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Electronic Transmittal of Prescriptions

Questions and Answers

This document is designed to respond to frequently asked questions regarding new provisions for electronic transmittal of prescriptions affecting authorized prescribers and pharmacists. It is not a substitute for reading the provisions of law, rule or regulation. For further information, a list of contacts is provided at the end of this document.

General Information | Pharmacist/Pharmacy Requirements | Pharmacy Personnel | Controlled Substances | Refills | Transfer of Prescriptions | Confidentiality | Further Information

General Information

  1. What is an electronically transmitted prescription?

    Answer: An electronically transmitted prescription is created, transmitted, recorded or stored by electronic means such as facsimile or computer systems.

  2. Are there any special requirements when transmitting prescriptions electronically?

    Answer: YES. Prescribers and pharmacists must have a secure (encrypted or encoded) system for electronic transmission from computer to computer. Any equipment used for electronic transmission of prescriptions should be so located to ensure the security and confidentiality of the transmission. Procedures for electronic transmission of prescriptions should be documented. Electronically transmitted prescriptions must:
    • Contain the prescriber's signature or the electronic equivalent
    • Be protected from unauthorized access, alteration or use
    • Have the initials of the pharmacist or pharmacy intern entered into the pharmacy's records to indicate acceptance of the prescription by the pharmacy.

    The information retained electronically should be capable of being reconstructed in the event of a computer malfunction or accident resulting in the destruction of data.

    Other electronic transfer requirements are outlined in the following questions and answers.

  3. Who may transmit original prescriptions electronically?

    Answer: Only a person legally authorized to prescribe, or an employee expressly approved by the prescriber consistent with existing law, may transmit a prescription electronically (Section 6810 of the Education Law). When electronic data processing equipment is used, the input of drug information may be performed by an authorized prescriber or a pharmacist. If orders are entered by other personnel, the pharmacist must certify the accuracy of the information entered and verify the prescription prior to the dispensing of the medication.

  4. Are pharmacists/prescribers obligated to transmit prescriptions electronically?

    Answer: NO. Electronic transmission of prescriptions is an option. Prescribers and pharmacists do not have to transmit prescriptions electronically.

  5. Can a prescriber direct prescriptions to a particular pharmacy?

    Answer: NO. Patients have the right to choose the pharmacy where they wish to have their prescription filled. Practitioners who exert undue influence on a patient (known as steering) to have a prescription filled at any one pharmacy over another whether electronically transmitted or via a written or oral prescription are subject to charges of professional misconduct.

Pharmacist/Pharmacy Requirements

  1. Is a pharmacist responsible for determining the authenticity of a prescription transmitted electronically?

    Answer: YES. Pharmacists are responsible for assuring the validity of all written, oral and electronically transmitted prescriptions. There are a number of ways to do this, such as using new software programs that require passwords, personal identification numbers (PINs) or other authentication of the prescriber. These programs also notify the pharmacist if an encrypted or encoded electronic message or "envelope" has been tampered with or altered. Prescribers and pharmacists must use compatible programs.

    The Board of Pharmacy, in an effort to assist practitioners, is sharing information on companies that have either indicated that they now have or are developing software that will provide secure electronic transmission of prescriptions. Please note that this information is neither an endorsement of the referenced companies and their products, nor a guarantee that the software meets or exceeds the requirements of the regulations. Each licensee is responsible for assuring that their hardware/software systems comply with all requirements.

    This list will be updated as additional information is received.

    Aridni.Com
    123 West 44th Street, Suite 9F
    New York, NY 10036
    Phone: 212-768-2472
    Fax: 212-202-6144
    Email: bmehta@aridni.com

    Daniel Gibbons & Associates
    125 City Centre Drive
    Cincinnati, OH 45216
    Phone: 513-761-6500
    Fax: 513-761-6070
    Email: dgibbons@one.net

    RHI Group, Inc.
    3445 Winton Place, Suite 240
    Rochester, NY 14623
    Phone: 716-273-8140
    Fax: 716-273-8179
    www.rhigroup.com

    SIGNETRUST, Inc.
    10 East 38th Street, 9th Floor
    New York, NY 10016
    Phone: 212-889-1800 Ext. 242
    Fax: 212-889-4600
    E-mail: acherlands@signetrust.com
    Internet: www.signetrust.com

    Prescriptions transmitted by facsimile also require careful attention. For faxed prescriptions, we suggest that pharmacists apply strategies similar to those now used to verify oral and written prescriptions received when authenticity is not apparent. The best professional judgment of the pharmacist is the key to a safe and effective process. The steps used to verify phoned prescriptions may also be useful for faxed prescriptions. These steps may include:

    • Calling the prescriber's office to verify a prescription if the prescriber is not known to the pharmacist;
    • Accepting a phoned in prescription in lieu of the faxed or computer transmitted prescription;
    • Asking for proof of identity if the person picking up the prescription is not known to the pharmacist;
    • Asking prescribers in the area to use an identifier on the faxed prescription form that indicates recopying or retransmittal. Such marks are commonly used to indicate if that document has been copied from an original;
    • Ensuring that the prescribed drug, based on quantity, directions for use, etc., is consistent with the patient's medication profile;
    • Using other methods such as installing "Caller ID" on the phone line that is used to receive fax prescriptions;
    • Considering whether the prescribed drug is one with an abuse potential or otherwise has "street value."

