CONSUMER
QUESTIONS
PHARMACY
PRACTICE
INTERNSHIP
Q:
How do I file for internship?
A:
Complete and submit the “FAQ
for Pharmacy Internship” form.
Q:
How do I file for foreign graduate internship?
A:
Complete and submit the “Foreign
Graduate Information” form.
For
other FAQ's regarding Wisconsin Pharmacy Internship Program, click here.
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CONSUMER
QUESTIONS
Q:
What types of electronic signatures are permissible in Wisconsin for
an electronically transmitted prescription order?
A:
The pharmacy may maintain a practitioner signature file for comparison
where a computer generated facsimile signature is affixed. By pre-agreement
with the pharmacist a practitioner may place a signature on file for
comparison.
The
pharmacy may maintain a code or name file from practitioners wishing
to use electronic transmission utilizing a signature that is a printed
practitioner name, alpha numeric string or other numbering system for
validation, but not constituting public key infrastructure. The signature,
in whatever form, cannot be affixed by default, rather the practitioner
must perform an affirmative act to affix the signature, contemporaneously
with the electronic transmittal of the prescription order. Vendors of
such systems can assist the acceptance process by educating practitioners
to contact a pharmacy prior to using such systems in order to obtain
agreement regarding, (a) form and content of the order, (b) assuring
the pharmacist of the non default application of a signature for the
system used, and; (c) any other security measures used with the electronic
transmission system. A public key infrastructure system could certainly
be used by agreement but is not required.
IMPORTANT
REMINDER - The DEA does not currently allow the electronic transmission
of a prescription orders for controlled substances. A practitioner must
continue to follow the current requirement of orally communicating the
prescription order to a pharmacist for a schedule III-V controlled substance
where a written order is neither manually signed by the practitioner
and faxed to the pharmacy or provided directly to the patient. An unsigned
fax prescription order for a schedule III-V controlled substance sent
by a practitioner to the pharmacy will require a return telephone call
by the pharmacist to the practitioner to verify the order, in similar
manner to receiving an oral order.
Q.
Does the pharmacist have to talk to a patient about prescription medication
being dispensed?
A.
The pharmacist is required to talk to a patient about all new and refill
prescription medication prior to giving the patient the medication.
This is called patient counseling and is very important.
The
patient should know the answers to at least the following questions
before taking prescription medications:
1.
What is the name of the medicine and what is it supposed to do?
2.
How and when do I take it and for how long?
3.
What do I do if I forget to take my medicine?
4.
Are there any side effects, and what do I do if they occur?
5.
Is there any written information available about the medicine?
Q.
Can the pharmacy refuse to take back prescription medication?
A.
Yes, the pharmacy is not required by law to take back prescriptions
that have been dispensed.
Q.
Can the pharmacist give out a patient's personal health care records
or information?
A.
Wisconsin and federal law places requirements on what information can
be released. In most cases, the patient must approve the release of
personal health care records or information contained in them. A pharmacist
may contact another health care provider, such as the patient's treating
practitioner, without the patient's consent, regarding the patient's
health care. A pharmacist can also in good faith provide another health
care professional with information concerning a violation of pharmacy
law or the controlled substances act. Records can also be obtained without
the patient's consent by a court order, or the written request of a
state or federal agency. A patient has a right to receive a copy of
their health care records upon request.
Q.
Can a patient receive more than a 30 day supply of a controlled substance?
A.
Yes. Often a patient will need to discuss this issue with their insurance
provider who may have limits regarding the amount that can be dispensed
at any one time. However, Wisconsin law does not restrict the amount
that may be dispensed.
Q.
Can a patient receive assistance from a pharmacist in repackaging medications
to better allow the patient or a caregiver to manage their medication
administration? Even if that pharmacist never dispensed the medication
originally?
A.
Yes, a pharmacist may assist a patient in meeting the patient's need
to manage health care. Depending on the circumstances, many options
are available that a pharmacist may recommend to better meet a patient's
need. Using professional judgment, a pharmacist may determine when,
if and how certain repackaging may be appropriate. The pharmacist may
also need to speak with the practitioner that originally prescribed
the medication to verify certain details. Sometimes, however, if the
pharmacist cannot determine certain information regarding directions
for use, or other needed information, the pharmacist may decline to
repackage medications if it might be unsafe for the patient. Also,
other state law may apply which will determine when or how medication
may be repackaged. Certain patients in long term care facilities and
community based residential facilities will need to discuss with their
pharmacist any applicable rules of the Department of Health and Family
Services which affect repackaging.
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PHARMACY
PRACTICE
Q.
Does Wisconsin require out of state
pharmacies to be licensed to dispense in Wisconsin?
A.
Yes. A Wisconsin pharmacy license must be obtained by pharmacies licensed
in another state which dispense prescription medications, including
schedule II controlled substances, by mail or other delivery to patients
in this state. .
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 substances. However, prescription orders for
controlled substances 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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