by
Astrid Fiano, DOTmed News Writer | October 11, 2010
The Drug Enforcement Agency has released new guidelines that will help get medicines to long term care facilities (LTCFs) more quickly by allowing authorized agents to call in the prescription to a pharmacy. The authorized agent in a LTCF is usually a nurse.
The Controlled Substances Act (CSA) does not allow a prescribing practitioner to delegate to an agent the practitioner's authority to issue a prescription for a controlled substance, or to delegate the authority to make a medical determination of the need for medication. However, the guidelines explain that the DEA regulations allow a practitioner to use an authorized agent with communicating prescription information to a pharmacy, including through hand delivery, facsimile, phone call or an electronic transmission.
The guidelines state that a pharmacist may dispense a Schedule III, IV, or V controlled substance when an authorized agent transmits a practitioner-signed paper prescription via facsimile or by oral communication. A pharmacist may inquire into the legitimacy of the prescription if need be.
For Schedule II controlled substances, the CSA requires that they be dispensed by a pharmacy only pursuant to an original written or electronic prescription prior to dispensing. However, an authorized agent may transmit a valid Schedule II controlled substance prescription to a pharmacy via facsimile for patients enrolled in a state or Medicare hospice care program or residents of LTCFs. In that case, the facsimile serves as the original written prescription.
The DEA recommends that the designation of persons authorized to act on behalf of the practitioner and the scope of any such authorization be in writing.
In March of this year, DEA Deputy Assistant Administrator Joseph Rannazzisi testified before the Senate Committee on Aging, acknowledging the special challenges LTCFs and residents face. The LTCF is the patient's residence; the LTCF does not usually have daily care from an on-site physician as opposed to patients in hospitals who are regularly monitored by attending or staff physicians. Hospitals are authorized to have independent controlled substance authority and to maintain common stocks of controlled substances for immediate dispensing or administration whereas a LTCF is not. Because the LTCF resident's physician is usually not located on the premises, he or she may not be able to visit the resident as frequently or as quickly as may be necessary, and may not be present when the patient is in pain. The guidelines are to help alleviate the situation where residents may have to wait excessive periods for prescription relief.
The full guidelines may be found here: http://www.gpo.gov/fdsys/pkg/FR-2010-10-06/pdf/2010-25136.pdf.
