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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.
*There is currently an exception to this:
(A) After issuing an initial prescription pursuant to Section 2-309I of Title 63, an individual practitioner may issue one (1) subsequent prescription for an immediate-release opioid drug in Schedule II in a quantity not to exceed seven (7) days if:
(i) The subsequent prescription is due to a major surgical procedure and/or “confined to home” status as defined in 42 U.S.C. 1395n(a);
(ii) The practitioner provides the subsequent prescription on the same day as the initial prescription;
(iii) The practitioner provides written instruction on the subsequent prescription indicating the earliest date on which the prescription may be filled (i.e. “do not fill until” date); and
(iv) The subsequent prescription is dispensed no more than five (5) days after the “do not fill until” date indicated on the prescription.
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.
The technician will not have to retake the initial exam, if that was taken, and the technician does not need to reapply for the permit. There must be documentation of pharmacy technician training at each facility where the technician is working. The technician must receive updated training yearly and this must be documented. The Technician permit is site specific and the PIC of the specific pharmacy must sign the permit that is required to be posted at all times. [OAC 535:15-13-13(d),(e)]
Yes. If the pharmacy and the prescriber have the appropriately credentialed software then you are able to accept any prescription through that system. However, you cannot transfer a CII prescription to another pharmacy if you are unable to fill it. The doctor will need to re-transmit it to the new pharmacy. [OAC 475:30-1-4(h)]
Upon loss or theft of a controlled dangerous substance a pharmacy must fill out a DEA form 106: http://www.deadiversion.usdoj.gov/21cfr_reports/theft/index.html.
Copies of the completed form may be sent to:
Keep a copy of the completed Form 106 in your files. If a crime was committed, a police report may be filed as well. Other questions may be directed to the OKC DEA at 405-475-7500 or to OBN at 800-522-8031. Theft or any violation of the Oklahoma Controlled Substance Act by a pharmacist, technician, intern or other registrant must be reported to the Oklahoma State Board of Pharmacy.
[OAC 475:20-1-5(c), Oklahoma Pharmacy Law Book Appendix D, Form DEA-106 OMB Form No. 1117-0001, DEA:Title 21 CFR 1301.76(b)]
The pharmacy must obtain a drug supplier permit with the Board which is $20/year. They must create an invoice with the following items: name and address of purchaser, drug description, quantity, price, and date of transaction. These invoices must be maintained by the pharmacy.
If a pharmacy chooses to run a mock prescription through their system for perpetual inventory purposes only, it must not be submitted to the PMP.
If a pharmacy or prescriber is wishing to purchase a Schedule II medication, the purchaser must issue a Drug Enforcement Administration (DEA) Form 222 and the drug supplier must complete Form 222 and send the appropriate copy to DEA.
Keep in mind that all invoices must bear the name of the entity/prescriber licensed to purchase prescription drugs. It is prudent to ask for a copy of their license or go online to their licensing board and verify that their license is current.
If an entity such as a fire department or ambulance service wishes to purchase drugs, their medical director must request the medications under the authority of his license.
As of November 1, 2018, Oklahoma licensed Pharmacies can fill non CDS prescriptions from out of state Advanced Practice Registered Nurses (APRN’s), Physician Assistants (PA’s), and Optometrists.
Only Oklahoma licensed mid-level practitioners supervised by Oklahoma licensed physicians may prescribe and issue valid Oklahoma CDS prescriptions.
For licensure status and formulary information, contact the Medical Board at 405-962-1400 or access their website at www.okmedicalboard.org.
*The following OKLAHOMA LICENSED Advanced Practice Nurses (APN’s) may apply for authority from the Oklahoma Board of Nursing to prescribe drugs subject to supervision by a physician: Advanced Registered Nurse Practitioners, Clinical Nurse Specialists, Certified Nurse Midwives. Parameters of prescribing include: the prescribed drug must be within the APN’s specialty area of practice; prescribing includes C-III thru C-V limited to a 30-day supply (the 30 days supply may be a combination of the initial fill and a number of refills which add up to the 30 days supply); and prescribing is subject to an Exclusionary Formulary [list of drugs which may NOT be prescribed]. The Exclusionary Formulary is available at www.ok.gov/nursing/prac-exclusfrm.pdf.
*OKLAHOMA LICENSED Certified Registered Nurse Anesthetists (CRNA’s) authorized by the Oklahoma Board of Nursing may select, order, obtain and administer drugs only in the perioperative and periobstetrical periods. CRNA’s may select, order, obtain and administer drugs including C-II thru C-V (with OBNDD and DEA registrations) from an Inclusionary Formulary [list of drugs which MAY be prescribed]. The Inclusionary Formulary is available at www.ok.gov/nursing/prac-crnafrm.pdf. CRNA’s may NOT write outpatient prescriptions. Verification of licensure/advanced practice prescriptive authority is available from the Nursing Board’s website at www.ok.gov/nursing or by contacting the Nursing Board at 405-962-1800.
