Pharmacists in Florida May Dispense Opioid Antagonist Pursuant to Standing Order.

Pharmacists in Florida may dispense an emergency opioid antagonist pursuant to a non-patient-specific standing order prescribed by a health care provider, according to a recently passed law that goes into effect on July 1, 2016. The standing order would be for an auto-injection delivery system or intranasal application delivery system, which must be appropriately labeled with instructions for use, indicates the law (House Bill 1241).

Prescribers in the state of New York must issue electronic prescriptions directly to a pharmacy according to a new law. All prescriptions must be transmitted in electronic format, except for certain limited circumstances, effective March 27, 2016, under the Internet System for Tracking Over-Prescribing (I-STOP) Act. The regulations require prescribers and pharmacists to have a secure system for electronic transmission of the prescription from computer to computer in order to protect the confidentiality of patient information, notes the Office of the Professions (OP) advisory notice. For additional information on the electronic transmittal of prescriptions in New York, visit the OP section of the New York State Education Department website.
 
The New York Times states that New York is the first state to mandate electronic prescribing and enforce penalties, such as fines and imprisonment, for physicians who do not comply. The New York Times also notes that Minnesota has an electronic prescribing law but does not enforce or fine physicians for not complying with the mandate.

Idaho Bill Seeks to Lower Age for Children to Be Immunized by Pharmacists.
 
Pharmacists in Idaho would be able to prescribe and administer immunizations to children who are six years of age or older, under proposed legislation passed in the Idaho House of Representatives. Current Idaho law authorizes pharmacists to prescribe and administer immunizations to persons age 12 and older. Senate Bill 1294 has been reported as delivered to Governor Butch Otter.
 

Section 1 Question 5 and Section 2 Question 15

Continuing Education Requirements Are Changed.

A registrant seeking renewal of a personal registration shall submit to the Board with a renewal application a statement, signed under the penalties of perjury, that the applicant has satisfactorily completed a minimum of thirty (30) forty (40) contact hours of continuing education required for such renewal.

Effective for the renewal period beginning January 1, 2015, a registrant seeking renewal of a personal registration must complete a minimum of fifteen (15) twenty (20) contact hours of continuing education each calendar year of the two-year renewal cycle.

(a). All registrants must complete at least two contact hours per calendar year in the area of pharmacy law;

(b). No more than ten (10) fifteen (15) contact hours per calendar year acquired through home study and other mediated instruction may be applied toward the minimum of 20 contact hours per calendar year;

(c). A registrant who oversees or is directly engaged in the practice of sterile compounding or who practices in a pharmacy licensed pursuant to M.G.L. c. 112, § 39G or 39I, must complete at least five (5) contact hours per calendar year of continuing education in the area of sterile compounding.

(d). A registrant who oversees or is directly engaged in the practice of complex nonsterile compounding or who practices in a pharmacy licensed pursuant to M.G.L. c. 112, § 39H must complete at least three (3) contact hours per calendar year of continuing education in the area of complex non-sterile compounding.

No CEUs may be carried over from one calendar year to another.

A registrant may not earn more than eight hours of continuing education in a calendar day.

A registrant shall not be required to complete continuing education in the calendar year in which the registrant has graduated from an approved college/school of pharmacy.

Section 1 Question 1

A Number of Pharmacy Board Members Are Changed.

The governor shall appoint 13 members to the board. Members shall be residents of the commonwealth.

No person who has been convicted of a felony or other crime involving embezzlement, theft, fraud or perjury shall serve as a member of the board.

The board shall be comprised of: 8 registered pharmacists; 1 pharmacy technician; 1 representative of the public with experience in health care service delivery, administration or consumer advocacy, 1 physician registered; 1 nurse registered; and 1 expert in patient safety and quality improvement.

(b). The 8 registered pharmacists of the board shall each have had at least 7 consecutive years of experience in the practice of pharmacy and shall be currently employed in the practice of pharmacy in the commonwealth at the time of appointment or reappointment.

