Board News & Announcements

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THURSDAY, SEPTEMBER 2, 2010

IMPORTANT INFORMATION FOR PHARMACISTS CONCERNING HURRICANE EARL. As the Outer Banks area braces for a brush with Hurricane Earl, some important reminders for pharmacists.

First, remember your authority under Rule .1815, which states that if a pharmacist is unable to obtain refill authorization due the prescriber’s “inability to provide medical services” (often the case in the wake of a natural disaster), then the pharmacist may provide a one-time 90-day refill to the patient so long as:

(1) The prescription is not for a Schedule II controlled substance;
(2) The medication is essential to the maintenance of life or to the continuation of therapy in a chronic condition;
(3) In the pharmacist's or permit holder's professional judgment, the interruption of therapy might reasonably produce undesirable health consequences;
(4) The dispensing pharmacist or permit holder creates a written order entered in the pharmacy's automated data processing system containing all of the prescription information required by Section .2300 of these Rules and signs that order;
(5) The dispensing pharmacist or permit holder notifies, or makes a good faith attempt to notify, the prescriber or the prescriber's office of the emergency dispensing within 72 hours after such dispensing.

Second, under North Carolina insurance law (NCGS § 58-3-228), health benefit plans must have in place a procedure to “waive time restrictions on filling or refilling prescriptions for medication” including “waiver or override of electronic ‘refill too soon’ edits to pharmacies and shall include provision for payment to the pharmacy in accordance with the prescription benefit plan and applicable pharmacy provider agreement” so that a patient my obtain a refill and/or replacement prescription when, among other things, a patient lives in an area that is “declared to be under a state of emergency in a proclamation issued by the Governor.” Governor Perdue has issued such proclamation.

Third, pharmacist managers are required to “prepare a plan to safeguard prescription records and pharmaceuticals and minimize the interruption of pharmacy services in the event of a natural disaster such as hurricane or flood.” All pharmacist managers located within the areas that may be affected by Hurricane Earl should implement those plans.

WEDNESDAY, SEPTEMBER 1, 2010

Pharmacists are reminded that all licensees shall give the Board notice of a change of mailing address or a place of employment within 30 days after the change (90.85.17).

Again this year, the NC Board of Pharmacy will utilize electronic renewal of licenses. Pharmacists who have not notified Board staff of current employment information will not be allowed to renew. At any time during the year you may update your employment information by completing the Pharmacist Change of Employment Notification Form. Please note, if you are UNEMPLOYED or RETIRED, you still must notify the board staff of your status.

In addition, your street address is now a required field. The system will not allow renewal of your 2011 license unless you provide a street address. Please note you will still be allowed to enter a P.O. Box as your mailing address. You may update your Residential address here: https://www.ncbop1.org/NCBOPCE.

It is your responsibility to make sure the NC Board of Pharmacy always has a current home and business address on file for you. Please check your file and make sure your addresses are current before the renewal period begins.

WEDNESDAY, SEPTEMBER 1, 2010

“Pharmacy Law Update for Pharmacists and Technicians”
NC Board of Pharmacy Executive Director Jay Campbell will present a Pharmacy Law Update on October 26, 2010. The one-hour, ACPE-approved presentation will occur at the North Carolina Association of Pharmacists Annual Convention being held October 24-26 at the Sheraton Imperial in Research Triangle Park, NC.

"Immunization Update" CE Opportunity for Immunizing Pharmacists
In conjunction with the NCAP Convention, an Immunization Update will be held from 2:30 to 6:00 pm at the Sheraton Imperial in Research Triangle Park, NC.

For more information about these and other CE opportunities visit http://www.ncpharmacists.org

MONDAY, AUGUST 30, 2010

CONTINUING UPDATE ON ELECTRONIC PRESCRIPTIONS FOR CONTROLLED SUBSTANCES.

Board staff continues to receive many inquiries concerning electronic prescriptions for controlled substances (CSERx). By way of recap:

The DEA issued a CSERx rule that was “effective” earlier this year. As noted in prior updates, however, the rule is “effective” only in the academic sense. That rule requires any system that either transmits or receives CSERx to be “certified” as meeting DEA’s security and control standards in the CSERx rule. As of today DEA has not certified any transmitting or receiving system as meeting these security standards. Accordingly, CSERx’s still do not meet federal law requirements. Much more information about the rule and its operation may be found here: http://www.ncbop.org/faqs/Pharmacist/ControlledSubstanceE-RXFAQsApr2010.pdf. The DEA has published FAQ guidance on CSERx, which is found here: http://www.deadiversion.usdoj.gov/ecomm/e_rx/index.html#faq.

So where does that leave everyone? Basically, at the same place we’ve been all along. Any electronically signed prescription for a controlled substance does not satisfy federal law at this time. DEA has also stated clearly (see the DEA FAQ link above) that prescribers may not print out or print out and fax a prescription for a controlled substance that is electronically signed. Rather, the practitioner may print or print/fax a controlled substance prescription that they have actually signed (with the exception of C-II prescriptions, which may be faxed only for residents of long-term care facilities or for terminally ill patients). A pharmacist who receives an electronic prescription for a Schedule III, IV, or V medication may call the prescriber, confirm the prescription, and treat it as a verbal order.

Board staff is aware that a number of physicians and physician office managers have insisted – often vehemently – that electronic prescriptions for controlled substances are allowable. This insistence, however well intentioned, is simply not correct. Board staff has asked that the North Carolina Medical Board communicate this information to their licensees to clear up confusion.

