Lecture 16 Flashcards
(22 cards)
Professional Standards
Professional standards apply to all practitioners (including pharmacists) recognized in Indiana under IC 25-1-9-2.
Standards are “established by the board regulating the profession in question…”, in our case the Indiana Board of Pharmacy
The main goal of the board of pharmacy is protecting the public and enforcing the laws and rules that govern
pharmacy.
There are many things listed in IC 25-1-9-4 which the Board of Pharmacy must act upon
Sanctions
It is the state’s responsibility to show a practitioner has
done something requiring a sanction
Will typically have a hearing (usually means the state board of pharmacy will present evidence against the practitioner)
Practitioner is allowed to have legal representation
If a sanction is imposed, the practitioner is allowed to appeal to a court of law.*
*Appeal looks at if board followed appropriate procedures and followed the
law (not at the case facts)
Revocation
License taken away permanently
License can NOT be reinstated
Can apply for a NEW license (with a new license number) after seven years from the date of revocation (take all the licensing exams again). Board may or may not allow it
Suspension
license taken away temporarily
Can NOT practice
Typically suspended indefinitely and board can set a minimum amount of time before you can apply for
reinstatement
Reinstatement may include additional disciplinary or corrective measures or probation
Probation
Can practice but with limits or additional requirements
Letter of reprimand
Written expression of disapproval (describes what practitioner did wrong)
Censure
Verbal expression of disapproval
Fine
up to $1000 for each violation
Surrender (NOT a sanction)
Practitioner petitions the board to surrender their license INSTEAD of a hearing (Board may or may not agree to accept)
Board may impose additional conditions on the surrender (such as lifetime prohibition against reinstatement or issue of a new license)
Board Mandated Physical/Mental Exam
Board may require a physical or mental examination to determine if a practitioner is capable to practice
This must stem from a disciplinary hearing in which the practitioner’s physical or mental ability to practice is at issue
Refusal of Licensure
Refusal of licensure can occur if:
The applicant has been disciplined or could be disciplined by another state or jurisdiction; and
The violation the applicant may have been disciplined for has a direct bearing on the applicant’s ability to practice in Indiana.
Anyone who has practiced without a license may also be refused a license
Alternatively, the board may issue a probationary license
Probationary Licensure
The board may issue a probationary licensure and impose one or more of the conditions:
- Report regularly to the board on the matters requiring a probationary license
- Limit practice to those areas prescribed by the board
- Continue or renew professional education
- Engage in community service as directed by the board
- Perform, or refrain from performing, an act that the board considers appropriate to public interest
What prescriber types are not required to issue controlled substances electronically?
Veterinarians and medical assistants
Exemptions to Electronically Prescribing Controlled Substances
- technology issues
- prescription to be dispensed outside of Indiana
- prescriber and pharmacist are the same entity
- elements not supported by technical standards by NCPDP
- FDA requires elements that cannot be supported by electronic transmission
- non patient prescription in response to public health emergency
- issued under research protocol
- prescriber received a waiver
- board determines issuing electronically is impractical and delay
- prescriber determines issuing electronically is impractical and delay
- jail
- compound with two or more products
- drug orders
The prescriber has received a waiver from the board
There is a process for prescribers to obtain a waiver to IC 25-1-9.3.
Any prescriber with a waiver will have their waiver number included on the Indiana search and verify website
A prescriber with a waiver must write their waiver number on the prescription along with their DEA and Indiana Controlled Substance Registration (CSR) numbers
Who can provide Telehealth?
Pharmacists included:
Physician
PA
APRN
Optometrist
Dentist
Vet
Podiatrist
What is Telehealth NOT?
Email
Instant messaging
Fax
Internet questionnaire
Internet consultation
Service provided by employee of practitioner
Individual employed by the same entity that employs practitioner
Telehealth prescription is valid if:
- The prescriber meets the standard of care in treating the patient
- The prescription is issued within the prescriber’s scope of practice
- The prescription is not for an abortion inducing drug
- If the prescription is for a medical device, the prescriber must use technology that is sufficient to allow for an informed diagnosis and treatment
plan.
What must a prescriber do when issuing a controlled substance via Telehealth?
- The prescriber maintains a valid Indiana CSR
- The prescriber follows federal law (21 USC § 829)
- The prescription is issued for a legitimate medical purpose
- The Telehealth communication is conducted using an audiovisual, real time, two-way interactive communication system
- The prescriber complies with the requirements of the INSPECT program
- All other federal and state laws are followed
*The prescription may not be for an opioid unless it is a partial agonist that is used to treat or manage opioid dependence.
Limitations for opioid prescribing
A prescription for an opioid may not be written for greater than 7 days:
If the prescription is for a child less than 18
If the prescription is for an animal for the first time by the veterinarian
Exemptions for prescribing opioids
The 7 day limit does NOT apply if a prescriber is issuing a prescription for:
- Cancer
- Palliative care
- Medication-assisted treatment for SUD
- A condition that is exempted by the medical licensing board
Or if, in the prescriber’s professional judgement, a patient requires more than the prescription limitations listed on the previous slide
Prescriber must document in the patient’s medical record if they are using the palliative care or professional judgement exemption
Dispensing Opioids: Partial Fill
Shall dispense upon request of the:
- patient; representative of the patient; or guardian of the patient
If an opioid prescription is partially filled, the pharmacist must:
1. Comply with 21 USC §829
2. Document that a request for partial fill was made by one of the people listed above
