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FROM THE INSPECTOR'S DESK:
CDS Prescriptions: In Oklahoma, a physician cannot issue multiple prescriptions to a patient for the same drug. The DEA allows this but the Oklahoma Bureau of Narcotics and Dangerous Drugs does not have a corresponding law or rule that allows it in Oklahoma. It is illegal for a prescriber to postdate a prescription. All CDS prescriptions must be dated and signed on the day when issued. If a prescriber does not want the patient to fill it that day, then they can put instructions on the prescription as to the date when it can be filled. The date to be filled should not exceed 30 days from the date written for CII prescriptions.
Clarification of transferring “on hold” CDS prescriptions: The Drug Enforcement Administration (DEA) has issued a statement allowing pharmacies to transfer “on-hold” Schedule II-V electronic prescriptions from one pharmacy to another if they had not been filled at the original pharmacy. However, they require the transfer to be done electronically and the EPCS software does not permit pharmacies to transmit prescriptions from one pharmacy to another. Fax transmittal is not considered to be electronic transmission. If software is changed to accommodate the requirements of EPCS, then “on-hold” CDS prescriptions may be transferred between pharmacies.
DEA does not permit pharmacies to transfer “on-hold” CDS prescriptions that have been received by any other means of communication, including facsimile, verbal, or written.
These requirements do not apply to the transfer of refills of CDS prescriptions. Refills may be transferred as per OAC 535:15-3-12 and 535:15-3-12.1.
Program notes for the Oklahoma State Board of Pharmacy (OSBP) programs that were presented in conjunction with the 2016 OPhA Fall District Meetings are available for download:
"Pharmacy Law Update - 2016"
"What Pharmacists Need to Know about Training Technicians"
The 2016 Oklahoma Pharmacy Law Book is now available online. The new law book contains laws & rules as effective September 11, 2016 and certain laws as effective November 1, 2016. Printed law books will be availalbe October 1, 2016 and may be purchased for $10 each while supplies last. Online order may be placed via the "Online Store". (also see "Laws & Rules" page)
APRN Prescribing - The Board would like to remind hospital pharmacists that Advance Practice Registered Nurses (APRN) are not allowed to prescribe C-II's, even under physician protocols in a hospital. There has been some information circulated recently that indicates otherwise, so we want to make sure that hospital pharmacists are adequately informed. Click here to view the Oklahoma Board of Nursing Letter and Attorney General Opinion.
MEMO to All Medical Gas Suppliers & Medical Gas Distributors. (click to view)
FRAUDULENT PRESCRIPTION FORM (click to view) - In an effort to reduce prescription fraud and abuse, the Oklahoma Bureau of Narcotics and Dangerous Drugs (OBNDD) has provided an avenue to report fraudulent prescriptions to their Compliance Division. If you would like to report a fraudulent prescription to the OBNDD, please complete this form and fax it to the phone number provided. A link to this form is also available under "Related Links".
OPTOMETRIST RX'S FOR HYDROCODONE CONTAINING MEDICATIONS:
Oklahoma pharmacies my fill prescriptions written by doctors of optometry (optometrists) for Hydrocodone containing medications for up to a 5 day supply by virtue of a state law which went into effect November 1, 2014.
59 OS Sect 581 (B). The practice of optometry shall also include the prescribing of dangerous drugs and controlled dangerous substances for all schedules specified in the Uniform Controlled Dangerous Substances Act except Schedules I and II but allowing for the prescribing of hydrocodone or hydrocodone-containing drugs regardless of schedule for a period not exceeding five (5) days of supply, and the issuance of refills for such prescriptions following sufficient physical examination of the patient for the purpose of diagnosis and treatment of ocular abnormalities. The practice of optometry shall not include the dispensing of drugs but may include the dispensing of professional samples to patients.
E-PRESCRIBING OF CDS:
E-Prescribing of CII and CIII-V is permitted as long as the pharmacy and prescriber are EPCS (E-Prescribing of Controlled Substances) certified. A pharmacy whose software is EPCS certified will recognize other EPCS certified software and will accept CDS prescriptions from those prescribers who are also EPCS certified or reject those who are not.
