Pharmacist FAQsFrequently Asked Questions for Pharmacists on Prescriptions Generated By Telemedicine Encounters
Q. I have received a prescription generated by a telemedicine encounter. May I dispense it? A. Yes, upon appropriate exercise of professional judgment. The pharmacist must exercise professional judgment in evaluating the prescription to determine if it is appropriate for the patient. The pharmacist shall not fill or refill a prescription “if, in the exercise of professional judgment, there is or reasonably may be a question regarding the order’s accuracy validity, authenticity, or safety for the patient.” ---------------------------------------------------------------------------------------------- Q. I thought the Board’s rules prohibited pharmacists from dispensing a prescription generated by a telemedicine encounter? A. At one time, Board rule .1801 provided that a pharmacist could not fill or refill a prescription if the pharmacist knew or reasonably should have known that a prescription was issued in the absence of a prior prescriber-patient relationship or a physical examination. That rule reflected the Medical Board’s then-current position on telemedicine-based prescribing. In late 2014, however, the Medical Board amended its position on telemedicine, which is found here: http://www.ncmedboard.org/resources-information/professional-resources/laws-rules-position-statements/position-statements/telemedicine That position notes that telemedicine-based encounters may be appropriate for evaluating patients “if the licensee employs technology sufficient to accurately diagnose and treat the patient in conformity with the applicable standard of care.” In response to the revised Medical Board position, the Board of Pharmacy amended Rule .1801 (effective August 1, 2015) to state that a prescription order is valid if “issued by a health care provider for a legitimate medical purpose, in the context of a patient-prescriber relationship, and in the course of legitimate professional practice as recognized by the [Medical Board].” ---------------------------------------------------------------------------------------------- Q. May I dispense a prescription for a controlled substance generated by a telemedicine encounter? A. The Medical Board’s statement states: “It is the position of the Board that prescribing controlled substances for the treatment of pain by means of telemedicine is not consistent with the standard of care.” http://www.ncmedboard.org/resources-information/professional-resources/laws-rules-position-statements/position-statements/telemedicine Furthermore, the federal Controlled Substances Act and regulations state that a pharmacist may only dispense a prescription for a controlled substance issued for legitimate medical purpose in the usual course of professional practice. Finally, the Ryan Haight Online Pharmacy Consumer Protection Act, a federal statute passed in 2008, specifies at least one in person medical evaluation must precede issuing a controlled substance prescription for any indication (pain or otherwise). 21 USC 829(e). The statute does provide that telemedicine may qualify as medical evaluation, but only if the patient “is being treated by, and physically located in, a hospital or clinic” or “while the patient is being treated by, and in the presence of, a practitioner.” 21 U.S.C. 802(54); 21 CFT 1300.04(i) In general, then, an in-person evaluation is required for a controlled substance prescription for any indication to be valid. And the DEA notes that the absence of an in-person evaluation remains a “’red flag’ indicating that diversion is occurring.” 75 Fed Reg at 15,599 (Apr. 6, 2009)
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