might be able to, I don't know where you practice. You can't on the one had say out of scope of practice and on the other hand say I don't have to follow the law that defines scope of practice. Also, in PA you need a hazardous waste license to take back prescription medication so we can't take part in those drug bring back days the DEA does, even though the Pharmacy Act says nothing about this except it can't be resold.

So let's recap:

• Scope of practice has nothing to do with specialization. There is NO state that I am aware of that licenses doctors by specialty (except maybe anesthesiology). All physicians have a physicians license and they are entitled to exercise all of the rights and privileges of any other person who holds that license.
• Physicians are free to prescribe anything they want.
• Pharmacists have the duty to make sure any order written by any physician complies with all laws of the jurisdiction in which they practice and is medically appropriate and safe for the patient to take.
• Pharmacists may refuse to fill any order they want as long as they comply with the laws of their jurisdiction.

Dude stop changing your argument. You do this every time you're wrong. No one is saying that MD can't write for anything. We're arguing about dispensing, not prescriptive authority. You argued that pharmacist cannot reject for scope of practice, so you need to quote a law that supports this or just stop it with all the non sense.

I always stand by my words and there's a definitely lack of honor among professionals here. If you're wrong...just say "I stand corrected" and move on. Constantly changing and shifting your argument to avoid this is very....immature.

 

[Old Timer]

Dude stop changing your argument. You do this every time you're wrong. No one is saying that MD can't write for anything. We're arguing about dispensing, not prescriptive authority. You argued that pharmacist cannot reject for scope of practice, so you need to quote a law that supports this or just stop it with all the non sense.

I always stand by my words and there's a definitely lack of honor among professionals here. If you're wrong...just say "I stand corrected" and move on. Constantly changing and shifting your argument to avoid this is very....immature.

Know I know why I put you on ignore years ago, back you go.

 

[BenJammin]

But the doctors can write for whatever they want.

Correct. What's your point? I can also drive at whatever speed I want. I may get a speeding ticket for driving 80 in a 40 but I can drive at whatever speed I want. Doctors can write for whatever they want but their prescriptions must follow the law.

 

[Old Timer]

Correct. What's your point? I can also drive at whatever speed I want. I may get a speeding ticket for driving 80 in a 40 but I can drive at whatever speed I want. Doctors can write for whatever they want but their prescriptions must follow the law.

Waiting for your citation for scope of practice. What state do you practice in. BTW, of course with pen he could physically write anything. That's obviously not the point. When I say I dentists can't write for diabetic medication, I mean they not permitted to prescribe that. Your inane and frankly juvenile idea that I meant he couldn't physically write is absolutely mind boggling.

And of course you still refuse to prove you know anything at all about this subject. Because you say so is no answer.....

 

[Lnsean]

Know I know why I put you on ignore years ago, back you go.

If you can't stand behind your words then don't speak.

 

[Corpseman]

Correct. What's your point? I can also drive at whatever speed I want. I may get a speeding ticket for driving 80 in a 40 but I can drive at whatever speed I want. Doctors can write for whatever they want but their prescriptions must follow the law.

My post wasn't dripping with as much sarcasm as I had hoped.

 

[zelman]

Correct. What's your point? I can also drive at whatever speed I want. I may get a speeding ticket for driving 80 in a 40 but I can drive at whatever speed I want. Doctors can write for whatever they want but their prescriptions must follow the law.

Technically, you can't exceed 186000 miles per second. If you've got a problem with that, take it up with Einstein.

 

[pharmgirl2440]

Pharmacist act like the state board is gonna bust down the door and take their license. We are not police and I think that some pharmacists are on a power trip and enjoy denying prescriptions. I am all about safety and will work with doctors if safety is an issue for any medication.

 

[BidingMyTime]

Pharmacist act like the state board is gonna bust down the door and take their license. We are not police and I think that some pharmacists are on a power trip and enjoy denying prescriptions. I am all about safety and will work with doctors if safety is an issue for any medication.

No, not the state board, the DEA. And there have been many pharmacists and pharmacies that have lost their DEA license (or worse, faced criminal charges.) This is a major concern, you will figure this out by the time you go through pharmacy school.

 

[Lnsean]

No, not the state board, the DEA. And there have been many pharmacists and pharmacies that have lost their DEA license (or worse, faced criminal charges.) This is a major concern, you will figure this out by the time you go through pharmacy school.

Why are you even debating with someone who doesn't even practice? What does he/she know about real-life scenarios.

 

[swatchgirl]

Why are you even debating with someone who doesn't even practice? What does he/she know about real-life scenarios.

IF one could safely assume that the drug is being used to treat AK as a cheaper alternative to cream, does it mean that the physician's scope of practice, besides the obvious prescribing powers, also includes doing extemporaneous compounding of a drug that's already available on the market? I mean if the drug is dispensed to him, the pharmacist is basically acting as a supplier for the physician's personal compounding project (assuming he did tell the truth and will be using the topical on himself or his wife). So if he or his wife (or whomever else) has an adverse reaction to the topical product that he made, can the the pharmacist who supplied the raw drug material to him be held liable?

What if he wasn't planning on actually making the topical himself, but was going to take the drug to an expert who IS licensed to compound topicals for treating AK? Could a pharmacist safely dispense in that case? Just ask him to detail his plans and the steps he will take after he receives the drug? I was gonna say that it would make me uncomfortable to dispense a drug to a patient when I don't know what exactly he'll do with it after the drug leaves my hands, but isn't that the case for every drug ever dispensed? You could only hope that the patient will follow the directions on the script, but in this case, the ophthalmologist is the one writing the script and making up the directions... and he IS authorized to do so by his license. Assuming he does know what he's doing, if the pharmacist just counsels him on the potential dangers of the drug, and documents it, then it should be fine to dispense, right?

I'm so confused. Personally I'd just tell him "no, I'm not comfortable dispensing it" to avoid the potential troubles, but I also want to help the pharmacy sell drugs since that's what a pharmacist is paid to do... Would the law protect the pharmacist if the drug is dispensed and something does go wrong? I just don't know if it's worth the risks just to help the doctor save a few bucks, then again, aren't we supposed to help patients save money as long as it is legal to do so?

 

[Old Timer]

No, not the state board, the DEA. And there have been many pharmacists and pharmacies that have lost their DEA license (or worse, faced criminal charges.) This is a major concern, you will figure this out by the time you go through pharmacy school.

For dispensing 5FU, really? What schedule is it?

 

[zelman]

For dispensing 5FU, really? What schedule is it?

Schedule six controlled substance in Massachusetts.

 

[Old Timer]

Schedule six controlled substance in Massachusetts.

Really, I call BS. This means every drug in MA is a controlled substance.

Q: What is Schedule VI?
A: Schedule VI drugs consists of all prescription drugs, which are not included in Schedules II -V. This is a special Massachusetts schedule (MGL 94C, 105CMR720.002).

It's not a controlled substance and even if it was, the DEA does not enforce MA law......

 

[zelman]

Really, I call BS. This means every drug in MA is a controlled substance.

Q: What is Schedule VI?
A: Schedule VI drugs consists of all prescription drugs, which are not included in Schedules II -V. This is a special Massachusetts schedule (MGL 94C, 105CMR720.002).

It's not a controlled substance and even if it was, the DEA does not enforce MA law......

It is a controlled substance in MA. Just like every legend drug. So, it doesn't fall under DEA jurisdiction, but they would be happy to tip off the state CSA's enforcers.