Pharmacy Practice

Question 1

What are the requirements for a pharmacist to be designated as a “provider” for reimbursement purposes and what tasks are permitted under this designation?

Answer 1

Texas recognizes pharmacists as “practitioners”, which allows for reimbursement of pharmacist-provided services within their scope of practice. This could include medication management, administering CLIA-waived tests, chronic disease management or patient education programs.

Question 2

Does a drug therapy management protocol need to be submitted to the board?

Answer 2

Yes

Question 3

How often does a drug therapy management protocol need to be renewed?

Answer 3

Annually

Question 4

What actions are pharmacists allowed to perform under a drug therapy management protocol (e.g., initiate, modify, monitor medications)?

Answer 4

Collect and review patient drug use histories

Order or perform routine patient assessment procedures including temperature, pulse and respiration

Order drug therapy-related laboratory tests
Implement or modify drug therapy following diagnosis, initial patient assessment and ordering of drug therapy by a physician as detailed in the protocol

Any other drug therapy related act delegated by a supervising physician

Question 5

Are there any restrictions on what diseases a pharmacist can manage under a drug therapy management protocol?

Answer 5

No

Question 6

Is every pharmacy required to have a pharmacist-in-charge?

Answer 6

Yes

Question 7

How many pharmacies can a pharmacist serve as the pharmacist-in-charge (PIC) at one time?

Answer 7

A pharmacist can only serve as the PIC for one pharmacy unless one of the following exceptions apply:

1) Can serve as the PIC for multiple community (Class A) pharmacies if the additional pharmacies are not open to provide pharmacy services simultaneously
2) During an emergency, up to 2 community pharmacies open simultaneously if the PIC works at least 10 hours per week in each pharmacy for no more than 30 consecutive days.

Question 8

What is the minimum number of hours the pharmacist-in-charge (PIC) must be present at the pharmacy?

Answer 8

The PIC must be considered full-time, defined as working 30-40 hours/week, or, if the pharmacy is open for less than 60 hours/week, then working one-half of the time the pharmacy is open.

Question 9

What activities are interns permitted to perform (e.g., counseling, compounding, final verification, taking verbal prescriptions)?

Answer 9

While under the supervision of a certified pharmacist preceptor, an intern can perform any pharmacist duty except that an intern cannot sign/initial documents that must be signed/initialed by a pharmacist unless the preceptor cosigns the document. An intern cannot independently supervise pharmacy technicians/trainees.

If the intern is under the supervision of a pharmacist who is not a certified preceptor, then the intern may only perform a pharmacy technician’s duties.

Question 10

Can technicians accept new prescriptions over the phone?

Answer 10

Yes

Question 11

What are the requirements for tech-check-tech (e.g., practice site type, training or certification required)?

Answer 11

Registered pharmacy technicians (not pharmacy technician trainees) can participate in tech-check-tech in an institutional pharmacy setting after completing training.

Question 12

What activities can a clerk perform (e.g., cashier functions, receive refills, put a bottle of medication on the shelf)?

Answer 12

Texas pharmacy laws do not specify what activities can be performed by personnel other than pharmacy technician trainees, pharmacy technicians, pharmacist interns and pharmacists.

Question 13

What are the limits on prescribing controlled or non-controlled drugs to oneself or family members?

Answer 13

The provider must first obtain an adequate history, perform a proper exam and create and maintain adequate records to prescribe for oneself, a family member or an individual with a close personal relationship. A provider must only prescribe controlled substances if there is an immediate need, and the prescription should not exceed a 72 hour supply.

Question 14

Can new prescriptions or refills be filled if the prescriber is known to be deceased or retired?

Answer 14

Yes, a pharmacist can dispense up to a 30-day supply if there are no other available means to obtain a new prescription and failure to refill the prescription might result in an interruption of a therapeutic regimen or create patient suffering.

Question 15

What other countries can pharmacists fill prescriptions from and what are the limitations, if any?

Answer 15

Canada and Mexico.

Prescriptions for non-controlled drugs can be filled if the out-of-country prescriber is practicing in a health profession that can legally prescribe in Texas.

Controlled substance prescriptions from Canada or Mexico cannot be filled.

Question 16

How many years must prescription records be kept?

Answer 16

2 years

Question 17

Within what time frame from the issue date are non-controlled prescriptions permitted to be refilled?

Answer 17

1 year

Question 18

What is the maximum number of refills permitted for non-controlled drugs?

