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dependent of the cost of the ingredients and thus does not vary from one prescription to another. Some pharmacists use a vari- able or sliding professional-fee method, whereby the magnitude of the fee is varied somewhat on the cost of the ingredients.

In practice, the professional fee may vary widely between phar- macies, depending on the cost and types of pharmaceutical ser- vices rendered (eg, family record systems, delivery service, home health-care needs, cognitive services) and the professional de- sires of the pharmacist. Pharmacies using the professional fee commonly make adjustments for prescriptions requiring com- pounding to compensate for the extra time, materials, and equip- ment. Some pharmacies may charge their patients an annual fee for professional services. This fee then might entitle the patient to the following: routine professional service each time a pre-

scription is filled, a yearly record of prescriptions, regular blood pressure checks, plus a yearly one-on-one consultation. Governmental units, such as state human services agencies and most insurance companies and prescription card services, have adopted the professional-fee method for the reimburse- ment of pharmacists in filling prescriptions covered under their programs. Such third-party payers negotiate the professional fee to be used with pharmacists interested in participating in the programs. This practice has resulted in lower fees being paid to many pharmacists as large-volume pharmacies attempt to maintain profits by increasing prescription volume. Most of these programs have a copayment provision that requires the patient to pay a portion of the charge for each prescription he/she has filled. As the cost of prescription drugs has in- creased, most prescription drug plans have implemented a tiered copayment system where the percentage the patient must pay is reduced if generic drug or preferred formulary products are prescribed and dispensed. PRESCRIPTION REFILLING—Instructions for refilling

a prescription are provided by the prescriber, on the original prescription or by verbal communication. Although prescrip- tions for noncontrolled substances have no limitation according to federal law as to the number of refills permitted or the date

of expiration, state laws may impose such limits. Many states

limit refills to 1 year after the prescription was written. Refill- ing prescriptions for controlled substances is limited as de- scribed in Chapter 111. Physicians and pharmacists should work together so that prescriptions are renewed only with the frequency consistent with directions for use, and the pharmacist should check with the prescriber after a reasonable time to assure himself/herself that his/her intent is being met. No prescription should be re- newed indefinitely without the patient being reevaluated by the prescriber to assure that the medication as originally pre- scribed remains the medication of choice. Renewals should be noted on the reverse side of the pre-

scription order or in the prescription computer with the date,

the quantity dispensed if different from the original, and the name or initials of the pharmacist dispensing the medication. If verbal authorization has been obtained from the prescriber, this should be recorded. The maintenance of accurate records of renewals is impor- tant for following federal and state laws and for providing in- formation on the patient’s medication history. COPIES AND TRANSFERS OF PRESCRIPTION ORDERS—Occasionally, these are requested by the patient or

a pharmacist on behalf of the patient. In some instances, the in-

tention is to provide information, and in other instances, the pa- tient is desirous of having the copy refilled at another pharmacy.

Patients who change residences either temporarily or perma- nently may request their prescriptions be transferred to another pharmacy. Chain pharmacies that have centralized computer systems can access a patient’s prescription records from any of their pharmacies throughout the US and can easily transfer any remaining refills on the original prescription order. Although the FDA maintains that a copy of a prescription order has no legal status and should not be honored, the agency

CHAPTER 101: THE PRESCRIPTION

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has opened the door for honoring copies under certain circum- stances. The FDA does not object to the exchange of prescrip- tion copies between pharmacies for the purpose of renewal, pro- vided that certain safeguards are taken: (1) the original order is voided and marked to indicate that a copy has been issued, the individual to whom it has been issued, and the date of issuance; (2) the copy should be so marked and the location and number of original noted; (3) the copy shows the date of original dis- pensing, the date of the last renewal, and the number of re- newals remaining. 8 This procedure does not apply to Schedule II controlled drugs or if individual states prohibit such a procedure. In instances in which copies of prescriptions are provided by the pharmacist and in which the copy may not be refilled legally, the pharma- cist supplying the copy should write Copy—Not to be Dispensed or a similar designation across the top. A copy should be made exactly like the original, including all pertinent information that a pharmacist might require in dispensing the medication as originally provided. The copy preferably should be written or typed on a preprinted form identifying the pharmacy. The DEA amended the Code of Federal Regulations (CFR) in 1981 to permit the transfer of prescription orders between two pharmacies for controlled-substance prescriptions that may be renewed lawfully. The amendment allows for the transfer of an original prescription order for controlled sub- stances listed in Schedules III, IV, or V between pharmacies on a one-time basis only. To comply with these regulations, pharmacists first must as- certain if the transfer of a prescription order for renewal dis- pensing purposes is permissible under state or other applicable law. When a prescription order is transferred, it must be com- municated directly between two licensed pharmacists, and the transferring pharmacist must record the following information:

Write VOID on the face of the invalidated prescription order. On the back of the invalidated prescription order, the name, the ad- dress, and the DEA registration number of the pharmacy it was transferred to and the name of the pharmacist who received the in- formation. The date of transfer and the transferring pharmacist’s name.

The pharmacist receiving the transferred prescription order must reduce to writing the following:

The word transfer on the face of the transferred prescription order. All information required on a controlled-substance prescription order as it appears on the original prescription order. The date of issuance of original prescription order. The original number of renewals authorized on the original prescription order. The date of the original prescription order. The number of valid renewals remaining and the date of the last re- newal. The pharmacy’s name, address, DEA registration number and the orig- inal prescription number for which the prescription order was trans- ferred. The name of the transferring pharmacist.

The DEA requires that the original and the transferred pre- scription orders must be maintained for 2 years from the date of the last renewal. Most states now allow the transfer of pre- scriptions via computers within their states, whereas some al- low computer transfers from other states. Pharmacies electron- ically accessing the same prescription record must satisfy all information requirements of a manual mode for prescription transferral.

PATIENT COMPLIANCE WITH PRESCRIBED MEDICATION

When a prescriber writes a prescription, it is with the intent that the patient fills the prescription promptly and begins using the medication according to directions. Patient adher-