e-Profile Login and ID Quick Search
Ohio News: Electronic Prescribing Issues
Published in the November 2008 Ohio State Board of Pharmacy Newsletter
On June 27, 2008, the Drug Enforcement Administration (DEA) published proposed rules for the electronic prescribing of controlled substances. The comment period for these rules ended on September 25, 2008. DEA will now have to review all of the comments received and determine whether changes need to be made to the proposed rules prior to publishing them as final rules. Until DEA publishes a final rule, federal regulations do not allow for the transmission of electronic prescriptions for controlled substances. Contrary to what the Board may have encouraged pharmacists to do in the past, DEA does not recognize either computer to computer or computer to fax transmissions of controlled substance prescriptions to be valid prescriptions. For the time being, therefore, any controlled substance prescription received other than by oral transmission must bear a manual signature (not a computer-generated one) when received from the patient directly or via the fax machine. Of course, prescriptions for Schedules III through V may also be transmitted orally by either the prescriber or his or her agent to the pharmacist. Until DEA’s electronic prescribing rules are published in final form, please make sure you do not accept any controlled substance prescriptions transmitted directly by the prescriber’s electronic prescribing system to your pharmacy without a manual signature unless you follow up with the prescriber and get verbal authorization. If you do that, make sure you document the verbal authorization on the electronic prescription. As you will see below, the prescriber could print out the prescription in the office, manually sign it, and then fax it like a traditional prescription. Hopefully, DEA will be able to publish its final regulations in a timely manner and thereby resolve this issue.
For non-controlled substances, the Board has been getting too many calls from prescribers where pharmacists are refusing to fill computer to fax prescriptions that are valid. Some pharmacy owners, managers, and district managers are telling all their pharmacies to refuse to fill electronic prescriptions from certain locations. If the prescription is written for a legitimate medical purpose, refusing to fill the prescription certainly would not be in the best interests of the patient. Please review the following items to help you determine if a fax received from an electronic prescribing system is valid.
Traditional fax – The prescription is written on a traditional prescription blank or can be printed from a computer and must be manually signed by the prescriber in ink, placed in a fax machine, and transmitted to the pharmacy. If an agent transmits the prescription instead of the prescriber, the agent’s full name needs to be noted on the prescription. You should see a fax header, usually at the top or bottom of the page, identifying the location of origination and the date the order was faxed to help you determine that the fax came directly from the prescriber and not the patient. The header and agent information must remain on the paper. Do not cut it to fit into your file. The original prescription is required to stay in the patient’s chart in the prescriber’s office. You should not see the sentence “approvable by OSBP” on the fax. This method is an acceptable way to transmit Schedule III through V controlled substance prescriptions.
Computer to fax transmissions – The prescription is typed into a computer by the agent or prescriber and transmitted by the agent or prescriber to the pharmacy. Generally, these prescriptions do not utilize an intermediary like SureScripts-RxHub. Unlike a traditional fax, the computer to fax format for an Ohio prescriber will contain a unique transaction or order ID number that is traceable for security and accountability purposes. There will be a logo or identification of the software company that will allow the pharmacist to verify on the Board Web site that the electronic prescription system is an approvable system. There will be a statement saying that the company’s prescribing system has been made approvable by the Board.
The signature for a computer to fax prescription can be confusing. There may or may not be a signature line. There may be blank space where the signature would be placed. If there is a line, it does not need to contain a signature, it can be just a line. Ideally, you may find words along the signature line or in the blank space that simply state that the prescription has been electronically signed. If there is a computer-generated signature, it must obviously be computer-generated or include words such as “electronically signed.” An electronic prescription transmission system can be made approvable with any of the above signatures, when used in conjunction with the transaction number, software identification, and approvable status information.
You might also see a rejected computer to computer prescription print from your fax machine. This will occur occasionally when SureScripts-RxHub or another intermediary is unable to obtain confirmation that your computer received the electronic prescription data or if your pharmacy computer system does not have the capability to receive computer to computer transmissions. In some instances, data that is too long for transmission is switched to a computer to fax transmission. These prescriptions have been reviewed by the Board office and are acceptable as is. They should be clearly marked with the name of the intermediary company that transmitted these prescriptions (eg, SureScripts-RxHub).
In summary, some electronic prescribing systems can generate printed prescriptions requiring manual signatures that may be given to the patient or sent via fax as a traditional prescription (manually signed). Therefore, you might see all three types of prescriptions (manual signature, computer to fax, or computer to computer) generated from one prescriber’s office. These, in addition to handwritten and manually signed prescriptions that are faxed, computer to computer rejects turned into a fax by the switch (intermediary), and oral orders placed by telephone make six ways new prescriptions from one office may arrive at your pharmacy.
As a reminder, refill requests sent by traditional fax to a pharmacy may not be manually signed by office staff. These are not telephone refill orders. These faxes must be signed by the prescriber and treated as a new prescription in your pharmacy. A pharmacist or pharmacy intern may accept refill authorizations from a prescriber’s agent only through oral telephone contact. However, refill requests made and refills authorized through an Ohio approvable electronic prescription transmission system are acceptable.
