posted
I will likely delete this after gathering some answers.
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According to y'all's training, is it okay for a pharmacist to fill a prescription from a physician that is not licensed to practice medicine in that state (i.e., the state that pharmacy is located in)?
And (for the pharmacists) if it isn't, how often do you check to see if the physician phoning in a script is licensed in that state to do so?
Thanks!
(Just checking up after a discussion by looking for pharm & law input.)
posted
I have spent the last two years working in a mail-order pharmacy, so that's pretty much all I do all day. When I worked retail, it wasn't uncommon for someone to come in from out of state with a prescription from their doctor, and it was never a legal problem to fill it. I have even taken phone orders from out-of-state doctors for patients on vacation. And from my mail-order experience, I've seen plenty of people cross state lines to see doctors, either for purposes of seeing a specialist, or if they live in a suburb that's across the state line from their metro area. As far as I remember from my semester of pharmacy law, these things are all perfectly legal.
If it's a matter of wanting to call in a prescription for a friend that lives in another state and isn't currently under your care, there may be scope-of-practice issues to deal with. Dag would probably be a better person to ask about that than I would; it's never come up (as far as I know), and those laws seem a little nebulous to my legally untrained mind. But if you're trying to phone in a prescription for someone you have an established doctor-patient relationship with, you should be able to do that anywhere in the USA.
posted
By the way, if you're really worried about it (and I don't know why you would be), just phone it in to the local Walgreens. Then have the patient go to whichever Walgreens is sure to be next door to wherever they happen to be standing right now (or possibly just past the Starbucks) and have it electronically transferred.
Don't you just love the 21st century?
Posts: 2804 | Registered: May 2003
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posted
Come to think of it, what is it with the Germanic/Nordic pharmacies? Kerr, Eckerd, Walgreen, etc.
Posts: 3354 | Registered: May 2005
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quote:Originally posted by Speed: But if you're trying to phone in a prescription for someone you have an established doctor-patient relationship with, you should be able to do that anywhere in the USA.
That is so curious. A part of my training was that the license to practice medicine was state-by-state, and so we should not be prescribing out of state unless covered by reciprocity agreements.
I wonder if maybe the problem isn't for the pharmacists but for the physicians? That is, maybe you can accept them without ramifications, but our licensing boards might have issue with us writing them (separate from your responsibilities). Or maybe not. I have written to some state boards for more information.
quote:Hope that helps.
Thanks so much for the speedy reply!
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quote:By the way, if you're really worried about it (and I don't know why you would be),
I think this is covered under "practice of medicine," and our licenses to practice are state-specific. The rules and regulations on a state-by-state basis are quite complex, but some state medical boards have easily negotiable FAQs, and in some this is addressed directly, e.g., for Massachusetts:
quote:Q. I do not have a Massachusetts license but I have a license in another state; can I write a prescription for a patient in Massachusetts? A. No, you must have a current license in Massachusetts to prescribe medication. Click here to go to our prescribing guidelines.
I don't think it comes up except when there is a significant negative outcome, but those are usually unforeseen. When significant problems do occur, my understanding is that prescribing out of state (excepting specific reciprocity agreements between certain state boards) is something that puts a physician at risk of losing the license.
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quote:just phone it in to the local Walgreens. Then have the patient go to whichever Walgreens is sure to be next door to wherever they happen to be standing right now (or possibly just past the Starbucks) and have it electronically transferred.
That was my exact advice, as well.
Anyway, I'll update this if I hear back from the state boards before I mayfly this out of existence. Thanks again.
Posts: 14017 | Registered: May 2000
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quote:Originally posted by steven: Come to think of it, what is it with the Germanic/Nordic pharmacies? Kerr, Eckerd, Walgreen, etc.
Oh, it's no big secret. They're just dedicated to exterminating all impure and inferior races of drug companies, and spreading their glorious heritage to all corners of the world.
posted
My dad has prescribed things such as inhalers and antibiotics for friends and family out of state at the time who forgot, lost, or otherwise needed a new prescription; however, he was always sure there was reciprocity. (I think he had to say no one time.)
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posted
I've actually seen a case on this recently. The question is controlled by the laws of the state in which the pharmacy is located. In Texas (the case I saw), pharmacists may fill a prescription from a doctor licensed out of state (but not out of country) as long as a genuine doctor patient relationship exists. Certain drugs (narcotics) will have some extra verification steps.
