NORTH CAROLINA BOARD OF PHARMACY

*UPDATE* CDC ACCEPTS ACIP-RECOMMENDATIONS FOR ADMINISTRATION OF COVID-19 VACCINE; PHARMACISTS’ ABILITY TO ADMINISTER BY PROTOCOL NOW EFFECTIVE

UPDATED TUESDAY, OCTOBER 7, 2025

On October 6, 2025, the Acting Director of the CDC accepted The Advisory Committee on Immunization Practices’ recommendations concerning the COVID-19 vaccine. More information here. Accordingly, immunizing pharmacists’ authority to administer the COVID-19 vaccination to adult patients by protocol, to patients age 7 to 18 by protocol, and to patients age 6-18 by prescription is now effective. Below is an overall update on pharmacist authority to administer COVID-19 vaccine to patients who request it.

1. Administration of COVID-19 Vaccine to Patients Age 18 and Older Pursuant to Prescription. The Pharmacy Practice Act grants immunizing pharmacists authority to administer vaccines. G.S. 90-85.15B. A fuller description of that authority is found here.

An immunizing pharmacist may “administer vaccinations or immunizations to persons at least 18 years of age pursuant to a specific prescription.” G.S. 90-15.15B(a). Accordingly, a pharmacist may administer the COVID vaccine to any patient over age 18 upon receiving a prescription to do so.

On September 12, 2025, State Health Director Larry Greenblatt issued standing orders that pharmacists may deploy to satisfy the prescription requirement for administering COVID vaccine to patients age 18 and up who wish to receive it. The standing orders (one for each of the current COVID vaccine formulations) are found here on NC DHHS’s website. Dr. Greenblatt’s standing order bridged the challenge presented by the delay in ACIP recommendation. In light of ACIP recommendations becoming effective, Dr. Greenblatt’s order will sunset on Monday, October 13, 2025. Pharmacies may continue to use the order until that date while making any necessary adjustments to their protocols or procedures for COVID vaccine administration. Once the standing order sunsets, pharmacists may of course continue to administer COVID-19 vaccine to patients who present a prescription from a provider.

2. Protocol-Based Administration of COVID Vaccine to Adults Age 18 and Up, and Pediatric Patients Age 7 to 18, Now Effective. The Pharmacy Practice Act authorizes immunizing pharmacists to administer vaccines “recommended by the Advisory Committee on Immunization Practices” to patients age 18 or older pursuant to protocol, G.S. 90-85.15B(a1), and to patients age 7-18 by protocol and with parental or legal guardian permission, G.S. 90-85.15B(b1).

CDC has now accepted ACIP’s recommendation that COVID vaccine be administered by health-care providers pursuant to shared clinical decision-making, which “means that the clinical decision to vaccinate should be made on patient characteristics that unlike age are difficult to incorporate in recommendations, including risk factors for the underlying disease as well as the characteristics of the vaccine itself and the best available evidence of who may benefit from vaccination.”

Vaccination is recommended for every patient age 65 or older who wishes to obtain it.

ACIP’s recommendation “emphasized that the risk-benefit of vaccination in individuals under age 65 is most favorable for those who are at an increased risk for severe COVID-19 and lowest for individuals who are not at increased risk . . . .” CDC advises providers presented with a request for a vaccine: “Some health care providers may choose to discuss immunizations recommended for shared clinical decision-making with all or most of their patients who could receive it, while some providers may be more selective when discussing these immunizations with their patients. Health care providers should also be receptive to patient-initiated conversations about these immunizations.” More on the shared clinical-decision making process is found here. NC DHHS’ August 2025 update on FDA’s 2025-2026 COVID vaccine approvals – found here – includes links to information about high-risk conditions that counsel in favor of vaccination for a patient under age 65.

Pharmacies should review their protocols and make any changes needed to reflect ACIP recommendations.

3. Prescription-Based Administration of COVID Vaccine to Patients Age 6 to 18 Now Effective. The Pharmacy Practice Act authorizes immunizing pharmacists to administer vaccines to patients age 6 to 18 pursuant to prescription order “in accordance with recommendations by the Advisory Committee on Immunizations.” G.S. 90-85.15(c). In light of ACIP’s COVID vaccine recommendations, immunizing pharmacists may exercise this authority. Board of Pharmacy staff advise that pharmacists may treat the issuance of a prescription to a patient age 6 to 18 as evidence that the prescriber and patient/parent/guardian have already engaged in shared clinical decision-making.