    Without special safeguards, E-mail transmissions do not independently assure the required confidentiality of patient records and do not, therefore, meet the definition of an electronically transmitted prescription in the new rules and regulations. If a pharmacist has reason to question the authenticity of the electronically transmitted prescription, the pharmacist's professional judgment must prevail. If verification is not possible, the pharmacist can choose not to accept the electronically transmitted prescription and can request transmission by another means from the prescriber.

  2. Is a pharmacy required to print and maintain a hard copy of an electronically transmitted prescription?

    Answer: YES. Just as other records must be maintained under existing laws, printed copies of electronically transmitted prescriptions must be maintained for five (5) years. Likewise, facsimile copies must be maintained in a readable fashion for five (5) years.

  3. What should a pharmacist do if he or she believes that dispensing a prescription will cause harm to the patient?

    Answer:All pharmacies, including those providing prescriptions through a mail order service, are required to maintain a medication profile for each patient and to check for adverse drug reactions. Each licensee must practice according to his or her best professional judgment and the law. If there are concerns that a prescription can cause harm to a patient, a pharmacist may contact the prescriber. If a pharmacist believes that a prescription can cause harm to a patient, even after discussion with the prescriber, the pharmacist can choose not to fill the prescription.

  4. What should a pharmacist do if he or she believes a prescriber is ordering a prescription that is not consistent with the prescriber's scope of practice?

    Answer: If a prescriber cannot legally order the prescription based upon the prescriber's scope of practice, the pharmacist must not fill the prescription.

Pharmacy Personnel

  1. What changes have been made concerning the professional reference books that pharmacies are required to have?

    Answer: Pharmacies are no longer required to have one specific reference book, the United States Pharmacopoeia Dispensing Information. However, pharmacies must have copies of current laws, rules and regulations governing the practice of pharmacy in New York. Pharmacists must also have ready access to current references such as books, CD-ROM or other online resources.

  2. Has the ratio of unlicensed assistants to pharmacists been changed?

    Answer: YES. Effective with the implementation of these regulations, pharmacists may now have the assistance of two unlicensed assistants at one time (Part 29.7(a)(22) Rules of the Board of Regents). However, the responsibility of dispensing rests with the pharmacist. The pharmacist must check all prescriptions filled by an unlicensed assistant before they are dispensed.

  3. Do registered pharmacy interns count in the ratio?

    Answer: NO. Registered pharmacy interns may practice as pharmacists under the supervision of a licensed pharmacist.

  4. Has there been a change in what functions an unlicensed person may perform in a pharmacy?

    Answer: YES. Unlicensed persons may now key data into computer files. However, the pharmacist must verify all of the information prior to dispensing of a prescription by entering his or her initials or other personal identifier. The record of the dispensing must clearly identify the dispensing pharmacist. The responsibility of dispensing rests with the pharmacist.

Controlled Substances

  1. May a controlled substance prescription be electronically transmitted?

    Answer: NO. A prescription for a controlled substance may not be transmitted electronically pursuant to Article 33 of the Public Health Law.

  2. Can controlled substance refills be transferred from one pharmacy to another?

    Answer: NO.

Refills

  1. May a non-controlled substance prescription with authorized refills remaining be refilled at another pharmacy?

    Answer: YES. One refill at a time from one pharmacist to another may be transferred at the express request of the patient.

  2. Can all remaining authorized refills be transferred to another pharmacy at once?

    Answer: NO. Transfers of authorized refills must occur one at a time.

  3. What happens to all the remaining authorized refills?

    Answer: The original pharmacy may continue to dispense the balance of the authorized refills.

Transfer of Prescriptions

  1. What is the responsibility of the pharmacist who is transferring information for a prescription refill?

    Answer: To record the following:
    • the name of the patient;
    • that an authorized refill of the prescription has been transferred;
    • name, address and telephone number of the pharmacy to which it was transferred;
    • name of the pharmacist receiving the prescription information;
    • name of the pharmacist transferring the information; and
    • the date of the transfer.

  2. What is the responsibility of the pharmacist who receives a refill transfer?

    Answer: To produce a hard copy of the prescription information, ensure that the term "refill transfer" appears on the face of the hard copy, and record the following:
    • the name of the patient;
    • that an authorized refill of the prescription has been transferred;
    • the name, address and telephone number of the pharmacy from which it was transferred;
    • the name of the pharmacist receiving the prescription information;
    • the name of the pharmacist transferring the information;
    • the date of the original prescription and most recent transfer; and
    • the original prescription number.

Confidentiality

  1. Must a pharmacy obtain permission from a patient to enter in or access from a shared database the patient's medical and/or prescription information?

    Answer: YES.

  2. Does such permission have to be documented?

    Answer: YES. The pharmacist is required to obtain permission that is documented as a patient's express written consent.

  3. What if a person refuses to have his/her information entered into a shared database?

    Answer: A consumer may refuse to have his/her information entered into a shared database. The pharmacy that originally filled the prescription must place a "firewall" around the data. This "firewall" must prevent access to patient-specific information by an unauthorized individual at another location.

Further Information

  1. Who do I contact for more information about the electronic transmission of prescriptions?

    Answer: The mailing address for all individuals and offices listed below is: Office of the Professions, State Education Building - 2nd floor, 89 Washington Avenue, Albany, New York 12234


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