Pharmacist FAQsFrequently Asked Questions for Pharmacists on Electronic Prescriptions Q: May a prescriber electronically transmit a prescription for a controlled substance? A: Electronic prescribing is an increasing fact of life in pharmacy practice today. Many pharmacists are confused, though, about whether or not and under what circumstances e-prescribing is permissible for The Board understands that DEA continues to take the position that e-prescribing for Schedule II substances is never appropriate. 21 C.F.R. 1306.05. Federal law permits faxing of Schedule II prescriptions in limited circumstances (such as for residents of long-term care facilities and hospices). But beyond these narrow cases, e-prescriptions for Schedule II substances are prohibited. These positions may change in the coming months. DEA has for a number of years pledged to take a fresh look at e-prescribing issues, with no visible result. Medicare Part D, however, specifically directs Centers for Medicare and Medicaid Services (CMS) to develop uniform standards for e-prescribing, a practice that the statute encourages as a potential cost-savings and patient safety improvement. CMS and DEA have jointly noticed a conference among their agencies to discuss e-prescribing issues as they relate to CS. It seems almost certain that DEA will be forced to critically reevaluate its position on these issues. -------------------------------------------------------------------------------- Q: Are Internet prescriptions legal? A: The Board of Pharmacy has a Rule, which allows the transmission of prescription orders electronically. It can be found at 21 NCAC 46.1813. It is up to the Pharmacist to determine the legitimacy of each prescription, which arrives in the Pharmacy. One important consideration is the Board’s Rule on prescription orders, 21 NCAC 46.1801(b). Please note that the Rule specifically provides that a Pharmacist shall not fill or refill a prescription if the order was produced from a prescriber without a prior prescriber-patient relationship or without a physical examination. This concept was taken from a policy from the North Carolina Medical Board, which has disciplined physicians for prescribing over the Internet without a prior relationship or physical examination. Both Pharmacists and Physicians have been disciplined for violation of this concept. -------------------------------------------------------------------------------- Q: Can prescriptions be transmitted electronically? A: Board rule at Section .1813 provides that prescriptions may be transmitted electronically. Part of that rule specifies that an electronic signature is acceptable for this kind if transaction. A graphical representation of the prescriber's signature is sufficient to satisfy this rule. But it is not necessary. It is enough that the prescription contains an electronic signature "unique to the practitioner." The Board further notes that e-prescribing standards are in flux, and CMS standards are likely to become the norm in the near future. When in doubt, pharmacists should, of course, call the prescriber to confirm a prescription.
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