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

Pharmacists are considered providers solely based on their licensure as a pharmacist.

Question 2

Does a collaborative practice agreement need to be submitted to the board?

Answer 2

Yes

Question 3

How often does a collaborative practice agreement need to be renewed?

Answer 3

Every 2 years

Question 4

What actions are pharmacists allowed to perform under a collaborative practice agreement (e.g., initiate, modify, monitor medications)?

Answer 4

Pharmacists can initiate, modify and discontinue therapy as allowed in their collaborative practice agreement.

Question 5

Are there any restrictions on what diseases a pharmacist can manage under a collaborative practice agreement?

Answer 5

No

Question 6

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

Answer 6

Yes

Question 7

Can a pharmacist serve as the pharmacist-in-charge (PIC) at more than one pharmacy?

Answer 7

No

Question 8

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

Answer 8

50% of business hours not to exceed 40 hours per week on average

Question 9

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

Answer 9

An intern can do everything a pharmacist can do as long as the intern is supervised by a pharmacist:

1) Certifying medical and prescription orders

2) Performing final verification of the product prior to dispensing

3) Initialing medical/prescription orders and noting appropriate comments

4) Providing patient counseling

5) Providing direct patient care services

6) Providing drug information to patients, caregivers, and health care providers

7) Supervising compounding

8) Evaluating and establishing criteria for selection of drug products and suppliers

9) Opening and closing the pharmacy

Question 10

Can technicians accept new prescriptions over the phone?

Answer 10

Yes. Certified technicians may receive new or transferred oral medical and prescription orders.

Question 11

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

Answer 11

Certified pharmacy technicians may verify the contents of unit dose carts/automated dispensing systems prepared by other technicians when an additional verification by use of bar code technology or a licensed health care professional if performed prior to administration to the patient.

Question 12

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

Answer 12

The TN Board of Pharmacy does not specify what tasks a pharmacy clerk/cashier can perform.

Question 13

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

Answer 13

Self-prescribing should only be done in emergency situations. Treatment of family members should be only for minor, self-limiting illnesses or emergency situations.

Controlled drugs can be prescribed to family members in emergency situations. Prescribing controlled substances to oneself is prohibited.

Question 14

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

Answer 14

When a pharmacist becomes aware that a prescriber has died, the prescription may continue to be dispensed based on the pharmacist’s professional judgment and with the following requirements:

1) If the prescription is new and has not previously been dispensed, it may be dispensed within 90 days of the date when the prescriber died

2) If the prescription had been previously dispensed and has valid refills, the refills may be dispensed for no more than 90 days from the date when the prescriber died for Schedules III, IV, and V and 180 days for non-scheduled drugs

3) The drug is not a schedule II drug

Question 15

Can pharmacists fill prescriptions written by prescribers in other countries?

Answer 15

The board does not specify if it is acceptable to fill prescriptions written by prescribers of another country.

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 from the date of issue

Question 18

Is there a maximum number of refills permitted for non-controlled drugs?

Answer 18

No

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

3 days

Question 20

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

Answer 20

1) Name, address and telephone number of pharmacy
2) The medical or prescription order serial number
3) Name of prescriber
4) Name of patient
5) Directions for use
6) Date originally dispensed, and/or refill date
7) “Poison”, “shake”, “caution”, or other appropriate advisory labels
8) Name of product (unless otherwise required by the prescriber)
9) Expiration date of the product (if applicable)

Question 21

What must the pharmacist do when labeling and dispensing a drug to a person who is blind, visually impaired, or otherwise print-disabled?

Answer 21

The pharmacist must make all reasonable accommodations for individuals who are blind, visually impaired, or otherwise print-disabled.

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, for all patients for whom medical and prescription orders are dispensed

Question 23

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

Answer 23

2 years from the last dispensing record on the profile

Question 24

What is required to be in a patient profile?

Answer 24

Follows federal law.
1) Full name, address and phone number of the patient
2) Patient’s age or date of birth
3) Patient’s gender
4) Chronic medical conditions
5) A list of all prescription drug orders with the drug name, strength, quantity and date received, prescription number and prescriber
6) Known allergies, drug reactions and drug idiosyncrasies
7) Other information deemed relevant by the pharmacist’s judgment (e.g., any information specific to the patient or drug, patient’s weight, over-the-counter drug use)

Question 25

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

Answer 25

No

Question 26

Is the offer to counsel required for all prescriptions?

Answer 26

Yes

Question 27

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

Answer 27

Pharmacist or person designated by the pharmacist

Question 28

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

Answer 28

Not specified in the state law, but it is stated that the pharmacist shall personally counsel the patient or caregiver “face-to-face” if the patient or caregiver is present. If the patient or caregiver is not present, a pharmacist shall make a reasonable effort to counsel through alternative means.

Question 29

Are pharmacies required to provide translation services to limited-English proficient (LEP) patients?

Answer 29

No

Question 30

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

Answer 30

The pharmacist must notify the patient of the substitution by noting the substitution on the label.

If the drug is an anti-epileptic drug, the patient and the prescriber must be notified before the substitution.

Question 31

What resource/s can be used to select a suitable substitution (e.g., Orange Book, state formulary)?

Answer 31

The Orange Book

Question 32

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

Answer 32

The prescriber must designate the brand name drug is medically necessary and make a notation on the prescription not to substitute such as by writing “Brand name medically necessary”, “dispense as written”, “medically necessary”, “brand name”, “no generic” or any abbreviation of these terms or circling of these pre-printed terms.

Question 33

What documentation is required when a generic substitution occurs?

Answer 33

The pharmacist will note the substitution on the prescription bottle label.

Question 34

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

Answer 34

No, but substitution of anti-epileptic drugs requires the pharmacy to notify the prescriber and the patient (or patient’s representative) before performing the interchange. This section does not apply to inpatients of a hospital, nursing home or assisted care living facility.

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

Yes, the pharmacist can refuse to fill a prescription based on moral or religious objections.

Question 36

Does the state have death with dignity laws?

Answer 36

No