*OKLAHOMA LICENSED Optometrists certified by the Oklahoma Optometry Board to prescribe may prescribe C-III thru C-V limited to a 7-day supply (no refills without a follow-up examination). Optometrists may prescribe up to a 5-day supply of Hydrocodone-containing drugs. Drugs prescribed have to be for abnormalities of the eye. For licensure status and formulary information, contact the Optometry Board at 405-733-7836 or visit their website at www.optometry.ok.gov.
Language is included in the statutes of the professions above to require their prescriptions be filled by a pharmacist for added patient protection. Pharmacists are responsible for the dosage and drug utilization review.
[O.S. Title 59 Sec 353.1a; Oklahoma Pharmacy Law Book – Appendix E]
The OK Bureau of Narcotics and Dangerous Drugs (OBNDD) requires that the pharmacy submit the ID of both the patient and the person picking up the controlled substance. Identification means valid passport, military identification card, driver’s license, or state-issued identification.
"State" means any state, territory, or possession of the United States, the District of Columbia, or foreign nation.
If any questions arise, contact the Oklahoma Bureau of Narcotics and Dangerous Drugs at 405�??521�??2885.
The ID number does not need to be written on the prescription, however, it does need to be maintained.
[OAC 475:30-1-10(a), O.S. Title 63 Sec 2-309, O.S. Title 63 Sec 2-314]
The identification of both the ‘ultimate user’ and the person who picks up the prescription must both be reported to the PMP. In many cases these are the same person. [OAC 475:45-1-2]
A person who has been licensed as a registered pharmacist and engaged in the practice of pharmacy for a period of not less than one (1) year and is currently licensed as an Oklahoma pharmacist is eligible to take the preceptor exam and apply for a certificate. [OAC 535:10-5-8]
Pharmacists must complete fifteen (15) clock hours of CE each calendar year, i.e. January - December. A pharmacist is required to report 15 clock hours of CE obtained in the PREVIOUS CALENDAR YEAR annually upon renewal Pharmacists must maintain proof of CE for a period of two years from the date their renewal is submitted. [O.S. Title 59 Sec 364]
Full Quantity Unavailable: If the pharmacy is unable to supply the full quantity, the remaining portion may be filled within seventy�??two (72) hours. If the remaining portion is not or cannot be filled within the 72�?? hour period, the pharmacy shall so notify the prescribing registered individual practitioner. No further quantity may be supplied beyond the seventy�??two (72) hours without the issuance of a new prescription.
LTCF or Terminally Ill Patient: A Schedule II prescription written for a patient in a Long Term Care Facility (LTCF) or for a terminally ill patient may be filled in partial quantities. The pharmacist must record on the prescription whether the patient is "terminally ill" or an "LTCF patient". A prescription that is partially filled and does not contain the notation "terminally ill" or "LTCF patient" shall be deemed to have been filled in violation of the Uniform Controlled Dangerous Substances Act. For each partial filling, the dispensing pharmacist shall record the date of the partial filling, quantity dispensed, remaining quantity authorized to be dispensed, and the identification of the dispensing pharmacist. The total quantity dispensed in all partial fillings must not exceed the total quantity prescribed. Schedule II prescriptions for patients in a LTCF or terminally ill patients shall be valid for a period not to exceed 60 days from the issue date unless sooner terminated by the discontinuance of medication.
[OAC 475: 30-1-7]
According to OBNDD regulations, if an error is made in filling out a C-II prescription, a new prescription must be written by the prescriber.
However, if the following items have been omitted from a C-II prescription, a pharmacist may add them to the prescription:
After consulting with the prescriber, the following may be added and documentation of contacting the prescriber must be noted on the back of the prescription:
* A recent letter from the DEA dated May 2, 2016 allows the pharmacist to add the DEA number to a prescription after confirmation with the prescriber.
Items that may NOT be added to a C-II prescription are:
Do not erase, use white-out, or mark-out anything on a C-II prescription.
Clarifications may be made for things such as a drug name being misspelled, a patient’s name being misspelled or changing a maiden name to a married name, but the name of the patient may not be changed if it is the wrong patient.
No. The partial filling of a prescription for a controlled dangerous substance listed in Schedules III, IV or V is permissible; PROVIDED that:
(1) Each partial filling is recorded in the same manner as a refilling.
