Published in the January 2008 Oklahoma State Board of Pharmacy Newsletter
- Mid-Level Practitioner Update: Physician assistants (PA) may now prescribe for up to a 30-day supply of Schedule III to V if they have a mid-level Drug Enforcement Administration (DEA) number. They may not issue any refills on CDS prescriptions, even if the prescription is for less than a 30-day supply. Nurse practitioners (NP) may prescribe for a seven-day supply of Schedule III to V with no refills. NPs and PAs may not write outpatient prescriptions for Schedule II under any circumstances. Oklahoma pharmacies may not fill prescriptions from out-of-state PAs or NPs. If a prescription is received from an out-of-state mid-level practitioner, the pharmacy must call and obtain permission to fill the prescription under the supervising physician’s authority. Pharmacies may now place the PA or NP name on the patient’s label without the supervising physician’s name; however, the supervising physician’s name must still be indicated on the original prescription.
- Hospice/Long-Term Care Facility Schedule II Prescriptions (Faxed): The Oklahoma Bureau of Narcotics has clarified its rules regarding faxed Schedule II prescriptions for hospice and long-term care facility patients. If the pharmacy intends to use the fax as the original prescription, the fax must be sent from the practitioner’s office. If the fax is sent from the hospice or long-term care facility, then the original hard copy written prescription must be presented at the time it is dispensed.
- Hospital-Affiliated Clinics: Hospital-affiliated or hospital-owned clinics may not obtain their medications from hospital pharmacies or drug rooms. These medications are only intended for the patients of the hospital and transfer of drugs outside the hospital may be a violation of federal law.
- Background Checks on Employees: In 2002, the Board revoked eight pharmacy technician permits for drug diversion. This year, 31 of 43 total Board hearings were regarding pharmacy technicians diverting controlled substances or stealing money. In many cases, the pharmacy technician had prior convictions that he or she lied about on his or her original application. It is highly recommended that you conduct a background check on all employees that will have access to controlled substances. It costs $15 and can be obtained through the Oklahoma State Bureau of Investigation. Information and forms may be found at its Web site: www.ok.gov/osbi/Criminal_History/. As any pharmacist who has been a victim of diversion can tell you, this is inexpensive insurance compared to the financial loss, paperwork hassle, and time involved in an internal theft. Furthermore, a pharmacy with controlled substances may not employ any person with a drug-related conviction without obtaining a waiver from the Oklahoma Bureau of Narcotics and DEA.
- Electronic Version of DEA Form 106: A pharmacy must complete a DEA Form 106 any time there is a loss or theft of CDS. This form is available and may be submitted online at: https://www.deadiversion .usdoj.gov/webforms/app106Login.jsp. It is also available as a PDF. Please make copies of the completed DEA Form 106. Keep a copy at the pharmacy, send one copy to the Board of Pharmacy, and send one copy to the Oklahoma Bureau of Narcotics. Addresses and further information are located in Appendix D of the Oklahoma Pharmacy Law Book.
- New DEA Rules Limited in Oklahoma: DEA has amended its rules and now allows practitioners to issue multiple prescriptions for Schedule II medications on one day with instructions “do not fill until a particular date” for up to 90 days. However, the Oklahoma Bureau of Narcotics does not allow Schedule II prescriptions to be filled beyond 30 days after the prescription has been written. Therefore, this DEA rule will be extremely limited in the state of Oklahoma.
- Misfill Prevention: Misfills are the primary complaint the Board receives from the public. With technological advances and bar coding, the wrong drug seems to be less frequent; although, pharmacists and technicians often override or skip the safety measures in place. Wrong directions are frequently an issue, especially in pediatric dosing. Make sure your pharmacy has implemented checks and balances to prevent someone from getting the medication of another person with a similar name. Many pharmacies ask the patient to verify date of birth or address at the register. If the medication is a controlled substance, the pharmacists are required to obtain positive identification if they do not know the patient. Create a way of flagging the prescription so that the clerk will check before completing the transaction. Most importantly, do not allow clerks and technicians to answer questions from patients regarding a medication looking “different” than last time. This should be a red flag to all pharmacists. Most of the Board’s complainants tell us that they asked and were told by a technician that it is a “different generic” before finding out later that it was the wrong drug.
- E-Signatures: Electronic signatures for non-controlled prescriptions are considered valid. E-mailed Schedule III to V controlled prescriptions should be treated as phoned-in prescriptions and validated if necessary. You should be able to validate the source of the e-mail. Oklahoma Bureau of Narcotics rules state “All written prescriptions shall be manually signed by the practitioner.” Faxed and/or walk-in Schedule III to V controlled prescriptions must bear the actual signature of the prescriber. If the prescription does not bear the signature or states “e-signature on file,” then the pharmacy may call the prescriber and treat the prescription as a phoned-in prescription.
Change of PIC: Any time there is a change of pharmacy manager, the pharmacy must submit a CDS inventory to the Board within 10 days. Please, include a cover sheet with the inventory indicating that there has been a change in manager by listing both the outgoing and incoming manager’s name and license number and the date the change was effective.