Answer 18

There is no maximum number of refills for a non-controlled prescription, but a non-controlled drug prescription cannot be refilled beyond one year from the issue date.

Question 19

What is the maximum days’ supply that can be dispensed for an emergency refill of non-controlled drugs without prescriber authorization?

Answer 19

If the emergency is due to the pharmacist being unable to contact the prescribing practitioner, the pharmacist can dispense up to a 72-hour supply.

If the emergency is due to natural or manmade disasters, the pharmacist can dispense up to a 30-day supply.

Question 20

What information is required to be on a prescription container label?

Answer 20

Pharmacy name, address and phone number

Prescription serial number and date dispensed

Drug name, strength, quantity and beyond-use-date

Initials or identifier of the dispensing pharmacist

Prescriber name

Patient name (if for an animal, the animal species and owner's name)
Instructions for use and appropriate ancillary statements

Schedule II - IV drugs: “Caution: Federal law prohibits transfer of this drug to any person other than the patient for whom it was prescribed”

If a generic equivalent is dispensed: “Substituted for Brand Prescribed” or “Substituted for ‘Brand Name’”

Question 21

Is it required to provide a larger type size on the container label for patients with visual impairment?

Answer 21

No

Question 22

Are patient profiles required to be kept in the pharmacy for all patients (e.g., a traveling patient on vacation getting a one-time fill)?

Answer 22

Yes

Question 23

How long must patient profiles be kept after the last fill?

Answer 23

2 years

Question 24

What is required to be in a patient profile?

Answer 24

Patient name, address, telephone number, gender, and age or date of birth

Known allergies, drug reactions, chronic conditions or disease states

Any other drugs currently being used that may relate to a prospective drug regimen review

Prescriptions dispensed in the past 2 years: date dispensed, drug name, strength and quantity, prescriber’s name, prescription number, and name/initials of dispensing pharmacist

Question 25

Is patient identification required to dispense non-controlled drugs in the community pharmacy setting?

Answer 25

No

Question 26

When must the offer to counsel a patient be made (e.g., all new prescriptions)?

Answer 26

It is required for all new prescriptions, defined as any prescription that has not been dispensed by that pharmacy to the patient in the same dosage and strength within the last year. It is also required if the patient requests it.

Question 27

Who can provide the offer to counsel (e.g., pharmacist, intern or technician)?

Answer 27

Pharmacist, pharmacist intern, pharmacy technician or pharmacy technician trainee

Question 28

What are the counseling requirements for medications delivered to the patient or sent by mail?

Answer 28

The following statement must be on the prescription container or a separate sheet (in English and Spanish): “Written information about this prescription has been provided for you. Please read this information before you take the medication. If you have questions concerning this prescription, a pharmacist is available during normal business hours to answer these questions at (insert the pharmacy’s local and toll-free phone numbers).”

Question 29

What are the requirements for providing translation services to limited-English proficient (LEP) patients?

Answer 29

Must post signs in English and Spanish explaining the generic substitution process and encouraging patients to ask the pharmacist questions. Medications delivered to a patient must contain written information in English and Spanish with the statement, “Written information about this medication has been provided to you. Please read this information before you take the medication. If you have questions concerning this prescription, a pharmacist is available during normal business hours to answer these questions.”

Question 30

What are the requirements for generic substitution (e.g., must notify the patient)?

Answer 30

Must obtain the patient’s consent prior to substituting for a generic equivalent.

Question 31

What resource can be used to select a suitable substitution?

Answer 31

The Orange Book

Question 32

What actions can be taken by the prescriber or patient to prevent generic interchange?

Answer 32

The patient can refuse the substitution, or the prescriber can handwrite “Brand Necessary” or “Brand Medically Necessary” on the face of the prescription.

Question 33

What documentation is required when a generic substitution occurs?

Answer 33

Must document the generic drug name, strength and manufacturer

Question 34

Are there any drugs (e.g., narrow therapeutic index) that cannot be substituted?

Answer 34

No

Question 35

Does the state have a conscience clause (if so, what are the stipulations of the clause, or what drugs does it specifically apply to)?

Answer 35

There is not a clause related to specifically to pharmacy but the state has a more broad clause that allows a health maintenance organization, physician or provider to refuse to recommend or provide services that violate their religious beliefs.

Question 36

Does the state have death with dignity laws?

Answer 36

No