STATE HEALTH DIRECTOR ISSUES STATEWIDE STANDING ORDERS IMPLEMENTING PHARMACISTS’ AUTHORITY TO TEST FOR AND TREAT INFLUENZA

OCTOBER 2, 2025

Effective October 1, 2025, SL2025-37 conferred authority on pharmacists to “order and perform a CLIA-waived test and initiate treatment pursuant to the result of the CLIA-waived test for influenza in accordance with statewide protocols.” State Health Director Larry Greenblatt has issued statewide standing orders implementing this authority. The announcement is found here. The standing orders (one for testing and treatment and one for influenza prophylaxis) and supporting forms and materials are found here. Board members and staff are grateful to Dr. Greenblatt and his team at NC DHHS, Cheryl Viracola at NCAP, and the many stakeholders who contributed to this effort.

To prepare to offer test and treat services, NCAP is hosting a webinar on Sunday, October 19: “From Standing Order to Standing Ready: Pharmacists and Influenza Care in NC.” State Health Director Greenblatt, and Cheryl Viracola, NCAP Director of Practice Advancement, will discuss this new authority in detail and share practical guidance for implementation. Register here to attend the October 19th webinar.

COMPREHENSIVE GUIDANCE TO EXPANDED CLINICAL PHARMACIST PRACTITIONER (CPP) AUTHORITY

september 12, 2025

Effective October 1, 2025, changes to CPP scope of practice enacted in SL2025-37 become effective. Board staff have updated all resources in the CPP Guidance section of the Board website to reflect the changes in both CPP substantive authority and in Board staff’s revised process for reviewing and approving CPP applications. Current and aspiring CPPs should review the updated resources (including general guidance to the broadened CPP practice authority, a step-by-step guide to the revised CPP application, and edited FAQs). Board staff will begin reviewing and processing CPP applications in accordance with the revised authority and procedures immediately. CPP candidates with an application on file do not need to file a new application.

NORTH CAROLINA CSRS TO LAUNCH PHARMACY COMPLIANCE PROGRAM ON SEPTEMBER 3, 2025

AUGUST 21, 2025

On September 3rd, 2025, NC DHHS CSRS will begin contacting pharmacies or dispensers with outstanding dispensation errors from the previous quarter in accordance with NC General Statute 90-113.73 (e). Registered NC CSRS users with a dispenser role type receive automated dispensation error notifications based upon dispensation errors associated with their profile Employer DEA. Dispensers receive notifications each day error(s) exists for 30 days. NC DHHS CSRS staff will contact by phone or email pharmacies or dispensers from the previous calendar quarter regarding outstanding errors requiring correction. Failure to correct these errors may result in civil penalties.

Resources are available to assist with error correction. Dispensers may visit the NC DHHS CSRS webpage for the NC Dispensers Guide and NC Veterinary Dispensers Guide.

For questions regarding error correction or for technical assistance, please contact NC DHHS CSRS at nccsrs@dhhs.nc.gov.

GABAPENTIN PRESCRIPTIONS WRITTEN BY VETERINARIANS

REMINDER SEPTEMBER 12, 2025

Board of Pharmacy staff continue to field calls regarding the state law that requires, as of March 1, 2025, all veterinary dispensations of gabapentin to be reported to the NC Controlled Substances Reporting System (NC CSRS). The North Carolina Drug Control Unit has specific guidance on veterinary gabapentin reporting, including instruction on how a pharmacy / dispenser may use the veterinarian’s North Carolina license number to report the gabapentin dispensing to the NC CSRS. The Board also has an FAQ outlining what information must be reported to the NC CSRS as well as guidance documents and contact information for NC CSRS about veterinary gabapentin reporting.

NORTH CAROLINA CLASS C DRIVERS LICENSE EXTENSION AND IDENTIFICATION FOR CONTROLLED SUBSTANCE DISPENSING

JULY 9, 2025

North Carolina law (G.S. 90-106.1) requires that a pharmacy obtain a qualifying identification prior to dispensing certain controlled substances. Full detail on that requirement and its application to various scenarios is found here. With respect to a qualifying identification, the statute requires that it be “valid” and “unexpired.” G.S. 90-106.1(a).

