1. The Prescription The pharmacy technician is often the first person to examine the patient’s prescription for completeness and other issues. Due to this it is very important that a pharmacy technicians understands the basic elements of the prescription to save time and to ensure customer satisfaction. This is probably the technician’s primary function in the retail setting.

2. The Elements of the Prescription Patient’s name Prescriber’s name, address and phone. Date it was written Name, strength, and quantity of drug Directions for use (sig) Signature of the prescriber (very important) Route of administration Refills

3. Controlled Substance Prescription In addition to the above elements, the following is required as well: Patient’s and Prescriber’s address Prescriber’s DEA number Date written

4. Anatomy of a Prescription Dr. John Doe, MD 55 5 th Street Anywhere, NY 11379 718-555-000 Lic: 1234567 NPI: 76543211112 DEA: BD1234567 ____________________________________________________________________________ Patient: Mary Jane Date of Birth: 01/01/1971 Address: 56 th street Anywhere NY 11379 Age: 44 Date written: 02/22/2015 Lopressor 50 mg tablets Sig: 1 Tab PO BID Dispense: 60 Signature: _________________________ ____________________________________________________________________________ Maximum day supply Dispense as written Serial barcode (used for many state PMP) Pharmacist Test Area Prescriber’s name required by law Address and phone required by federal law for controlled substances Patient’s name required by law Address required by federal law for controlled substances Prescriber’s state license number (LIC) NPI = required for payment by CMS DEA = required by federal law for prescriptions MMIS= Medicaid number that shows a prescriber is enrolled in medicaid (optional) Date is required for controlled substance Rx Drug Name, strength Sig: # of doses, route, frequency Dispense qnty or “day supply” Signature of Prescriber is required to be a valid prescription Required day supply for controll drugs Prescriber indicate here if he/she wants brand Thermochrome for testing validity

5. Probably the most important element on the prescription is the signature of the prescriber. Whether electronic or hard copy the signature must be there for the prescription to be valid. In NYS, according to article 137 of the education law 6802 electronic prescriptions are allowed in NYS. An electronic prescription is a prescription that is created and generated by the prescriber and sent electronically (E prescribing). Prescriptions for controlled substances are not permitted to be electronically generated in NYS; however under federal law CII-CV can be sent electronically. Section 6810 states that in addition to the signature, the stamped or imprint name of the prescriber must be on the prescription

6. In NYS, the pharmacist is permitted to clarify and enter data on the prescription to include all information with the exception of the signature. If a prescription is filled without the signature the pharmacist will be guilty of professional misconduct under Part 29.7 of the board of regents. In addition, the date can’t be added on an Rx for a controlled substance If the patient’s information and/or the prescriber’s information is readily retrievable in the pharmacy computerized records, the physical presence of this information on the prescription is not necessary The face of the prescription must be signed or initialed by the pharmacist with the date filled; refills must be documented on the back with the date filled along with the Pharmacist’s initials. Records of refills may be stored electronically (NYS) Remember, CII can’t be refilled. CIII can be refilled 5 times or 6 months CIV and CV for 11 refills or one year.

7. Prescription Elements Continued Other elements on the prescription may include Prescriber’s license number and registration number Prescriber’s DEA number (required to write a controlled substance prescription) Prescriber’s NPI or national provider’s identification number.

8. NPI numbers The NPI is a ten digit number that was created by HIPAA act of 1996. The NPI is a unique identifier that is used by CMS to identify healthcare providers for the purposes of administrative issues and reimbursements. Often other third party payers utilize this number to file claims and payments to pharmacies. Often an adjudication is denied because of lack of prescriber’s NPI. The NPI for various providers can be found at: https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forwa rd=static.npistart

9. Who can write prescriptions? MD NP DO DVM DPM Ophthalmologists DDS PA Physician’s assistants can in general write for prescriptions so long as their primary supervising physician name, address, and registration number is on the prescription. Often the PA will use his/her physician’s prescription blank so long as the PA signs the Rx and stamps his/her name on it with his registration number. Physician Assistants, as of 2007, can write for prescriptions for CII and other scheduled drugs. In this case he/she would use his own Rx blanks with their own DEA numbers.