(c). 2 of the 8 registered pharmacist members shall be independent pharmacists employed in the independent pharmacy setting.

(d). 2 of the 8 registered pharmacist members shall be chain pharmacists employed in the chain pharmacy setting.

(e). 1 of the 8 registered pharmacist members shall have had at least 7 years of experience in a hospital setting within the commonwealth.

(f). 1 of the 8 registered pharmacist members shall have had at least 7 years of experience being employed in a long-term care pharmacy setting.

(g). 1 of the 8 registered pharmacist members shall have had at least 7 years of experience in the practice of sterile compounding and shall be engaged in sterile compounding as a routine function of the member's employment.

(h). 1 of the 8 registered pharmacist members shall be employed in an academic or scholarly position related to the practice of pharmacy with an institution of higher learning licensed by the commonwealth.

(j). the pharmacy technician member shall have had at least 7 years of practical experience as a pharmacy technician and shall be engaged in the practice of pharmacy as a routine function of the member's employment.

(n). Board members shall be appointed and shall serve for a term of 3 years. The term shall begin on the first day of the month following the member's appointment. A member whose term has expired shall continue in office until a successor is appointed.

No member shall serve more than 2 consecutive terms on the board. Members who have served the maximum number of consecutive terms shall be eligible for reappointment after not serving for at least 1 term.

Section 2 Question 9

Reporting Requirement For CII Drug Is Changed.

Each pharmacy shall submit the information in accordance with transmission methods and frequency requirements promulgated by the department; provided, however, that the information shall be submitted at least once every 15 7 days.

Section 2 Question 18 and Section 3 Question 10

Controlled Substances Reporting Requirements Are Changed.

(2).The endorsed prescription shall be retained by the proprietor of the pharmacy for a period of five years. The prescription information shall be filed electronically with the Bureau of Narcotic Enforcement, utilizing a transmission format acceptable to the Department, not later than the 15th day of the next month following the month in which the substance was delivered.

(2). The endorsed prescription shall be retained by the proprietor of the pharmacy for a period of five years. The prescription information shall be filed electronically with the Bureau of Narcotic Enforcement, utilizing a transmission format acceptable to the Department, not later than 24 hours after the substance was delivered.

A waiver allowing a pharmacy to make such filings within a longer period of time may be issued by the commissioner based upon a showing of economic hardship, technological limitations that are not reasonably within the control of the pharmacy; or other exceptional circumstance demonstrated by the pharmacy.

Such waiver and any subsequent waiver shall be applied for in the same manner and shall be subject to the same requirements as specified in Section 80.63(c)(2)(x) of this Part and, if granted, such waiver shall not provide for a filing period longer than the 15th day of the next month following the month in which the substance was delivered.

Section 1 Question 26 and Question 28

Answer explanations are updated.

Difenoxin (Lyspafen)

Dihydromorphine

Heroin (Diacetylmorphine, diamorphine)

Lysergic acid diethylamide (LSD, lysergide)

Marijuana (Cannabis, marijuana)

PB-22 and 5-Fluoro-PB-22

Mescaline

Peyote

Section 2 Question 17

Answer explanation is updated.

At the direction of the prescriber, verbal drug orders may be transmitted to the pharmacy by the prescriber's agent,including a hospice nurse, except for Schedule II drug orders.

Section 3 Question 7

Question and Explanation both are updated based on new requirement.

Which of the following statements are TRUE about continuing education requirements according to Ohio State Pharmacy Law?

I. The C.E.U.s must be obtained within a period of time that is no more than three years prior to September fifteenth of the year in which evidence of the continuing pharmacy education is required for identification card renewal.

