Medication Order Entry and Filling Pharmacy Technician Tasks Accepting new prescriptions from patient New telephoned prescriptions in some states, NY included, are not permitted to be accepted by pharmacy technicians Receiving refill requested from the patient Calling doctor’s office for refill authorizations Collecting patient’s data Maintaining patient’s profiles

First step in order entry Receiving the prescription. According to federal law, a prescription may be transmitted to the pharmacy in the following ways (controlled substances may differ and state laws also apply) Written Telephoned Faxed Electronically, e-prescribing Step 2 Obtain patient and prescriber information Patient information includes full name, address, contact, date of birth, any drug and food allergies, medical history Prescriber’s information Name and address with contact DEA (required for controlls) NPI (required for most insurances) Registration/license (required by some insurances)

Step 3 Data input into electronic patient profile Name, address and other demographic data DOB Medical history Drug allergy information and Food Prior Medication/OTC/Herbal use Drug selection NDC of the drug chosen must match the one entered into the computer Determining if a generic can be used Keying in direction data Entering refills DAW codes

DAW Codes DAW codes are used by insurances companies to help determine the reimbursement to the pharmacy and if the medication is eligible for full or partial coverage These codes are universal and used by all pharmacies and insurance companies Codes are not required to be memorized for the exam but know the following DAW=0 means no preference is indicated (generic ok) DAW=1 means prescriber indicates brand drug to be dispensed DAW=2 means that generic is ok but patient requires brand DAW=8 generic is ok but generic is not available in market

Step 5: Generating the label Submitting the prescription claim to the insurance company for payment. This online claim processing is called adjudication Step 5: Generating the label the following on all retail prescription labels affix to the container Pharmacy full information, including telephone Patient, prescriber, and drug name (state) Strength of the medication Direction for use Quantity dispensed Date prescription was filled or refill Rx number Initials of the RPH Number of refills Manufacturer of drug (new amendment) Expiration date of prescription Step 6 affix auxiliary Label to product Provide additional info to patient Common labels Avoid Alcohol: example Metronidazole May cause drowiness: BDZ (Xanax); antihistamines (Bendryl) Take with food or milk : example NSAIDS, (ibuprofen, diclofenac) Shake well: all suspensions (including eye drops) Augmentin, Amoxicillin

Sample Label on Retail Prescription Vial Milan Pharmacy 1600 Broadway New York, N.Y. 10019 212-555-0000 John Doe Rx# 1222222 1 Central Avenue, Ridgewood, N.Y. 11385 (optional) Date filled: 03/5/2015 Date Rx written: 03/4/2015 (optional) Simvastatin 20 mg Take one tablet by mouth every day Qnty: 30 Refills: 11 Prescriber: Dr. Jane Doe RPH: Milan Topalov Drug: Simvastatin for Brand Zocor Manufacturer: Dr. Reddy’s NDC: (optional) Prescription Expiration: 03/5/2016

Step 6 Select the container of dispensing. Most drugs are light sensitive and their dispensing in amber colored containers are required Vials for capsules and tablets “Ovals” are wide mouthed containers for compounded creams and ointments Glass or plastic amber bottles for liquid medications Some drugs require the original manufacturer labeled container to be dispensed. A very important one (hint: it may be on the PTCE) is Pradaxa ® (Dabigatran) is a anticoagulant used in place of warfarin for many condition. FDA in 2011 requires that the pharmacist dispense drug in the original container and the bottle be dated 60 days after opening Step 7 Pharmacist check. Labeled container with the pulled bulk medication and the original prescription

Step 8: Dispensing to patient For all new patients to your pharmacy it is important to give them a copy of the HIPPA notice of privacy practices and to document that the patient received it; same holds true for doctor’s office As per OBRA 90 requires, the pharmacist must offer counseling Use of teaching sheets that provide preset information in layman’s term of the medication Some medications require a patient package insert or PPI to be dispensed with the prescription as per Federal law. These medication classes include: Oral contraceptives (birth control) Estrogen and progesterone products (menopausal products) Isotretinoin (Accutane) Metered dose Inhalers PPI are laymen terms for what is contained in the Package Insert All dispensed prescriptions must comply with the poison prevention packaging act of 1970 Child resistant caps on all dispensed vials

Institutional Fill Process Hospitals, nursing homes, LTCF, etc follow the same procedures with some differences: Ambulatory (out patient prescriptions) are not filled Patient’s data is not collected but is available on the electronic patient’s profile Patient’s name, demographics, height, weight, address, DOB Patient’s insurance information Patient’s Diagnosis Patient’s allergies Patient’s laboratory data Admission date Admitting physician MAR Medication reconciliation record Dispensing to the patient directly is not done. Medication are administered by an RN

Dispensing to the patient’s nursing unit: Hand delivery to the unit by the pharmacy technician from a centralized pharmacy Technicians deliver unit dose medications to a ADC (automated dispensing cabinet). The medication is accessible to the RN from the cabinet after the medication is profiled by the pharmacist. Support a decentralized pharmacy system with specialty satellite pharmacies (cardiac ICU unit would stock cardiac medications in their ADC) supports with turn around time Supports pharmacy antidiversion efforts Omnicell and Pyxis Medistation are the industry standards