The question of whether a pharmacist can fill a prescription is separate from whether it was legal for the doctor to prescribe it. For example, a doctor in Oklahoma can see a patient from Texas and write a prescription. The patient can fill this in Texas.
If the doctor travels to Texas and practices illegally there (I don't know the state of reciprocity between Texas and Oklahoma), the prescription would not be legal. But unless the pharmacist knew about that, he could fill it.
All the above is general info based on a case I read last month, not to be used in practice. Posts: 26071 | Registered: Oct 2003
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posted
ketchupqueen, this was something that I think was a matter of course in the culture where I trained. It doesn't seem to be universal, though, but this came up with two relatively recently-licensed MDs.
I am wondering if it is a generational thing. That is, the older generation would not have grown up with the internet and its associated culture of access, and the younger generation has had so much additional information packed in to learn that this sort of thing may have gotten short shrift?
Or maybe I am completely wrong. I don't think so, as I've found several state boards that specify this on their websites, and there have been lawsuits over it. (Admittedly these are rare lawsuits, but they can be devasting to those involved.)
It is a fascinating topic, and I look forward to finding out more.
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posted
My dad is the compliance officer for his department (he works for the city.) (That means he's certified in medical law and stuff and has to do extra CE on it.) He has told me something similar to what Dag says-- it's not a problem in some states but is in others, and mostly depends where the pharmacy is, where the physician is (reciprocity), and whether the physician is the one who prescribed the medication originally and is refilling it or has otherwise seen the patient before. It also depends on the type of medication.
We had a discussion on this last year.
Posts: 21182 | Registered: Sep 2004
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quote:Originally posted by Dagonee: The question of whether a pharmacist can fill a prescription is separate from whether it was legal for the doctor to prescribe it.
That's what I expected. I think the State Boards of Medicine (who issue the licenses) generally have more restricted views, for whatever reason. I was particularly uncomfortable at the idea that we could rely on the pharmacies to know what the restrictions of our given State Boards are, since it's highly unlikely they would have read them.
I'll wait to hear back from a few State Boards and the Federation of State Boards of Medicine before I close the thread.
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Re: the limitations of your musings, not to be taken as specific legal advice:
posted
He also mentioned that ethically, he would not ever prescribe something if he didn't have personal knowledge of the patient and condition, had not checked out reciprocity to make sure he had it, and would never prescribe a narcotic out of state, but would instead find an avenue to help the patient get what he needed (i.e., calling a doctor in the area and explaining their condition.)
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posted
I would imagine what the situation is matters as well. If one of your regular patients is out of state then I am sure there wouldn't be a problem writing a perscription for them while they are traveling, or possibly even living out of state for part of the year. It also would not matter as much if you are refilling a script you have previously given them, as long as it was time for the script to be filled.
Also, I would imagine the type of drug would influence it as well...narcotics have a lot of different different controls on them from a parmacutical standpoint.
I do believe the burden is on the Doctor writing the script though rather than the pharmacist, at least most of the time. I will ask JenniK when she gets back and see what her training was on the subject.
Posts: 15082 | Registered: Jul 2001
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posted
I just spoke to JenniK about this. Since she worked as a pharm tech in MA, I thought she would have some valuable insight regarding this, as MA has very restrictive laws regarding these types of issues.
She said that if a patient came in with an out-of-state script it the pharmacist had to call the doctor and get his DEA # before it could be filled. That made sure that he was practicing at the location listed on the script, and it made sure that he had been certified by the DEA to write scripts.
She said there was never a problem transferring a valid perscription from state to state though, and they had to do that all the time.
If it is a refill, the best thing to do would probably call it in to his regular pharmacy and then have it transferred to a new one near his current location. As it was a script he had taken in the past it would clear with a minimum of problems.
Hope that helped, although it pretty much just confirms what others have said so far.
posted
Thanks, Kwea. Thank JenniK for me too, please! I'd have had little idea where to go for information on the pharmaceutical provider perspective, other than here.
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There may not be a problem for pharmacists filling prescriptions from out-of-state in MA, but it seems like there may be a problem (from the licensing authorities) on the physicians' side. The MA Board of Medicine is pretty clear on this (from their FAQ):
quote:Q. I do not have a Massachusetts license but I have a license in another state; can I write a prescription for a patient in Massachusetts?
A. No, you must have a current license in Massachusetts to prescribe medication. Click here to go to our prescribing guidelines.