On July 1, 2025, Governor Stein signed into law S.L. 2025-47. Section 18 of that law states: “Notwithstanding . . . any other State law to the contrary, a Class C regular drivers license shall remain valid for purposes of establishing the license holder’s driving privilege for a period of up to two years after its expiration. The section shall not apply to any drivers license that is currently canceled, revoked, or suspended.” The extension applies to “Class C regular drivers licenses that expire on of after [the statute’s effective date of July 1, 2025]” and the extension “expires December 31, 2027.”

Therefore, under the plain language of S.L. 2025-47, any (non-canceled, non-revoked, non-suspended) Class C North Carolina drivers license whose printed expiration date falls on or after July 1, 2025 is “valid” and “unexpired” through December 31, 2027. As such, it may be used for dispensing controlled substances under G.S. 90-106.1 – as well as any other pharmacy activities that require production of a valid, unexpired identification.

NORTH CAROLINA CONFIRMS MEASLES CASE; NC DHHS ISSUES PROVIDER MEMO

june 27, 2025

On June 24, 2025, NC DHHS confirmed the first measles case in North Carolina in 2025. A child who was visiting Forsyth and Guilford counties became ill while visiting from another country where measles outbreaks have been reported. You may have been exposed if you visited one of these Kernersville or Greensboro locations between June 19 and June 22. If you visited one of these locations during that timeframe, review your immunization records or contact your health care provider to make sure you are up to date on the measles-mumps-rubella (MMR) vaccine.

Prompt recognition, reporting, and investigation of measles cases is important because spread of the disease can be limited with early case identification and vaccination or quarantine of susceptible contacts. Please see this memo on measles reporting, testing, and vaccination. Additional materials for providers will be available in the coming days. Please check the NC DHHS Measles Page for the latest information and materials.

NCDHHS is recommending all unvaccinated people who are 1 year and older receive the measles vaccination to protect themselves and those around them. This contagious disease can lead to serious complications. It's dangerous for babies and children, and during pregnancy. Children who are not vaccinated are at the highest risk.

Go to the Division of Public Health's website to find out more about how to protect yourself and others, and how NCDHHS is preparing for potential outbreaks.

NCDHHS recently launched a Vaccines for Children and Teens webpage to help parents get answers to their questions, understand vaccine requirements and recommendations for schools and child care facilities, and more.

The Vaccines for Children (VFC) program helps eligible families get free vaccines. The VFC webpage includes an interactive provider map to connect families with local providers who offer free childhood vaccines for eligible children and teens.

*ALERT* PHARMACISTS AND PHARMACY PERSONNEL WARNED OF SCAM COMMUNICATIONS PURPORTING TO BE FROM NCBOP STAFF

Don’t fall victim to scammers! Pharmacists continue to report receiving calls from individuals purporting to be Board investigators/inspectors. The Board’s telephone number, (919) 246-1050, is often what appears on caller ID. Such calls as of late inform the pharmacist that they are the target of an investigation involving illegal drug activity and the caller sometimes claims to be part of a larger FBI (or SBI, DEA or other agency) investigation. The details and the names of the “investigator” vary, but these calls appear to be an attempt to get the recipient to disclose personal information.

Board staff reminds practitioners that the names of all the Board’s investigators are listed on the NCBOP’s website, and if they are unsure or suspicious when contacted by someone claiming to be a Board staff member (whether by phone, email, or other communication) that they should contact the Board immediately. To be sure, Board staff frequently contact pharmacists and pharmacy staff on all manner of issues. But, again, if you are suspicious about the true identity of the caller, please reach out to the Board office directly.

DEA DELAYS EFFECTIVE DATE OF TWO NEW RULES CONCERNING PRESCRIBING CONTROLLED SUBSTANCES VIA TELEMEDICINE

APRIL 4, 2025

The Drug Enforcement Administration has delayed the effective date of two final rules titled “Expansion of Buprenorphine Treatment via Telemedicine Encounter” and “Continuity of Care via Telemedicine for Veterans Affairs Patients” to December 31, 2025. More information found here: https://www.federalregister.gov/documents/2025/03/24/2025-05007/expansion-of-buprenorphine-treatment-via-telemedicine-encounter-and-continuity-of-care-via

As a result of this delay, The Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications (https://www.federalregister.gov/documents/2024/11/19/2024-27018/third-temporary-extension-of-covid-19-telemedicine-flexibilities-for-prescription-of-controlled) remains in effect and continues to allow practitioners to prescribe controlled substances via telemedicine through December 31, 2025.