II. At least 0.2 C.E.U.s of the total required 6 C.E.U.s must be obtained in patient or medication safety.

III. At least 3 C.E.U.s of the total required 6 C.E.U.s must be obtained in pharmacy jurisprudence.

a. I only
b. I and II only
c. II and III only
d. All

I and II only, [Ohio Administrative Code Chapter 4729 Sec.4729-7-02].

1. Continuing education unit (C.E.U.) is defined as ten contact hours of participation in an organized continuing pharmacy education experience presented by an approved provider.

2. At least 0.3 (NOT three) C.E.U.s or 3 contact hours of the total required six C.E.U.s or sixty contact hours education must be obtained in patient or medication safety.

3. At least 0.2 C.E.U. or 2 contact hours of the total required six C.E.U.s or sixty contact hours education must be obtained in pharmacy jurisprudence.

The C.E.U.s must be obtained within a period of time that is no more than three years prior to September fifteenth of the year in which evidence of the continuing pharmacy education is required for identification card renewal.

For the first four C.E.U. reporting years following the adoption of this rule (2014, 2015, 2016 and 2017), the board may accept C.E.U.s within a period of time from March first, three years prior to September fifteenth of the year in which evidence of the continuing pharmacy education is required for identification card renewal.

4. C.E.U.s obtained in excess of the required C.E.U.s at the time the continuing education is required for identification card renewal may not be transferred and applied to future requirements.

5. A pharmacist whose identification card has lapsed or has been suspended may renew his/her identification card by paying the required fee, completing the application for renewal, and, if requested, by providing evidence of having obtained the number of C.E.U.s required at the time of renewal by submitting the certificates of participation obtained during the three-year period immediately preceding the date of applying for renewal.

6. Registered pharmacists shall keep all certificates and other documented evidence of participation that have been issued for approved C.E.U.s for which the pharmacist has claimed continuing education units towards renewal of his/her Ohio registered pharmacist identification card for a period of one year following the year in which evidence was required for renewal.

Section 4 Question 3

Explanation is updated.

(A). Jurisprudence continuing education programs shall:

(1). Be any A.C.P.E. law program as identified by A.C.P.E. numbering convention "03"; OR

(2). If provided by an in-state provider of continuing education, be approved by the state board of pharmacy.

Section 5 Question 20

Explanation Paragraph (E) is updated.

(E). If a pharmacy or prescriber ceases to possess for the purpose of dispensing or personally furnishing any reported drug (including a sample drug), the responsible person shall notify the board of pharmacy electronically or in writing.

Section 5 Question 22

The Question answer and answer explanation are updated.

What changes may a pharmacist make to a prescription written for a controlled substance in schedule II after verbally consulting with a practitioner?

I. The dosage form of the drug
II. The name of the controlled substance
III. The quantity prescribed

a. I only
b. II only
c. III only
d. All of the above

Answer: d, All of the above. All of the above, [Oregon Pharmacy Board News Letter February 2015].

The compliance department continues to address the common inquiry: What can be changed on a Schedule II prescription without requiring a follow-up hard copy from the prescriber?

As this is not specifically contemplated in the Code of Federal Regulations, the answer may vary depending upon the state in which you practice.

In Oregon, any and all changes must be coordinated in a conversation with the prescriber directly, and the pharmacist must document the authorized change(s) granted by the prescriber.

This means that another person, such as an on-call practitioner, cannot make changes without furnishing a new hard copy.

Changes can be made to:

a. the strength,
b. dosage form, date, quantity, and directions.

Changes cannot be made to the patient name, prescriber name, or drug entity (or chemical) prescribed. A pharmacist may also add information, such as the date-to-fill, as that is considered part of the directions.

Here is an example: If a prescription is originally written for OxyContin® 20 mg, BID, #60, it can be changed verbally to oxycodone 5 mg, QID, #120 or to oxycodone/APAP 5/325 mg. However, if the prescriber prefers to change it to MS Contin®, then he or she must furnish a new hard copy prescription to the pharmacy, pursuant to federal regulations.