Unquestionably, the state of being for CSERx is one that is frustrating and confusing. Let’s all hope that the DEA will – and will quickly – certify some CSERx prescribing systems. In the meantime, Board staff encourages pharmacists and prescribers to communicate with their electronic prescribing system vendors about those vendors’ efforts to become certified. Those wishing to register complaints about the implementation – or lack thereof – of the CSERx rule should contact the DEA. Board staff will continue to provide updates on this issue.

FRIDAY, AUGUST 13, 2010

ACCESS NAPLEX & MPJE SCORE RESULTS ONLINE

NABP has implemented the functionality to provide scores to North Carolina NAPLEX and MPJE candidates. Simply click on the link below to go to the explanatory page and then click the login link on that page to enter your name, the last 4 digits of your SSN and your DOB to access scores:

http://www.nabp.net/programs/examination/naplex/naplex-and-mpje-score-results

TUESDAY, JULY 6, 2010

ANOTHER ROUND OF PRESCRIPTIONS FROM FLORIDA “PAIN CLINICS” SWEEPING THROUGH NORTH CAROLINA

Board staff has received numerous telephone calls regarding another wave of questionable prescriptions for various controlled substances (particularly oxycodone and hydrocodone products). These prescriptions typically purport to come Florida-based “pain clinics”. Patients presenting these prescriptions often provide identification showing they are Tennessee residents. Pharmacists attempting to verify the prescriptions with a prescriber often reach "office staff" who state that the prescription is legitimate.

Some of the prescriptions appear to have the drug name pre-printed on the prescription which is illegal in North Carolina. On other prescriptions, the name of the drug appears to have been stamped on the blank along with quantity and directions for use.

Pharmacists are strongly advised to exercise their professional judgment when presented with such prescriptions. Most, if not all, bear all the hallmarks of being issued without a legitimate patient-prescriber relationship and/or for reasons outside the usual course of medical practice. Under both North Carolina and federal law, pharmacists have a duty to exercise reasonable diligence and care to avoid dispensing a prescription that is not issued for a legitimate medical purpose in the ordinary course of medical practice.

NEW CE OPPORTUNITIES FOR 2010: PHARMACISTS & TECHNICIANS, Remember to check our CE page often for upcoming CE programs in your area. (LAST UPDATED SEPTEMBER 1, 2010.)

MONDAY, JUNE 21, 2010

UPDATE ON TECHNICIAN RULEMAKING. As many pharmacists are aware, the Board proposed and adopted a rule that would allow pharmacy technicians working in an acute-care hospital environment and holding an associate’s degree in pharmacy technology to take on additional duties and provide greater assistance to pharmacists in the areas of unit-dose packaging and certain unit-, cart-, and floor-stocking. The Board adopted the rule at its May 2010 meeting. The North Carolina Rules Review Commission then raised objections to the rule. At its June 17, 2010 meeting, the RRC determined that the Board had overcome all of those objections. Ordinarily, the new rule would take effect. In this instance, however, approximately ten people have written to the RRC expressing objections to the rule and requested legislative review of its terms. Therefore, by operation of state law, the rule – though adopted by the Board and cleared by the RRC – cannot become effective until the North Carolina General Assembly has had a certain number of days in which to introduce a bill to nullify the rule should any legislator desire to do so. Because this year’s legislature is a “short session”, it is unlikely that the requisite number of days will pass before the General Assembly adjourns. Accordingly, it is likely that this rule will remain in “limbo” until the General Assembly reconvenes in 2011, and the rule is unlikely to become operative until March 2011 (assuming that no bill is introduced to nullify the rule). Board staff is aware that this delay may pose a hardship for students who completed associate’s degrees in pharmacy technology at several North Carolina community colleges this May. Operation of state law, however, makes this result unavoidable. Board staff will continue to update pharmacists on this issue as more information becomes available.

FRIDAY, JUNE 18, 2010

FURTHER UPDATE ON ELECTRONIC PRESCRIPTIONS FOR CONTROLLED SUBSTANCES. In response to the Wednesday, June 16 update on this website concerning implementation of the DEA’s electronic prescribing rule, Board staff has received numerous calls and emails alternatively praising or condemning (mostly the latter) the “Board’s decision to disallow electronic controlled substance prescriptions.” These communications fundamentally misunderstand the update. The Board of Pharmacy has not issued any decision “disallowing” electronic controlled substance prescriptions. Rather, the update alerted pharmacists that the new DEA rule requires software systems for sending and receiving controlled substances to be “certified” by a “third-party auditor” as meeting the DEA rule’s security standards. DEA has not, to date, certified any such systems or identified any auditor that will be allowed to issue the certifications. Therefore, according to the DEA, no electronic prescriptions for controlled substances can be issued at this time.

Some correspondents to Board staff have complained about the Board’s failure to certify e-prescribing systems. Please note that the Board has no authority under the DEA’s rule to certify systems. Rather, as discussed the Board’s FAQ on the DEA rule (http://www.ncbop.org/faqs/Pharmacist/ControlledSubstanceE-RXFAQsApr2010.pdf), pharmacists and prescribers should contact their software vendors to inquire about certification status. Pharmacists and others who would like to communicate their feelings on the status of the DEA’s rule may contact the DEA’s Greensboro office at (336) 547-4219. In the meantime, Board staff will continue to communicate updates on the DEA’s rule as often as it receives them.

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The North Carolina Board of Pharmacy's mission is to protect the public health, safety and welfare in pharmaceutical matters. The Board sets standards for academic and practical experience programs prior to licensure, issues permits to operate pharmacies and DME facilities, and annually renews licenses, permits and registrations.

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