The Prescription The pharmacy technician is often the first person to examine the patient’s prescription for completeness and other issues. Due to this it is very important that a pharmacy technicians understands the basic elements of the prescription to save time and to ensure customer satisfaction. This is probably the technician’s primary function in the retail setting. Many states are moved to the electronic prescription, known as e-Prescription or eRx As of March 2016, NYS has mandated eRx, the paper prescription is slowly being phased out

The Elements of the Prescription Patient’s name Prescriber’s name, address and phone. Date it was written Name, strength, and quantity of drug Directions for use (sig) Signature of the prescriber (very important) Route of administration Refills

Controlled Substance Prescription In addition to the above elements, the following is required as well: Patient’s and Prescriber’s address Prescriber’s DEA number Date written

Anatomy of a Prescription Dr. John Doe, MD 55 5 th Street Anywhere, NY Lic: NPI: DEA: BD ____________________________________________________________________________ Patient: Mary Jane Date of Birth: 01/01/1971 Address: 56 th street Anywhere NY Age: 44 Date written: 02/22/2015 Lopressor 50 mg tablets Sig: 1 Tab PO BID Dispense: 60 Signature: _________________________ ____________________________________________________________________________ Maximum day supply Dispense as written Serial barcode (used for many state PMP) Pharmacist Test Area Prescriber’s name required by law Address and phone required by federal law for controlled substances Patient’s name required by law Address required by federal law for controlled substances Prescriber’s state license number (LIC) NPI = required for payment by CMS DEA = required by federal law for prescriptions MMIS= Medicaid number that shows a prescriber is enrolled in medicaid (optional) Date is required for controlled substance Rx Drug Name, strength Sig: # of doses, route, frequency Dispense qnty or “day supply” Signature of Prescriber is required to be a valid prescription Required day supply for controll drugs Prescriber indicate here if he/she wants brand Thermochrome for testing validity

Probably the most important element on the prescription is the signature of the prescriber. Whether electronic or hard copy the signature must be there for the prescription to be valid. In many states in addition to the signature, the stamped or imprint name of the prescriber must be on the prescription

Prescription Elements Continued Other elements on the prescription may include Prescriber’s license number and registration number Prescriber’s DEA number (required to write a controlled substance prescription) Prescriber’s NPI or national provider’s identification number.

NPI numbers The NPI is a ten digit number that was created by HIPAA act of The NPI is a unique identifier that is used by CMS to identify healthcare providers for the purposes of administrative issues and reimbursements. Often other third party payers utilize this number to file claims and payments to pharmacies. Often an adjudication is denied because of lack of prescriber’s NPI. The NPI for various providers can be found at: rd=static.npistart

Who can write prescriptions? MD NP DO DVM DPM Ophthalmologists DDS PA Physician’s assistants can in general write for prescriptions so long as their primary supervising physician name, address, and registration number is on the prescription. Often the PA will use his/her physician’s prescription blank so long as the PA signs the Rx and stamps his/her name on it with his registration number. Physician Assistants, as of 2007, can write for prescriptions for CII and other scheduled drugs. In this case he/she would use his own Rx blanks with their own DEA numbers.

Prescription Transfers A refill(s) may be transferred from one pharmacy to another either in the same state or different states. A pharmacist is to handle Rx transfers. Federal law permits the transfer of all the refills on a prescription provided that amount transferred does not exceed the total number of refills remaining. The pharmacist that transfers the refills must do the following documentation: Document the pharmacist he/she spoke with Name, address, DEA, and the NABP# of the pharmacy transferred to VOID that original prescription The receiving pharmacist must document: Pharmacist spoken with Name, address, DEA, NABP# of the pharmacy transferred from All the information on the original prescription with the old pharmacy Rx number Must write “TRANSFER” on the face of the prescription Federal Law allows transfer of controlled substance Rx in schedules III-V on a one time basis

Federal Law on Retail Prescription Federal law provides many means for prescribers to issues prescriptions Written Electronic Fax Telephone Fax copies of CIII-CV are acceptable as original (remember state law may be stricter) Controlled Substance Rx: Federal law CII No fax as original (exceptions: LTCF, Hospice, Infusion centers) 30 days maximum No refill Partial fill ok with remainder to be fill in 72 hours. If can’t fill balance in 72 hours, the balance is voided. (exception is LTCF or terminal ill patient) If Patient requests a partial fill; the balance cannot be fill later; the balance is void

CIII-CIV 30 days maximum 5 refills or 6 months life CV (Federal Law) Codeine containing cough syrup must be combined with other med and be no more than 2 mg/ml codeine opiates in small amounts combined with a noxious drug to prevent abuse (diphenoxylate 2.5 mg/Atropine mg) Depending on state law can be dispensed without a prescription 5 refills or 6 months life Oral Controlled Substances (Federal Law) Permitted on CIII-CV CII emergency oral Rx For the emergency period only Must reduce to writing by pharmacist No alternative available Seven days MD must deliver hard copy (72 hours in NY) If no cover Rx must report to DEA Must know prescriber in good faith If any are in question, can and should refuse to fill

Syringes and Needle Prescriptions Federal law is indifferent to the requirements for written prescriptions on “drug equipment” to include syringes and needles Due to rise of illicit drug use during the 20 th century many states require prescriptions for syringes and needles Federal Drug Paraphernalia Statute, 21 USC 863 (part of the CSA of 1970) provided a framework for what many states consider “drug paraphernalia” (equipment used to administer drugs) This included needles and syringes Freebase kits (baking soda, tealights) Bongs However, due to the rise of the AIDS epidemic many states have loosen their prescription requirements on syringes and needles In NYS, needles and syringes can be purchased without an RX for quantities of 10 or less if pharmacy participates in the ESAP-Expanded syringe access program passed in NY in 2001

Medication Orders in the Hospital An order usually contains patient name, DOB, and MRN. Patient’s Diagnosis, Allergies, Location in Hospital Patient’s height and Weight Date and hour the order is written. Name of Drug, dose, frequency and if routine, STAT or PRN. Route Name of the prescriber and the pager Can be a paper order sent to the pharmacy or an order entered into a CPOE.