Drug Topics - May 12, 2008 - (Page 50)

50 DRUG TOPICS MAY 12, 2008 www.drugtopics.com LEGAL Q&A John E. Dinardo, R.Ph., J.D. Can I fill self-prescribed Rxs or Rxs for family members? hen a pharmacist is presented with a self-prescribed prescription, or a prescription written for the prescriber’s family member, it should immediately raise a red flag and requires close scrutiny. Is the prescription valid? If not, can the pharmacist be disciplined for filling it? The short answer is the infamous “it depends” – on whether the script is valid or not. If it’s invalid and the pharmacist fills it - not an uncommon practice One state may - disciplinary action could and should result. consider a script First and foremost, it must be eminvalid, while the phasized that the rules governing this type of situation vary among the same script in states. Therefore, it is imperative another state may that a pharmacist knows and adheres to the particular state’s rules. For be acceptable example, one state may consider a script invalid and therefore subject the pharmacist to discipline if filled, while the same script in another state may be acceptable and valid. Most of the concern relates to prescriptions written for controlled substances, since they create an enormous potential for abuse and/or dependence. Likewise, prescribing controlled substances to family members is frequently associated with problems of self-medication and dependency by the prescriber and/or the family member. Therefore, restrictions on a physician’s ability to prescribe such prescriptions would logically result in a decrease of this abuse potential and is justified. However, some states are more restrictive than others. For example, in Massachusetts a physician is prohibited from self-prescribing a Schedule II through IV controlled substance. Therefore, any such script is invalid and cannot be filled. That state has concluded that the potential for abuse far outweighs the relatively minor inconvenience that is caused by requiring the physician to obtain such a prescription from another physician. Schedule II prescriptions written for family members are prohibited, due to the high potential for abuse, except in an emergency situation. That state also recommends that physicians consider refraining from prescribing any controlled substance to family members in non-emergency situations. On the other hand, Tennessee prohibits self-prescribing a Schedule II and III drug, but a Schedule IV drug is allowed in an W emergency situation. Except in emergency situations, Schedule II, III, or IV drugs should not be prescribed to family members. Other states’ rules aren’t as explicitly prohibitive. For example, New Hampshire simply states that it is “not appropriate” for physicians to prescribe controlled substances for themselves or to family members, except in emergencies. Montana takes a particularly interesting stance – although there is not a rule specifically prohibiting the self-prescribing of drugs or prescribing to family members, the state does inquire into such prescribing habits by exploring factors such as if the treatment is well-reasoned and well-documented, whether there’s a potential dependency problem, and whether the prescriber maintained objectivity in the process. That state strongly encourages its physicians to carefully consider the legal and medical disadvantages of such prescribing. Similarly, Kentucky doesn’t have any rules specifically prohibiting such prescribing, but it recommends avoiding doing so to prevent any appearance of impropriety. Some states consider self-prescribing and prescribing to family members as unprofessional conduct, usually due to factors such as the lack of a valid doctor/patient relationship, poor medical history, and the lack of a proper physical exam. It’s clear that some states will not tolerate such conduct. For example, South Carolina requires a valid doctor/patient relationship before a controlled substance can be prescribed. Due to the loss of objectivity in making the proper medical decisions, a practitioner cannot usually acquire the required relationship with him/ herself nor with a family member. Also, prescribing controlled substances for family members is considered outside the scope of good medical practice, except for a true emergency where the health and safety of an individual may be at great risk Likewise, Arizona considers prescribing controlled substances to family members as unprofessional conduct. Similarly, Tennessee states that a physician cannot have a bona fide doctor/patient relationship with him/herself. Florida law even states that when a pharmacist knows or has reason to believe that a purported prescription is not based on a valid doctor/patient relationship and the script is dispensed, the pharmacist is subject to discipline. Self-prescribing of non-controlled prescriptions presents problems as well. The primary concern is, again, http://www.drugtopics.com

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Drug Topics - May 12, 2008 Contents Latebreakers Letters R.Ph.s Say More Needs to be Done to Prevent Pediatric Drug Errors There's a New School of Thought on Use of Beta-Blockers for Hypertension Cover Story Guest Spot Letters Clinical Practice Special Report Professional Practice Broad Label for New Leukemia Therapy Looks Promising Treating Asthma During Pregnancy Safer than Not, Says New Guide In the Pipeline Clinical Q&A APhA Leader's Plan to Leave Office Takes Center Stage at its Conference Policies Passed at a Glance Giving a Talk to the Community? Check Out These Materials This Foundation has Funds to Spare JP at Large Cover Story: Employers and R.Ph.S: A Win-Win Combo FDA's Ilisa Bernstein Discusses Pharmacy Affairs Legal Q&A Manufacturers Unleash a Rash of Poison Ivy Treatments Are OTC Cold Remedies Safe for Kids? Probiotics are All the Rage: How You Can Capitalize on It CMS' Prices for Round One of DMEPOS Competitive Bidding Raising Concerns CVS Caremark's Mentoring Program Recruits and Retains R.Ph.s Antibiotic Resistance Among Community Pathogens Technology Update New Products Advertisers Index Classified Viewpoint

Drug Topics - May 12, 2008

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