Home Medicine Can I Prescribe Out Of State

Can I Prescribe Out Of State

by Dan Hughes
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Can I Prescribe Out Of State

Can I Prescribe Out Of State

If you have ever filled a prescription in person at your local pharmacy, then you know how convenient this can be and how much time you save each day. But what if there was no one around to help you? What if you needed to pick up an emergency supply or refill prescription order for someone who lives across town? Would you need to find some other source of medication? Could you even get it if you did?
The answer to these questions is yes. The most common way people obtain medications is through mail order from a pharmacy located outside their own area. Mail order pharmacies are commonly called “mail order” (also known as “internet”) or “out of network.” Another term used to describe them is “interstate,” which means they are not operated by a retail pharmacy within the same state. While many mail order pharmacies operate legally and safely, others engage in fraud, misrepresentation, and even outright theft (or diversion) of drugs. They often rely upon false promises of discounts, free samples, and special promotions to lure customers away from legitimate health care providers. Some use misleading advertisements, including those with pictures of happy smiling patients posing beside pill bottles or holding the latest product. Others advertise themselves as discount drugstores, offering prices lower than retail stores in the same vicinity but higher than mail order pharmacies.
This article will examine whether pharmacists practicing in states where it is allowed are able to prescribe for patients who live in different states. It will also discuss the regulations surrounding interstate prescribing and why certain rules apply to mail order pharmacies while others don’t. Finally, we’ll look at how patient rights differ between mail order pharmacies and retail pharmacies when it comes to obtaining out of state prescriptions.
Mail Order Pharmacy vs. Retail Pharmacy
Before talking about whether pharmacists can write prescriptions for out of state patients, lets first talk about retail pharmacies versus mail order pharmacies. There are actually two types of mail order pharmacies — retail chains and independent operators. In general, retail mail order pharmacies are owned by large national companies such as Walgreen’s, CVS Caremark, Target, Rite Aid, Kmart and Walmart. These operations typically offer more services and products than their smaller counterparts, including delivery to home, extended hours, and weekend deliveries. Many mail order pharmacies also provide in house lab testing and immunizations. They can usually accept insurance benefits and Medicare Part D plans. Their employees are trained to handle customer concerns regarding drug interactions, allergies, dosage, etc. And because they work closely with physicians, they tend to carry a larger inventory of generic and brand name medicines.
Independent mail order pharmacies, on the other hand, are owned and run by private individuals or small business owners. They typically have fewer locations and offerings than retail chain pharmacies. Independent operators may be limited in the number of active licenses they hold; may not offer in-house lab testing; may not accept insurance benefits, Medicare Part D plans, or Medicaid payments; and cannot accept orders over $600. However, they may be more willing to try new medicine lines before stocking them. Also, since they are privately owned, they often have less overhead costs, making them cheaper to buy pharmaceuticals from.
States With Interstate Prescriptions
In most states, pharmacists are allowed to practice regardless of where they obtained their license. This includes states where they completed residency training programs and states where they obtained an advanced degree. However, in some states, pharmacists must complete continuing education requirements every year to maintain licensure. Other states require periodic checks for recertification.
As long as pharmacists keep records of all prescriptions dispensed, they should be okay. However, it is important to note that interstate prescribers are subject to additional guidelines and restrictions in states where they operate. For example, in New York, pharmacists must follow strict confidentiality laws. If a patient asks for his/her prescriptions to be faxed to another doctor, the pharmacist must refuse unless he has consent from the patient. He/she may not disclose any information except the name, address, and telephone number of the recipient. Nor may the pharmacist give anyone else permission to receive the prescriptions without explicit consent.
Also, in New York, pharmacists are required to report any controlled substances they suspect of being diverted to unauthorized parties. Any prescriptions containing narcotics, barbiturates, amphetamines, benzodiazepines, methadone, phencyclidine, cocaine, cannabinoids, oxycodone, hydrocodone, alprazolam, diazepam, temazepam, buprenorphine, zolpidem, clonazepam, loperamide, promethazine, flunitrazepam, fentanyl, morphine, codeine, propoxyphene, or dextromethorphan must be reported. Patients would need to sign forms acknowledging the diversion. Pharmacists must take action immediately to prevent diversion of controlled substances. In addition, they must notify authorities of any suspicious activity. Violations could result in fines and jail sentences.
Finally, in New York and several other states, pharmacists are prohibited from issuing prescriptions for controlled substances to non-licensed persons. Non-licensed persons include patients under 21 years old, addicts receiving treatment, and minors without parental supervision.
Interstate Prescription Requirements
While pharmacists are allowed to issue prescriptions for residents of other states, they are still responsible for ensuring the safety of their patients. Therefore, they must make sure that the patient really needs the medicine prescribed. To ensure safe dispensing, pharmacists should ask for ID, including driver’s license or identification card. The patient should sign a statement indicating he understands the risks involved with taking drugs. A copy of the signed form should be placed in the patient’s medical record.
Pharmacists should perform a physical exam and review the patient’s current medical history. They should check for signs of abuse, addiction, or dependence. They should also evaluate whether the patient is eligible for the medication based on age, weight, height, gender, ethnicity, and medical conditions. Finally, pharmacists should explain the potential side effects of the medicine and how to recognize symptoms of overdose.
Now let’s go back to our original question about whether pharmacists can prescribe for out of state patients. While it varies from state to state, generally speaking, pharmacists are allowed to fulfill out of state prescriptions. You just need to remember to adhere to your state’s guidelines. As mentioned earlier, however, certain states impose stricter guidelines. So if you’re going to prescribe for someone in another state, always contact your physician to confirm your ability to do so.
For further reading on this topic, see the links below.
New York Department of Health – Interstates Drug Dispensing Guidelines
http://www.health.ny.gov/regulatory/consumeraffairs/prescribing/drug_dispensingschedule1.htm
American Association of Retired Persons (AARP) – Questions & Answers About Your Rights When Buying Medicines Online
http://www.aarp.org/money/basics/secretswitches/faqonline.html#questions3
National Council of Senior Citizens Information Center – How Do Doctors Get Licenses To Practice Medicine Abroad?
http://www.seniorcitizens.gov/pubinfo/fs/internationalmedicine.asp
Medicare Coverage of International Travel Services Manual
https://www.cms.gov/ResearchReports/MedicareProgramOffices/Manuals/InternationalTravelServices/ICSM1100119.pdf
Centers for Disease Control and Prevention – Pneumonia Urinary Tract Infection Fact Sheet
http://www.cdc.gov/mmwr/preview/mmwrhtml/00051080.htm
The Federal Register is the daily journal of federal agency rulemaking. It contains copies of executive departments, agencies, boards, commissions, courts, corporations, and other entities issued public notices, proposed rules, final rules, and significant regulatory actions. The register also lists court decisions, bankruptcy filings, and trade news. The publication can be searched online via subscription or purchase at bookstores nationwide.
Copyright 2003 National Pharmacy Benefit Manager

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