I'm beginning to suspect that the requirements of pharmacists are not necessarily consistent with the requirements of physicians. This may be the source of some confusion, especially if physicians rely on the pharmacists to decide what is and is not permitted for the physician to do. That is, it may be perfectly permissible from the pharmacist perspective, but not permissible by those who are licensing the physicians.
I'm waiting to hear back from a few people, and I'll update when I do.
posted
Dp they mean a patient in MA, or the Doctor? The wording is unclear.
It could be read to say that you cannot go to MA and write scripts, as you are not licenced in that state....but that doesn't mean the same thing as not being able to write a script for a regular patient who happens to be out of state at teh time, in MA>
Needs clarification to be sure. Posts: 15082 | Registered: Jul 2001
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posted
I've got a sneaking suspicion that guidelines for doctors may vary widely from state to state on this count, and that most doctors may not be aware of exactly what restrictions apply in states other than their own, so if they reside in a state where it is allowable to write/fax/phone in a scrip for a patient who is travelling out of state, and it is not allowable for them to prescribe for such a patient in that state (where the patient is travelling), they may not know. Especially if their licenses have any kind of reciprocity with that other state's medical board in other respects.
I also agree with Kwea on the wording question; while I think I know their intention I can't really be sure.
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posted
By the way, I got about two minutes of static on my answering machine the other day. Sounds like it's from you. It's funny as hell, so I'm saving it to play it for you next time you come down. Posts: 13680 | Registered: Mar 2002
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posted
Sounds cool.....Jenni and I are trying to plan a trip down to Disney for the holidays, but since she works now and I am crazy busy for the holiday's it is a little tough.
We MAY come down in two weeks, probably on a Sunday.
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posted
I wonder if there is some sort of interstate commerce clause also that actually helps clarify things.
In the actual confines of the first question asked, it appears to me that if a physician, sees the patient in one state, and writes a paper prescription for the patient while both of them are in the same state, it seems that the patient could then hand carry the paper prescription to a different state and get it filled, without the physician breaking any laws or rules. The physician isn't attempting to practice medicine in a different state than they are licensed in. The prescription pad on which the prescription was written, should have the address and state of the physician on it.
So, if the above scenario is legitimate, (which I believe it is) then the phone-in situation is an added layer of complexity as far as physical location of patient and doctor goes.
The irony, appears to be that it is totally legitimate for a doctor in Los Angeles to phone in a prescription to say San Fransisco, while a patient is visiting there, but it becomes cloudier when the same call would be made from Providence, RI to Boston, MA.
To me, the ethical question may actually start in the gap between a physical paper prescription, and a call-in prescription.
To my knowledge, most controlled substances require a physical paper prescription and can't be called in, to begin with. I don't know if this is a pharmacy rule, a gov't rule or a state-by-state rule though. But it appears to be the beginning of the legal dichotomy between the physical paper and call-in scenarios.
posted
Thank you CT. I was just trying to clarify the parameters in my own mind... although I'm neither a doctor nor a lawyer.
I think Dagonee is asking one of the same questions though. Does MA, specificaly prohibit a prescription, written in a different state, to be filled in MA. According to JenniK it appears they they don't, but they are required to verify information.
It may also come down to the definition of "practicing medicine" in a particular state too and the ambiguity that Kwea and kq pointed out doesn't really clarify that.
The new prescription/ refill prescription also might be a point of dichotomy ethically, although legally I'm not sure one can be treated differently than the other. Or maybe they can, because a lot of time you carry the first scrip in, and then after that the doc calls to authorize refills as needed.
AJ
(calling a prescription in to a local branch of a national pharmacy chain seems to be the most elegant solution in one technical legal sense, however if the doctor actually *knows* the patient is in another state at the time it is called in, I don't know if the loophole is truly a legitimate one, both ethically or legally) And for that matter it isn't like the doctor (for the most part that I know) does the physical calling, in my experience, an assistant is often authorized by the doctor to make the refill call, and they probably have less awareness of the ethical issues than the doc, although they are likely more skilled at navigating the red tape to get the prescription called in.
quote:Originally posted by BannaOj: Does MA, specificaly prohibit a prescription, written in a different state, to be filled in MA.
I don't think they have the authority to do that. Wouldn't that be a violation of interstate commerce? It's not like patients fall under the jurisdiction of a medical board in the way that doctors do. Posts: 32919 | Registered: Mar 2003
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Thank you CT. I was just trying to clarify the parameters in my own mind... although I'm neither a doctor nor a lawyer.![[Wink]](wink.gif)
