Pharmacist Prescribed Contraception

Question 1

Meaning of Behind the Counter

Answer 1

Over-the-counter with nonclinical restrictions: age, quantity, location of sale, or documentation (nicotine replacement, pseudoephedrine: SUDAFED)

-need interaction with the pharmacist

Question 2

Pharmacist Prescribing

Answer 2

Pharmacist has the authority to prescribe
referred to a single drug, drug class, or specific disease state

-commonly through a collaborative practice agreement, statewide protocol, standing order

Question 3

Prescriptive Authority

Answer 3

-Broad
-The state gives full autonomy to pharmacists to
prescribe medications
-based on clinical guidelines and professional judgment
-no protocol or agreement is needed

Question 4

Statewide Protocol

Answer 4

-issued by a state board or agency
-authorizes pharmacists who meet the
requirements to autonomously prescribe certain
medications
-within the law and regulations

Question 5

Example of Statewide Protocol

Answer 5

Virginia
-PPC: Pharmacist Prescribe Contraception
-Naloxone, and others

Question 6

Term Definition Collaborative Practice Agreement
(CPA)

Answer 6

-a voluntary agreement between a pharmacist and a prescriber
-the pharmacist can initiate, adjust, discontinue medications, and order laboratory tests

-Tennessee

Question 7

Standing Order

Answer 7

-often signed by a physician (high-ranked) within
the state agency or department of health
- authorize a pharmacist to provide care to patients when conditions in the standing order are met

-1 high-ranked MD signs for pharmacists in the whole state

-TN with Naloxone (when it was prescription only)

Question 8

Statewide Protocol and Standing Order

Answer 8

-are similar

-for the Statewide Protocol the government signs for the pharmacists

-for the Standing Order it is a high-ranked physician that signs for the pharmacists

Question 9

Issues with insurance

Answer 9

with Collaborative Practice Agreement (CPA) and Standing Order, often times the pharmacy will put the collaborative physician on the file even though the pharmacist was prescribing -> to get the prescription through the insurance

-f.e. Vaccines in Collaborative Practice Agreement

Question 10

Why is it important that the Collaborative Practice Agreement (CPA) for Contraceptives contains a nonpatient-specific prescriptive order?

Answer 10

-Example: CPA with Dr. Smith -> the pharmacist is allowed to prescribe for all patients eligible, not just Dr. Smith’s

-otherwise, the pharmacist would have to have a CPA with all the different doctors of the patients

Question 11

Which drugs are considered Hormonal Contraceptives and eligible to be prescribed by a pharmacist?

Answer 11

-Self-administered drugs
-Transdermal patch applied to the skin

Question 12

What are the Contraceptives that require a doctor’s intervention?

Answer 12

-Permanent (Vasoctemy, hysterectomy, tubal ligation)
-Copper IUD
-Hormonal IUD
-Implant (placed under the arm)

Question 13

Which Contraceptive formulations are eligible for Pharmacist Prescription?

Answer 13

-Shot
-Intravaginal Ring
-Transdermal Patch
-Oral Contraceptive Pill

Question 14

Which Contraceptive formulations are sold OTC without a prescription?

Answer 14

-External Male Condom
-Internal Female Condom
-Withdrawal - Plan B

Question 15

Requirements for patients to receive a prescription from a pharmacist

Answer 15

-Age of 18y
-Under 18y with proof that the individual is an emancipated minor as defined in § 39-11-106 (free from the control of their parents)

-does NOT affect the regular prescription filling from traditional prescriber

Question 16

In Tennessee
The pharmacist is allowed to require a patient to schedule an appointment for provision or dispensing of hormonal contraceptives - T or F

Answer 16

False

Question 17

In Tennessee
A pharmacist may charge an annual administrative fee for services provided pursuant to this section in addition to any costs associated with the dispensing of the drug and paid by the pharmacy benefit
T or F

Answer 17

True
Only for non-insured patients !!
right now there is not a reliable way to bill insured patients - due to reimbursement issues

Question 18

How is the liability protection issued for pharmacists and prescribers in the law?

Answer 18

-immune from disciplinary or adverse administrative actions, when acting in good faith and with reasonable care

Question 19

Board Rules for Pharmacies prescribing

Answer 19

-Cont’d Training:
Curriculum (Pharmacy school) + responsible for staying up to date; complement training if you change state

Question 20

Board Rules for CPA

Answer 20

-The pharmacy must submit the CPA to the Board within 30 days

-Save the records of patients who have received prescriptions from the pharmacists for 10 years

Question 21

Board Rules - Procedural Mandates

Answer 21

-requires a self-assessment tool (self-assessment form with Y/N questions to see if the patient is eligible for the vaccine or treatment (contraceptive))

-responsible for assessing the self-assessment, dispensing, counseling, and providing the FDA product information

-advise the patient to still see their primary care doctor; if they don’t have a doctor -> MUST provide a list of contact information of primary care provider within 72 hours

Question 22

Self-Screening Form for EXAM

Answer 22

-Breast cancer may be related to hormone exposure -> possible exclusion of a patient when breast cancer in the family hsitory