Lecture 15 Flashcards
(19 cards)
Citing Indiana law
As a reminder, Indiana Law is structured very similarly to U.S. Law:
The Indiana legislature passes laws, which are listed in the Indiana Code
The Indiana Board of Pharmacy passes rules, which are listed in the Indiana Administrative Code
Both have Titles, Articles, Chapters, and Sections, but are cited differently
Definition: Sale
“‘Sale’ means every sale and includes the following:
(1) Manufacturing, processing, transporting, handling, packing, or any other production, preparation, or repackaging.
(2) Exposure, offer, or any other proffer. (3) Holding, storing, or any other possession. (4) Dispensing, giving, delivering, or any other supplying.
(5) Applying, administering, or any other using.”
Each of the following could be described as a sale:
-Placing a legend drug outside the pharmacy in a publicly accessible area
-Administering a medication to a patient
-Transporting a drug from one pharmacy to another
It is important to keep this term in mind when reviewing the law, as the sale of drug products can include a vast array of actions
IC 25-1-9-2 - practitioners
A person that holds:
- An unlimited license, certificate, registration or permit;
-A limited or probationary license, certificate, registration or permit - A temporary license, certificate, registration or permit
-An intern permit
-An inactive license
IC 16-42-19-5 - Prescribers
A physician
A veterinarian
A dentist
A podiatrist
An optometrist
An advanced practice registered nurse
A physician assistant
IC 16-42-22-4.5 - practitioners that you can do generic substitution for
A physician (also physician assistants)
A dentist
A podiatrist
An optometrist
An advanced practice registered nurse
CANNOT do generic substitution for Veterinarians
Advanced Practice Registered Nurses (APRNs)
APRNs are:
Nurse Practitioners
Certified Nurse Midwives
Clinical Nurse Specialists
They must work under one of the following types of supervising practitioners:
Physicians
Podiatrists
Dentists
In addition to working under a supervising practitioner, APRNs must:
Apply for prescribing authority with the state
Have a collaborative practice agreement on file with the Indiana state board of nursing, which outlines the agreement between the APRN and the supervising practitioner
APRNs are limited to prescribing within the scope and practice specialty of the supervising practitioner, and may be further limited according to the terms of the collaborative practice agreement. - EXAMPLE if APRN is working under podiatrist they are limited to prescriptions for the foot and ankle (SCOPE) . If the APRN is working under a dermatologist althought a dermatologist is a physician and has prescribing authority of the full body the APRN can only prescribe for something related to dermatology (Specialty)
APRN prescribing
APRNs can prescribe controlled substances, so long as they have a DEA number and an Indiana Controlled Substance Registration (CSR)
APRNs can practice independently from their supervising practitioner (supervising practitioner does not have to be on site)
When prescribing, the APRN must sign their own name, their credentials, and provide their board-assigned ID
In Indiana, prescriptions written by APRNs from any state are honored, so long as the prescription is legally written from the APRN’s state of licensure - Not same in all state
Physician Assistants
Physician assistants work in a similar way as APRNs, but with more limitations:
They must work with a supervising physician (no other practitioner)
Must be directly supervised by a physician in person
In the same location, or
Via electronic method, with the physician immediately available via telecommunications to see the patient in a medically appropriate time frame
Physician Assistant Prescribing
can only prescribe things that the collaborative practice tells them they can prescribe (can be a long list but it must be directly stated)
Cannot prescribe ophthalmic devices under any circumstance, and cannot prescribe or administer general anesthesia or deep sedation (contacts or any corrective lenses)
Physician assistants can prescribe controlled substances, so long as they have a DEA number and an Indiana Controlled Substance Registration (CSR)
-When prescribing, the physician assistant must sign their own name, list their credentials as awarded by the National Commission on Certification of Physician Assistants (NCCPA), and provide their state license number - still independent practice
In Indiana, prescriptions written by physician assistants from any state are honored, so long as the prescription is legally written from the physician assistant’s state of licensure
Optometrists
Remember: optometrists are midlevel practitioners; ophthalmologists are physicians with a specialty in eye-related issues
Optometrists can prescribe independently without a supervising practitioner but may only do so according to a formulary. The formulary has three tiers:
-Independent prescribing - only use the first one at the moment dont need to use the rest
-Dependent prescribing by notification: must notify the patient’s primary care physician (PCP) of prescribing
- Dependent prescribing by consult: must call and consult with patient’s PCP before prescribing a listed medication
Optometrists Prescribing Formulary
The formulary utilized for optometrists is dictated by the Indiana Board of Optometry. Currently, the formulary is in the Indiana Administrative Code as follows:
The formulary of legend drugs…is any legend drug for the treatment of the eye or associated structures of the eye.
All formulary drugs may be independently prescribed by an optometrist.
Controlled substances as defined in IC 35-48-1 are prohibited from use by an optometrist.
However, Indiana code says “An optometrist who:
-holds a license under this article;
-meets the requirements of this chapter for certification to administer, dispense, or prescribe a legend drug; and
-maintains a controlled substance registration under IC 35-48-3;
may prescribe Tramadol (Ultram).”
Can an optometrist prescribe tramadol for the treatment of ocular pain?
Yes!
Indiana code overrides Indiana administrative code when the two are in conflict (not the same idea with federal rules and laws)
Indiana code states that an optometrist can prescribe tramadol so long as they hold a license under this article, meet the requirements of this chapter for certification to administer, dispense, or prescribe a legend drug and maintains a controlled substance registration under IC-35-48-3
Optometrist Prescribing
Can only fill a prescription if the optometrist is licensed in Indiana
You may not fill a prescription written by an optometrist who is not licensed in Indiana
Pharmacists as Independent Prescribers
While pharmacists are not recognized in IC 16-42-19-5, they do have limited independent prescribing authority in Indiana, most notably in two sections of the law:
IC 25-26-13-31: A pharmacist may prescribe any of the following devices or supplies approved by the FDA:
Inhalation spacer
Nebulizer
Supplies for medical devices
Normal saline and sterile water for irrigation
Diabetes blood sugar testing supplies
Pen Needles
Syringes for medication use
IC 25-26-25: Hormonal Contraceptives, which we will touch on in a future lecture.
Pharmacists: Statewide Standing Orders
Pharmacists may also have authority granted through a statewide standing order. The following state protocols are active currently:
Auto-Injectable Epinephrine
Vaccines
Naloxone
Tobacco Cessation
These standing orders must be renewed every year and can be terminated by the State Health Commissioner at any time.
Pharmacists: Protocols
Pharmacists may also act as prescribers under a collaborative practice agreements, also referred to as protocols in the law:
Pharmacists may adjust drug therapy regimens in a hospital setting (we will discuss this in more detail in a later lecture)
Outside of a hospital, pharmacists may enter a protocol with:
a physician
An APRN
A physician assistant
so long as the protocol is signed by a physician and applies to a single patient or group of patients, as specified by the physician
Pharmacist Prescribing
Like optometrists, pharmacists operating under these prescribing authorities must be licensed in Indiana for another pharmacist to fill one of these prescriptions.
You may not fill a prescription written by a pharmacist who is not licensed in Indiana***
Other Midlevel Practitioners
These are not recognized providers in Indiana
You may not fill a prescription written by one of these midlevel providers, even if they are a recognized provider in that state with prescribing authority
