Q. What types of
signatures are permissible on a written prescription order in Wisconsin?
A. Where any written, typed
or computer generated prescription order contains only the practitioner's
printed or stamped name, a strict reading of s. 450.11 (1), Stats.,
would render the order invalid as a written order. When faced with
such a prescription order the pharmacist's options would be either
to reject the order or contact the practitioner and verify the prescription
information on the order in the same manner as if an oral order had
been telephoned in to the pharmacist.
Stamping written prescription
orders with a practitioner's signature would not meet the requirements
of s. 450.11 (1), Stats., even where a nurse or other authorized person
initials the stamped signature. Wis. Stats. § 990.01 (38), provides
in part, “If the signature of any person is required by law it shall
always be the handwriting of such person…or subject to any applicable
requirements under subch. II of ch. 137, the electronic signature
of the person.” Therefore, either the practitioner's or delegate's
handwritten signature would be necessary to appear on a valid written
prescription order.
Examples:
· Written prescriptions
“signed” with prescriber's signature stamp. No agent's initials or
signature. Conclusion: Invalid.
· Written prescriptions
“signed” with prescriber's signature stamp. Agent's initials included.
Conclusion: Invalid.
· Written prescriptions
“signed” with prescriber's signature stamp. Agent's signature included.
Conclusion: Valid, if the agent was delegated the power to sign
under Wis. Adm. Code chapter Med 17, and Wis. Stats. Sec. 448.03 (2)(e).
The prescriber's stamp does not satisfy the requirement of a written
signature, rather the valid written signature is that of the delegate.
The prescriber's stamp only indicates the identity of the delegating
prescriber.
· Written prescription
“signed” with prescriber's name by agent. No agent's initials or signature.
Conclusion: Invalid.
· Written prescription
“signed” with prescriber's name by agent. Agent's initials included.
Conclusion: Invalid.
· Written prescription
“signed” with prescriber's name by agent. Agent's signature included.
Conclusion: Valid, if the agent was delegated the power to sign
under Wis. Adm. Code chapter Med 17. However, the prescriber's “signature”
is surplusage.
· Faxed prescriptions
must meet the same requirements as written prescription orders and
therefore the same analysis and outcomes indicated above would apply.
Wis. Admin. Code Phar 8.12 (1)(a).
Q. How many days
supply of a controlled substance may be dispensed at one time?
A. As of August 1, 2002
, the PEB revised Wis. Admin. Code § Phar 8.05, the dispensing
requirements for controlled substances, removing the 7-day date limitation
on schedule II controlled substances prescriptions and eliminating
the 34-day dispensing quantity limitation on all controlled substances.
The repeal of these sections of Phar 8.05 is intended to allow practitioners
and pharmacists to more fully exercise their professional judgment
in prescribing and dispensing controlled substances. This is consistent
with federal controlled substances prescription rules which have no
date or days supply restrictions.
The state requirement that
a schedule II controlled substance prescription may not be dispensed
more than 60 days after the date of issue still remains.
Q. Can prescriptions
be transferred more than once in Wisconsin?
A. Prescriptions for non-controlled
prescription drugs can be transferred from one pharmacy to another
indefinitely providing that refill authorizations exist and the transfers
are properly recorded as required in Phar Chapter 7.
However, there are restrictions
for controlled substances. A pharmacy may transfer prescription
information for the purpose of refilling a prescription order for
a controlled substance listed on Schedules III-V only in accordance
with the limitations placed on such transfers by the Drug Enforcement
Administration (DEA) and Phar Chapter 7. The transfer
of original prescription order information for the purpose of renewal
dispensing of a controlled substance is permissible between 2 pharmacies
only on a one-time basis, unless the pharmacies have access to a common
central processing unit and prior written approval is received from
the board.
Q. Can a pharmacist
dispense a prescription order for methadone?
A. Methadone can be dispensed
by a pharmacist pursuant to a prescription issued for analgesic purposes,
similar to any other controlled substance.
Note however, federal regulations
do not permit the prescribing of methadone for purposes of detoxifying
or maintaining a narcotic addict. Prescriptions issued for this purpose
are illegal and do not authorize pharmacists to dispense methadone
for these purposes. The federal regulations require that methadone
may only be administered for these purposes by drug treatment programs
approved by the FDA (21CFR 1306.07). 21 CFR 1306.04 (Purpose of issue
of prescription) provides that "a prescription may not be issued
for the purpose of dispensing of narcotic drugs in any schedule for
detoxification treatment" or "maintenance treatment".
Pharmacists practicing in
community pharmacies have received prescriptions in which it was obvious
that the prescriber was attempting to provide "detoxification
treatment" for a patient who has become dependent on morphine-like
drugs. These prescriptions are not valid and controlled substances
should not be dispensed under these circumstances. The pharmacist
needs to contact the physician to inquire about their intent and to
inform them about federal regulations governing the use of narcotics
to detoxify a patient.
Q. Can a pharmacist
fill or refill a prescription order for an out-of-state prescriber?
A. Yes, Wisconsin pharmacies
may legally fill or refill prescription orders from practitioners
practicing in another state, if they are licensed in another state
and recognized by Wisconsin as a person authorized to prescribe and
administer drugs. This includes prescription orders for a controlled
substance in Schedule II, III or IV. However, prescription orders
for a medication in controlled substance Schedule II, III, and IV
are only valid for practitioners having a current federal drug enforcement
registration number. A pharmacist should inquire further regarding
a practitioner's authority to prescribe if the pharmacist, using professional
judgment, is concerned that the prescription order might not be valid.
Pseudoephedrine
Regulations
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