ONYSRx Flashcards
ONYSRx Prescriptions rule and exceptions
All prescriptions written in New York must be on an Official New York State Prescription (ONYSRx).
Exceptions:
Prescribers not practicing in NYS.
Clinics/hospitals on federal land (VA, military installations, Indian reservations).
Nursing homes: Use a patient-specific prescription form.
ONYSRx Features and Signature
ONYSRx must include:
A touch-sensitive security feature.
A bar code.
A serial number.
Prescriptions must contain the signature of the prescriber (not “electronically signed”).
Non-Controlled Drug Prescription Requirements
Written prescriptions for non-controlled drugs must:
Be written in indelible pencil, ink, or typewritten.
Contain the patient’s name, address, and age.
Include the date written, drug name, strength, quantity, and directions for use.
Include the prescriber’s name, address, telephone number, profession, registration number, and signature.
Information the Pharmacist CANNOT Change or Add on Rx
Drug Name: Cannot be changed without a new prescription, except for generic substitution.
Prescriber’s Name: Cannot be changed or corrected.
Signature: Cannot be added or corrected; must always be signed by the prescriber.
Date Written: Cannot be changed, altered, or added if missing (must contact the prescriber for a new prescription).
Information the Pharmacist CAN Add or Change (with confirmation if needed)
Patient’s Address: Can be added or corrected.
Patient’s Age/Date of Birth: Can be added or corrected.
Strength of the Drug: Can be added or corrected if the
strength is missing but clearly implied (e.g., only one strength exists for that drug).
Quantity of the Drug: Can be added if missing or adjusted if it is consistent with the prescribed directions (e.g., number of days supplied for a chronic medication).
Directions for Use: Can be clarified or added if missing.
Prescriber’s Address: Can be added.
Prescriber’s Telephone Number: Can be added.
Prescriber’s Profession (e.g., MD, NP, PA): Can be added if missing.
One Drug Per Blank Rule (s6810[7])
Each prescription form in New York must contain only one drug.
No prescription form can authorize the dispensing or compounding of more than one drug.
Pharmacist’s Role in One Drug Per Blank
If a prescription contains more than one drug, the pharmacist must verify with the prescriber which drug(s) should be dispensed.
If the prescriber cannot be reached, the pharmacist may dispense the noncontrolled drug but not controlled substances.
Exceptions to One Drug Per Blank Rule
Article 28 Facilities: General hospitals, nursing homes, RHCFs.
Mental Health Hospitals and Developmental Centers.
Inpatients: More than one noncontrolled substance can be written on a single medical order or patient-specific prescription form.
Example Scenario: One Drug Per Blank
A prescription with Lantus U100 insulin and diabetic syringes on one blank:
You would need to contact the prescriber to verify which item to dispense.
RPh Responsibilities for Written Prescriptions
When receiving a written prescription, the pharmacist must:
Initial or sign.
Add the date.
Record the RX number (serial number).
Record the brand or generic name and manufacturer if applicable.
These notations should not interfere with the original details.
Filing Prescriptions
Prescriptions must be filed by:
Numerical order (RX number), or
Date for ready retrieval.
Pharmacy Intern Responsibilities for written prescriptions
Pharmacy interns must:
Add their initials or signature to the prescription.
The supervising pharmacist must also initial or sign.
This is typically placed on the front of the prescription.
Interns may complete these tasks electronically.
E-Prescribing Rules
Mandatory for all prescriptions in New York (as of March 27, 2016).
Requirements for electronic prescriptions are the same as ONYSRx.
Prescriptions must be processed through a DEA-approved system.
If prescriptions are scanned into the system, there is no need to pull paper copies for refills.
Electronic Prescribing for Pharmacies
Pharmacists may:
Sign electronically.
Take verbal orders electronically.
Make notations on prescriptions electronically.
Only practitioners can send electronic prescriptions.
Electronic Prescribing Application Requirements
PRs must use an electronic prescribing (EP) application that meets DEA requirements.
The prescription must:
Conform to the Controlled Substances Act (CSA).
Be valid, with no functions disabled when signed.
Hard Token for Electronic Prescribing
A hard token is a cryptographic key stored on a secure device (e.g., USB drive, smart card).
To sign a prescription, the practitioner must authenticate using two of the following:
Something they know (password or challenge question).
Something they are (biometric data).
Something they have (device like a hard token).
Electronic Prescribing Exceptions
Veterinarians.
Out-of-state prescriptions.
Temporary technological failures.
Waivers granted to PRs.
Impracticality affecting patient health (up to 5-day controlled substance supply).
Federal institutions (e.g., VA, Indian Reservations, military bases).
PRs issuing < 25 prescriptions per year.
Commissioner of Health Blanket Waivers (Effective Until October 31st, 2024)
Waivers apply to written ONYSRx or oral prescriptions for:
Complicated directions or those longer than 140 characters.
Compounded prescriptions or infusions.
Prescriptions with FDA-required elements.
Expedited Partner Therapy (EPT) or Collaborative Drug Management.
Public health emergencies and opioid antagonists.