(2) The total quantity dispensed in all partial fillings does not exceed the total quantity prescribed.
(3) No dispensing occurs after six (6) months after the date on which the prescription was issued.
A prescriber may not prescribe CDS for a patient related to them within the first or second degree, whether by blood or marriage. This includes spouses, parents, children, siblings, grandchildren, and grandparents.
Prescribing non-controlled substances for a family member is not prohibited. However, prescribers must have a valid doctor-patient relationship with all patients. The question of whether it is ethical is not answered in the law.
[OAC 475:30-1-3(d); Oklahoma Pharmacy Law Book Appendix F]
Before declining to fill the prescription, it is advisable to contact the prescriber and discussing your concerns with the prescriber. Once the prescriber has been contacted, if the pharmacist still feels as though the prescription should not be filled, the pharmacist can make a copy of the prescription and return the prescription to the patient. The pharmacist may also submit fraudulent prescriptions to the Oklahoma Bureau of Narcotics at https://www.ok.gov/obndd/documents/DIV FRAUD FORM.pdf.
You cannot be the PIC or the pharmacy manager in more than one pharmacy at a time, whether they are located in Oklahoma or a non-resident pharmacy. [OAC 535:15-3-2(b)(3)]
The Board of Pharmacy must be notified in writing (fax, mail, email) and a beginning controlled drug substance inventory must be taken and reported to the Board of Pharmacy. [OAC 535:25-3-7, Oklahoma Pharmacy Law Book Appendix B]
The Board of Pharmacy must be notified in writing (fax, mail, email) and an ending controlled drug substance inventory must be taken and reported to the Board of Pharmacy. [OAC 535:25-3-7, Oklahoma Pharmacy Law Book Appendix B]
The PIC shall be present and practicing at the pharmacy for which he holds the PIC position no less than 20 hours per week during the pharmacy's ordinary course of business. In the event the pharmacy's normal hours of business are less than 40 hours per week, the PIC shall be present and practicing at least 50 percent of the normal business hours.
A technician’s arrest not related to a violation of the Pharmacy Act must be reported to the Board of Pharmacy upon renewal of the technician’s license. [OAC 535:15-13-8]
A pharmacist can provide immunizations to a patient as long as they are registered with the State Board as an immunizing pharmacist and have an active CPR registration. The pharmacist must either have a patient-specific prescription or a protocol in place from a provider. The physician will set limitations regarding the types of immunizations and patient age, if any, via the protocol. The CDC has a vaccine schedule in place to help with ensuring that the patient does receive the correct vaccine at the correct time: https://www.cdc.gov/vaccines/schedules/. [OAC 535:10-11-3]
The CDC’s recommendations are a stand-alone refrigerator with enough space to accommodate inventory without crowding and a stand-alone freezer with enough space to accommodate inventory without crowding. The freezer should be between -58F and +5F while the refrigerator should be between 36F and 46F.
The CDC recommends using temperature monitoring equipment and also using a temperature log in the freezer and refrigerator.
The CDC’s best storage practice is to place vaccines in original packaging in the center refrigerator space, inside designated storage trays positioned 2 to 3 inches from the refrigerator walls.
Here is the link to the CDC document for convenience: http://www.cdc.gov/vaccines/hcp/admin/storage/toolkit/storage-handling-toolkit.pdf
If properly trained, a pharmacist may administer therapeutic injections on orders from a prescriber. This does not require a special license or permit. [O.S. Title 59 Sec 353:30]
A patient-specific prescription may be mailed to a prescriber’s office if the patient does not have a secure or permanent mailing address, the medication requires special handling (refrigeration or frozen), the medication is delivered to where it would be administered, the medication is filled under Medicare and/or Medicaid for ESRD program, radiopharmaceuticals or compounded medications. The physician must have the patient’s permission and it must be documented in the patient’s chart. The patient must maintain freedom of choice for their pharmacy. [O.S. Title 59 Sec 353:24-(A)(4)(a-e)]
Reciprocity shall meet the requirements set forth in OAC 535:10-5, 535:10-7-4 and 535:25.
Reciprocity applicants shall have a minimum of one year's experience obtained as an intern and/or as a pharmacist.
Reciprocity applicants shall submit to the Board a completed "NABP Official Application for Transfer Pharmaceutical Licensure" and the required Oklahoma fee by the deadline set by the Executive Director.
Oklahoma requires reciprocity applicants to reciprocate from an active original license by examination.
A guide sheet to obtaining an Oklahoma pharmacist license by Reciprocity is available at https://ok.gov/pharmacy/documents/License Info_RECIPROCITY.pdf.