Lecture 11: TPP + Drug Scheduling Flashcards
what is the purpose of the Alberta Triplicate Prescription Program?
◦ TPP Alberta has been monitoring the use of prescription drugs prone to misuse and abuse since 1986.
◦ When prescribing and dispensing data meet certain criteria, they alert physicians and others involved in
the care of the patient. We provide resources to address these issues.
Which drugs are monitored by the
Alberta TPP?
What are Type 1 Drugs
Type 1 Drugs (secure prescription required) ◦ Buprenorphine ◦ Codeine (oral liquid) ◦ Fentanyl ◦ Hydrocodone ◦ Hydromorphone ◦ Meperidine ◦ Methadone ◦ Morphine ◦ Methylphenidate (Biphentin® and Concerta® do not require a TPP) ◦ Oxycodone ◦ Others
Which drugs are monitored by the
Alberta TPP?
What are Type 2 Drugs
Type 2 Drugs (secure prescription not required) ◦ Benzodiazepines ◦ Buprenorphine/Naloxone ◦ Codeine ◦ Methylphenidate ◦ Tramadol
Netcare ID of patient with Type 2 drug monitored
Zopiclone on PDL Type 2 sometimes needs it
where do the copies of TPP forms go?
time limit?
Using TPP Alberta’s secure 2‐part form for Type 1 TPP drugs
◦ Two copies, top copy to pharmacist, second
stays with prescriber
◦ Prescriptions must be brought into a pharmacy
within 72 hours
◦ A separate form for each triplicate drug is required
◦ Prescriber must provide indication
who are the TPP program participants? (7)
To prescribe any TPP medication, prescribers must register with the program. The program requires the use of a two part prescription (triplicate form) for all Type 1 and veterinary practice prescriptions. TPP also relies on Alberta Netcare’s Pharmaceutical Information Network (PIN) as a data source
◦ Alberta College of Pharmacists (ACP)
◦ Alberta Dental Association and College (ADA+C)
◦ Alberta Veterinary Medical Association (ABVMA)
◦ College of Physicians and Surgeons of Alberta (CPSA)
◦ Yukon Medical Council
◦ College and Association of Registered Nurses of Alberta (CARNA)
◦ College of Podiatric Physicians of Alberta
Program participants need to be registered with a college to get a number and get a pad
Describe the diff TPP medication types
Type 1 medications – require a prescriber to register with the TPP and use a triplicate prescription pad when prescribing these drugs
◦ Pharmacist must be presented with the top copy of the TPP form for Type 1 medications and for all
veterinary use medications (see TPP medication list)
Type 2 medications – are monitored electronically but do not require a prescriber to register or
use a triplicate prescription pad
Veterinary Practice Specific medications – triplicate required for all TPP medications (i.e. for all Type 1 medications, Type 2 medications and additional listed drugs)
what does the prescriber need to fill out for TPP prescription?’
what is already preprinted on the pad?
◦ Health Care # (blank for an animal)
◦ Date
◦ Patient Name
◦ If pet (owners name will be in brackets behind pet’s name)
◦ Patient Address
◦ Patient DOB (or animal DOB)
◦ Drug Name and Strength
◦ Quantity (Numeric and Alpha) - so can’t add another number behind last digit
◦ Refills not allowed. Part‐fills may be indicated.
◦ Indication
◦ Directions
◦ Signature - Only prescriber can sign the pad
Preprinted
◦ Dr. Name and Address (prescribers are not allowed to share pads)
◦ Triplicate Rx Number (this is NOT the prescriber id)
◦ Two copies of the form = 1 triplicate
◦ Prescriber’s copy is kept in the patient’s chart
Mitte: 90 caps
Patient requires a prescription for Biphentin® 10 mg capsules. They take it as 1 capsule daily. They need a 3 month supply.
what example is this of?
No refills
Patient gets all 90 caps at once
Mitte: 30 caps, 2 refills (refill every 28 days)
Patient requires a prescription for Biphentin® 10 mg capsules. They take it as 1 capsule daily. They need a 3 month supply.
what example is this of?