10. Filing Prescriptions Most states require hard copy Rx to be stored for a 5 year period. Further federal regulations require that controlled substance Rx’s be filed in such a way as to be easily retrievable by law enforcement. Option 1: three separate cabinets for CII, CIII-CV, and other legend Rxs. Option 2: two drawer system: CII-CV with CIII-CV marked with a red “C” in the lower right corner in one drawer and all other prescription in second file. Option 3: CII in one file with CIII-CV/other legend drugs in second file. CIII-CV must have red C in lower right corner

11. Prescription Transfers A refill(s) may be transferred from one pharmacy to another either in the same state or different states. A pharmacist is to handle Rx transfers. Federal law permits the transfer of all the refills on a prescription provided that amount transferred does not exceed the total number of refills remaining. The pharmacist that transfers the refills must do the following documentation: Document the pharmacist he/she spoke with Name, address, DEA, and the NABP# of the pharmacy transferred to VOID that original prescription The receiving pharmacist must document: Pharmacist spoken with Name, address, DEA, NABP# of the pharmacy transferred from All the information on the original prescription with the old pharmacy Rx number Must write “TRANSFER” on the face of the prescription Federal Law allows transfer of controlled substance Rx in schedules III-V on a one time basis

12. Federal Law on Retail Prescription Federal law provides many means for prescribers to issues prescriptions Written Electronic Fax Telephone Fax copies of C3-C5 are acceptable as original (remember state law may be stricter) Controlled Substance Rx: Federal law C2 No fax as original (exceptions: LTCF, Hospice, Infusion centers) 30 days only No refill Partial fill ok with remainder to be fill in 72 hours. If can’t fill balance in 72 hours, the balance is voided. (exception is LTCF or terminal ill patient) If Patient requests a partial fill; the balance cannot be fill later; the balance is void

13. CIII-CIV 30 days only maximum 5 refills or 6 months life CV (Federal Law) Codeine containing cough syrup must be combined with other med and be no more than 2 mg/ml codeine opiates in small amounts combined with a noxious drug to prevent abuse (diphenoxylate 2.5 mg/Atropine 0.0025 mg) Depending on state law can be dispensed without a prescription Patient must be 18 or older Sale by pharmacist mandatory Log book maintained Max of 120 ml in 48 hours of a codeine containing product or 24 dose units per 48 hours per patient of solid dosage products Oral Controlled Substances (Federal Law) Permitted on CIII-CV CII emergency oral Rx For the emergency period only ( 5 days in NY) Must reduce to writing by pharmacist No alternative available 72 hours MD must deliver hard copy Must know prescriber in good faith If any are in question, can and should refuse to fill

14. Exceptions to the 30 day rule for controlled substance prescriptions With certain medical conditions many states have laws permitted greater than 30 day filling of Rx Code A= panic disorders Code B= ADHD Code C= neurologically (seizures) Code D= Pain relief in incurable conditions If a patient is a resident in a LTCF or a terminally ill patient then a CII prescription may be filled for up to 60 days.

15. Medication Orders in the Hospital An order usually contains patient name, DOB, and MRN. Patient’s Diagnosis, Allergies, Location in Hospital Patient’s height and Weight Date and hour the order is written. Name of Drug, dose, frequency and if routine, STAT or PRN. Route Name of the prescriber and the pager Can be a paper order sent to the pharmacy or an order entered into a CPOE.

16. Depending on State Law, a physician or other prescriber may call in a verbal order to the institution’s pharmacy as an emergency measure. This is called a Emergency Verbal Order This is called to help speed up the processing of the medication Example: Alteplase Injection. 100 mg/100 ml of Sterile water for injection. IV infusion over a 60 minute hang time A written order is followed up

17. Types of Institutional Medication Orders Routine orders- Daily order that are order on an ongoing basis. Example: Enalapril 10 mg Daily STAT orders- orders that are needed as an emergency measure. i.e. Dilitiazem 5 mg IVP X 1 PRN- as needed order- ordered as per patient request i.e. Percocet 1-2 tablets q4h PRN for pain

18. Intravenous Medication Labeling Labeling rules are governed by the state, non governmental agencies guidelines (JCAOH, USP797) Include the following: Patient’s name, location in institution, MRN Drug and strength Base fluid IV Route type: IVPB, CI (continuous infusion), or IVP The intended time of administration of drug Rate of administration if LVP (or hang time if SVP) Prep by field and Verified by field Product expiration field In addition a nursing label may be attached detailing: When product was “hung” (i.e. started) By whom the product was hung

19. Sample IV Label LaGuardia College Hospital 32 Thomson Ave Long Island City, N.Y 11345 Name: John DoeMRN: 1234567 Location: CICUBed: 2 Amiodarone 450 mg In: D5W 250 ml Continuous Infusion Administration time: 03/15/2015 19:00 Rate of Infusion: 33 ml/hr Prep by:____ Verified by:______ Expiration : 03/16/15 18:00

20. Sample IV Label II LaGuardia College Hospital 32 Thomson Ave Long Island City, N.Y 11345 Name: John DoeMRN: 1234567 Location: CICUBed: 2 Ceftriaxone 1,000 mg In: D5W 50 ml IVPB Administration time: 03/15/2015 19:00 Hang Time: 15 minutes Prep by:____ Verified by:______ Expiration : 03/16/15 18:00