Faxed prescriptions are not the same as electronic prescriptions. Faxed or written CDS prescriptions must bear the manual signature of the prescriber. They cannot bear a stamped, computer-generated signature, or “electronic signature on file”.
C-II prescriptions may not be faxed except under the exceptions allowed for hospice and LTCF patients. Please see OAC 475:30-1-4(f)(3) for complete rules.
NATIONAL TRANSPORTATION SAFETY BOARD (NTSB) ANNOUNCEMENT (click to view): On September 23, 2014, the NTSB issued a Safety Recommendation highlighting the importance of licensed health care providers and pharmacists routinely discussing with patients the effect their diagnosed medical conditions or recommended drugs may have on their ability to safely operate a vehicle in any mode of transportation.
NOTICE OF HYDROCODONE RESCHEDULE EFFECTIVE OCTOBER 6, 2014 (click to view): All products containing Hydrocodone will be rescheduled as a Schedule II (C-II) beginning October 6, 2014. To make the transition easier, the Board, working with multiple agencies, has summarized the essential information pertaining to the change. This summary is designed for the convenience of both pharmacists and practitioners and should be shared as necessary. Pharmacists should make an effort to share with all pharmacy staff.
TRAMADOL UPDATE: Tramadol will become a federally controlled Schedule IV beginning August 18, 2014. Though Tramadol has been a controlled substance in the State of Oklahoma since November 1, 2012, the DEA is requiring that pharmacies take an inventory of all Tramadol and Tramadol-containing products on AUGUST 18, 2014. The inventory must be kept on file in the pharmacy.
PSE questions & answers for pharmacies selling PSE. (click to view)
DEA Policy Statement on Role of Agents in Communicating CS Prescriptions:
Drug Enforcement Administration (DEA) issued a statement of policy that clarifies the proper role of a duly authorized agent of a DEA-registered individual practitioner in communicating controlled substance (CS) prescription information to a pharmacy. The statement, published October 6, 2010, in the Federal Register, reminds health care providers that a prescription for a CS medication must be issued by a DEA-registered practitioner acting in the usual course of professional practice. Such a practitioner may authorize an agent to “perform a limited role in communicating such prescriptions to a pharmacy in order to make the prescription process more efficient,” and the guidance emphasizes that medical determinations to prescribe CS medications may be made by the practitioner only. The specific circumstances in which an agent may assist in communicating prescription information to a pharmacy are detailed and include:
♦♦ An authorized agent may prepare the prescription, based on the instructions of the prescribing practitioner, for the signature of that DEA-registered practitioner.
♦♦ For a Schedule III-V drug, an authorized agent may transmit a practitioner-signed prescription to a pharmacy via facsimile, or may communicate the prescription orally to a pharmacy on behalf of the practitioner.
♦♦ An authorized agent may transmit by facsimile a practitioner signed Schedule II prescription for a patient in a hospice or long-term care facility (LTCF) on behalf of the practitioner.
The guidance also makes clear that generally, Schedule II prescriptions may not be transmitted by facsimile and that hospice and LTCFs are exceptions. Further,Schedule II prescriptions may only be communicated orally by the DEA-registered practitioner and only in emergency situations. DEA stresses that the practitioner should decide who may act as his or her authorized agent and advises that such designation be established in writing. An example written agreement is included in the policy statement, along with additional guidance related to designating an authorized agent. DEA also notes that as electronic prescribing for CS is implemented and its use increases, the role of the agent in communicating CS prescriptions will likely be reduced over time. The DEA policy statement is available on the Federal Register Web site at www.federalregister.gov/articles/2010/10/06/2010-25136/roleof-authorized-agents-in-communicating-controlled-substanceprescriptions-to-pharmacies.
EFFECTIVE IMMEDIATELY the following ID's are allowed in Oklahoma for PSE:
State Issued Driver's License
State Issued ID Card
If, and only if, a patient has none of these types of ID, such as a nursing home patient, then you may use a social security number to submit for PSE and PMP. For the purpose of accepting ID’s, please refer to the following definition: “State” means any state, territory, or possession of the United States, the District of Columbia, or foreign nation.
Any questions concerning PSE requirements should be directed to the Oklahoma Bureau of Narcotics at 405-521-2885.