Refills with interval
Patient gets 30 caps, next refill of 30 can be obtained in 28 days.
Mitte: 90 caps (release 30 caps every 28 days)
Patient requires a prescription for Biphentin® 10 mg capsules. They take it as 1 capsule daily. They need a 3 month supply.
what example is this of?
Part-fill (interval indicated)
Interval: Patient gets 30 capsules, next refill of 30 can be obtained in 28 days.
when can the pharmacist no longer accept a TPP (time)?
Must receive within 3 days of prescribing
◦ Day 1 is considered the date the prescription is written (cannot be honoured after midnight of the 3rd day). At their discretion, pharmacists may call the prescriber to obtain approval to use an expired prescription written on a TPP form. The authorization
should be documented on both copies.
what must the pharmacist add to the TPP opnce received?
what must they get to patient to do?
◦ Date filled or logged (write deferred if not filled and send the TPP after it has been logged)
◦ Assigned Rx Number
◦ DIN
◦ Quantity
◦ If triplicate prescribed for 90 tablets but only filled 30 tablets must write 30/90.
◦ Pharmacy License #
◦ Pharmacist Signature and License #
◦ Must have patient or agent: Sign the prescription upon PICK UP of drug
- signs at bottom to confirm they have received the prescription (or animal’s owner signs)
- do not get the pt to sign in advance
◦ Pharmacist makes a photocopy of the triplicate and
mails it to the College of Physicians and Surgeons
only if the triplicate is for a compound, vet
medication or Yukon Triplicate (Yukon jurisdiction like ours)
◦ You still need to meet the Narcotic Regulations - Narcotic sales
Can the same form be used for several TPP meds?
No. A separate form is required for each TPP medication. Different strengths of the same medication
may be ordered on one form only if the orders are legible, and clearly indicate the prescribed
dosage and quantity
Can TPPs be faxed?
If the prescriber has used a label to note patient demographics, ensure that this information appears on both the CPSA and PHARMACY copies
Faxing TPP forms directly from the prescriber’s office is acceptable
◦ The prescriber destroys the original copy of the TPP form or marks it “VOID” and must never give it to
the patient
- if faxed, you must make a copy for the patient to sign, then the signed copy can be photocopied (on permanent quality paper) and sent to the College of Physicians & Surgeons
Changes or notes added to the TPP form should be added to the back of the form. If note is made on the PHARMACY COPY, it should also be added to the back of the CPSA copy that is returned.
Triplicate Prescription for Veterinarians
how is the program diff for Vets?
Many times the veterinarian will dispense the product from within their practice to the patient
Veterinary Specific medications ‐ In addition to those on the CPSA website ABVMA requires that the following drugs must be written on a TPP form:
◦ All Barbiturate preparations
◦ All codeine‐containing preparations
◦ Benzodiazepines and all other targeted substances listed in Regulation under the Controlled Drugs and Substances Act
◦ Tramadol
◦ Anabolic Steroids
Veterinarians do not require a methadone exemption to prescribe buprenorphine.
what products cannot be dispensed from a vet clinc?
ABVMA policy requires that there will be no dispensing of the following products from a veterinary clinic, even if prescribed on a TPP form
◦ Ketamine
◦ Euthanasia Solutions
◦ Sodium Pentobarbital
◦ General Anaesthetics (ex: Propofol, Halothane, Isoflurane)
◦ Alpha ‐2 ‐Agonists
what changes to the TPP Program due to
COVID have been made?
◦ The TPP Program remains active and prescribers and pharmacists should continue to adhere to the polices outlined in the TPP Alberta Guide.
◦ The temporary exemptions from Health Canada mean prescriptions for type 1 TPP medications that are sent by verbal order from physicians and other prescribers, or written by pharmacists will not require a secure TPP form.
◦ Verbal prescriptions bring the risk of errors and diversion, pharmacists should take any steps
necessary to authenticate the source of the verbal prescriptions, while physicians should be prepared to provide identifiers such as their license number.
◦ For all other circumstances, physicians and other prescribers should make every effort to
provide a secure form whenever possible, to prevent diversion and protect the public.
