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 5th Street Anywhere, NY 11379 718-555-000 Lic: 1234567 NPI: 76543211112 DEA: BD1234567 ____________________________________________________________________________ Patient: Mary Jane Date of Birth: 01/01/1971 Address: 56 th street Anywhere NY 11379 Age: 44 Date written: 02/22/2015 Lopressor 50 mg tablets Sig: 1 Tab PO BID Dispense: 60 Signature: _________________________ 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) Prescriber’s name required by law Patient’s name required by law Address required by federal law for controlled substances Drug Name, strength Sig: # of doses, route, frequency Dispense qnty or “day supply” Date is required for controlled substance Rx Signature of Prescriber is required to be a valid prescription Required day supply for controll drugs Prescriber indicate here if he/she wants brand Maximum day supply Dispense as written Thermochrome for testing validity Pharmacist Test Area Serial barcode (used for many state PMP)

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 1996. 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: https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=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

Oral Controlled Substances (Federal Law) 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 0.0025 mg) Depending on state law can be dispensed without a prescription 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 20th 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