Pharmacy Application (PHA) Requirements (§1311.100)
The PHA can only accept an electronic prescription if:
The PHA meets DEA application requirements.
The prescription complies with all laws and regulations.
PHA Security Standards (§1311.205)
The PHA must meet DEA security standards, such as:
FIPS 140-2 Security Level 1.
Must use ASAP 4.2 software, which distinguishes between when the prescription was filled and when it was picked up.
Digital Signature Verification (§1311.205)
The PHA must verify the practitioner’s digital signature, signed with the practitioner’s private key and transmitted securely.
Prescription Data Recording and Retention (§1311.200)
The PHA must be able to record and retain:
Full DEA number of the private practitioner, or
Institution’s DEA number and specific internal practitioner code.
Allow for the addition of the number of units dispensed, date dispensed, and dispenser’s initials.
Retrieving Controlled Substance Prescriptions (§1311.205)
The PHA must be able to retrieve controlled substance prescriptions by:
Practitioner name, Patient name, Drug name, and Date dispensed.
Data must be downloadable into a database or spreadsheet.
If the pharmacist receives a written or verbal prescription that was originally transmitted electronically:
The pharmacist must check records to ensure the electronic version was not dispensed.
If both were received, one must be marked as void.
Handling Paper or Verbal Rx Sent to Another Pharmacy
Contact the other pharmacy to determine if it was dispensed.
If the electronic prescription was not dispensed, it should be marked void, and the paper version can be filled.
If the electronic prescription was dispensed, the paper version must be marked void.
Making Notations on Electronic Prescriptions
Any notations must be made and retained electronically.
The prescription and any annotations should be kept in the electronic record and must not be printed and rescanned.
How Long to Keep Patient Records
NYS BOP: 5 years.
BNE: 5 years.
HIPAA: 6 years.
Medicaid: 6 years.
Medicare: 10 years (Medicare Part D).
Verbal Prescription Requirements (§ 6810[4])
Verbal prescriptions must contain the same information as written prescriptions, except for the prescriber’s signature.
A common source of medication errors due to misinterpretation.
Noncontrolled Drugs: Verbal Prescription
Verbal prescriptions for noncontrolled drugs can be phoned in by the prescriber’s agent.
Nursing homes may follow special procedures for verbal prescriptions.
Pharmacist Responsibilities for Verbal Prescriptions
The pharmacist must indicate:
Signature or initials of the pharmacist who received the prescription.
The prescription number, date, time, and name of the person who phoned it in.
Signature or initials of the pharmacist who filled the prescription.
Verbal Orders in Nursing Homes
Verbal orders are allowed in nursing homes if warranted by circumstances.
Orders must be countersigned by the prescriber within 48 hours. If not signed, the order is terminated.
Controlled Substances Verbal Orders
Verbal orders for controlled substances must be phoned in directly by the prescriber.
An agent (e.g., a nurse) cannot phone in controlled substances.
Fax-to-Fax Prescriptions
Faxed prescriptions must be written on ONYSRx forms and signed by the prescriber.
Faxed prescriptions are allowed for both controlled and noncontrolled substances.
Refill Authorization
Prescriptions may be refilled if refills are authorized on the original or via oral order.
The pharmacist must indicate:
Date of refill.
Initials of the pharmacist.
Amount dispensed (if different).
Oral Authorization for Refills
Pharmacists may take oral authorization for refills of noncontrolled drugs from the prescriber.
There is no limit on the number of refills authorized this way.
Partial Filling
A partial fill is dispensing fewer dosage units than prescribed.
It is allowed as long as the total dispensed does not exceed the total prescribed amount.
Who Can Dispense Medications?
Pharmacists, Pharmacy Interns (under supervision), and Practitioners can dispense medications.
Practitioners can also dispense samples of medications.
Returning Unclaimed Prescriptions
Unclaimed prescriptions must be reviewed periodically in the will-call section.
Medications may be returned to inventory, but not to the original stock bottle.
Only a pharmacist can determine if the medication can be safely returned.
The medication can be used at the next possible opportunity within a few months.
Practitioner Dispensing Limits (Section 6807)
Practitioners may dispense a maximum of a 72-hour supply.
Exceptions include:
Prescribers 10+ miles from a pharmacy.
Medications dispensed for free.
Hospitals or clinics.
Veterinarians.
Emergency cases or compounded medications.
Who Can Request Drug Samples?
Only licensed practitioners can request samples.
Samples can be sent to hospital pharmacies or healthcare entities at the request of a licensed practitioner.
Drug sample requests must include
Practitioner’s name, address, signature.
Drug identity and quantity.
Manufacturer name.
Date of request.
Written receipt from the recipient upon delivery.
Hospital pharmacies can manage samples but must
Store samples separately.
Keep copies of written requests from practitioners.
Use original packaging when dispensing samples.
Community Pharmacies and Samples
Community pharmacies are not allowed to have prescription drug samples.
Controlled substance samples are prohibited in New York State.
Coupons for Controlled Substances
Coupons may be used for non-controlled and controlled substances, per specific guidelines.