Section 4 Question 25

The answer and answer explanation are updated.

I and II only changed to All.

(1). In accordance with guidelines of the Centers for Disease Control and Prevention for each recommended immunization or vaccine, a pharmacist, or a registered intern under the supervision of a pharmacist who is certified, may administer the following vaccines to an adult within the framework of an established protocol under a supervising physician licensed:

(a). Immunizations or vaccines listed in the Adult Immunization Schedule as of February 1, 2015, by the United States Centers for Disease Control and Prevention. The board may authorize, by rule, additional immunizations or vaccines as they are added to the Adult Immunization Schedule.

(b). Immunizations or vaccines recommended by the United States Centers for Disease Control and Prevention for international travel as of July 1, 2015.

The board may authorize, by rule, additional immunizations or vaccines as they are recommended by the United States Centers for Disease Control and Prevention for international travel.

(c). Immunizations or vaccines approved by the board in response to a state of emergency declared by the Governor pursuant to s. 252.36.

A registered intern who administers an immunization or vaccine under this subsection must be supervised by a certified pharmacist at a ratio of one pharmacist to one registered intern.

(2). In order to address any unforeseen allergic reaction, a pharmacist may administer epinephrine using an autoinjector delivery system within the framework of an established protocol under a supervising physician.

(3). A pharmacist may not enter into a protocol unless he or she maintains at least $200,000 of professional liability insurance and has completed training in administering vaccines authorized under this section.

(4). A pharmacist administering vaccines under this section shall maintain and make available patient records for a minimum of 5 years.

(5). Any pharmacist or registered intern seeking to administer vaccines to adults under this section must be certified to administer such vaccines pursuant to a certification program approved by the Board of Pharmacy in consultation with the Board of Medicine and the Board of Osteopathic Medicine.

The certification program shall, at a minimum, require that the pharmacist attend at least 20 hours of continuing education classes approved by the board and the registered intern complete at least 20 hours of coursework approved by the board.

(6). The pharmacist shall submit to the Board of Pharmacy a copy of his or her protocol or written agreement to administer vaccines under this section.

Section 2 Question 21

The answer explanation is updated.

The following drugs are classified under the Pregnancy Category-X.

1. Isotretinoin (Accutane)

2. Tetracycline

3. Chloramphenicol

4. HMG-COA inhibitors (Statins)

5. Misoprostol (Cytotec)

6. Finasteride (Proscar, Propecia)

7. Methimazole (Tapazole)

8. Warfarin (Coumadin)

9. Metronidazole

10. Valproic acid (Depakene, Depakote)

11. Lithium carbonate (Lithobid)

12. Alcohol

Section 1 Question 6

The answer should be 'False".

Section 2 Question 17. The answer explanation is updated.

A pharmacist shall determine the number of pharmacy interns, pharmacy technicians, and pharmacy technician trainees he can safely and competently supervise at one time; however, no pharmacist shall supervise more than four persons acting as pharmacy technicians at one time.

If a pharmacist declines to fill a prescription for any reason other than the unavailability of the drug prescribed, he shall record on the back of the prescription the word "declined"; the name, address, and telephone number of the pharmacy; the date filling of the prescription was declined; and the signature of the pharmacist.

Section 2 Question 25. The question is rephrased.

Which of the following information about reactivating or reinstating a pharmacist license to active status is/are TRUE?

I. A pharmacist whose license has been lapsed for less than 5 years must submit evidence of completion of 60 hours of CE.

II. A pharmacist whose license has been lapsed for more than 5 years must submit evidence of completion of 60 hours of CE.

III. A pharmacist whose license has been lapsed for more than 5 years must take and receive a passing score on the board-approved law examination.

A pharmacist whose license has been lapsed for more than 5 years must submit evidence of completion of 60 hours of CE and take and receive a passing score on the board-approved law examination.

Answer: True or False.

Section 3 Question 27

The answer should be 'True".