TN PPA Flashcards
Do non-US citizens have the right to receive a healing arts license?
Yes
Must board members be citizens of Tennessee?
Board members must be citizens of the state of TN
Describe the relationship between the Board and the treatment program.
- Rehabilitation of impaired practitioners (Tennessee Pharmacists Recovery Network)
- “The TPRN Committee cannot report the impairment of a practitioner to the BOP. However, if in the process of verification of the impairment, evidence is found that TN statutes have been violated or situation endangers public safety, the person initiating the report will be advised to contact the BOP. TPRN has no regulatory responsibility.
What happens if a pharmacist fails a drug test?
- Given three (3) business days from time of notification to the practitioner:
a. Produce a lawful prescription for the drug or a valid medical reason for using the drug to the employer
b. Report to the substance abuse peer assistance or treatment program of the appropriate board
c. As long as practitioner obtains and maintains the advocacy of the substance abuse per assistance treatment program, employer is not required to notify the board of the violation
Naloxone is OTC now. How does that change things statutorily?
- Standing orders; chief medical officer is authorized to implement a statewide collaborative pharmacy practice agreement specific to opioid antagonist therapy with any pharmacist licensed in, and practicing in this state
Can opioid antagonists be legally prescribed and dispensed for the prevention of drug overdose in the state? If so, to whom can such products be dispensed?
- 152
a. Prescriber specific
b. Immunity for dispensing
c. Standing orders allowed - Can be dispensed to:
a. A person at risk of experiencing an opiate-related overdose
b. A family member, friend, or other person in a position to assist a person at risk of experiencing an opiate-related overdose
Are health care prescribers allowed to dispense controlled substances? If so, under what circumstances?
- Electronic Prescriptions from NP or Pas must include the following info about the collaborating physician:
a. Name
b. Address
c. Telephone number
Can pharmacists dispense epinephrine to law enforcement officials?
“For any law enforcement agency that has developed an epinephrine-administration protocol in accordance with subsection b … pharmacist may dispense epinephrine kits to the law enforcement agency pursuant to a prescription issued in the name of the law enforcement agency.”
Are naloxone standing orders allowed in TN? And who are they authorized by?
- TN pharmacists are authorized to dispense in good faith pursuant to a valid statewide CPA executed by chief medical officer
a. To a person at risk of experiencing an opiate-related overdose
b. A family member, friend, or other person in a position to assist a person at risk of experiencing an opiate-related overdose - Pharmacist shall be able to provide documentation of completion of opioid antagonist training program within the previous 2 years (2 hour training)
- Immune from disciplinary or adverse administrative actions for acts or omissions during the dispensing
Is e-prescribing of C-IIs required in TN? If so, what are the exceptions? When did this take effect?
- After January 1, 2021
- “… any prescription for CII, CIII, CIV, or V issued by a prescriber who is authorized by law to prescribe the drug must be issued as an electronic prescription from the person issuing the prescription to a pharmacy”
- Exceptions (a lot)
a. Veterinarians
b. E-prescribing not available due to tech or electrical failure
c. To be dispensed in a pharmacy located outside the state
d. Prescriber and dispenser are in the same entity
e. During a research protocol
f. Prescriber has a waiver for a specific period of time
g. Impractical for the patient to obtain substances prescribed by electronic prescription in a timely manner
h. Fifty or fewer prescriptions for CII substances per year
When is partial filling of C-IIs in TN allowed? Does this align with CARA legislation?
- It is allowed and aligns with CARA:
1. PARTIAL FILLS A prescription for a controlled substance in schedule II may be partially filled if—
a. it is not prohibited by State law;
b. the prescription is written and filled in accordance with this subchapter, regulations prescribed by the Attorney General, and State law;
c. the partial fill is requested by the patient or the practitioner that wrote the prescription; and
d. the total quantity dispensed in all partial fillings does not exceed the total quantity prescribed.
2. REMAINING PORTIONS
a. Except as provided in subparagraph (B), remaining portions of a partially filled prescription for a controlled substance in schedule II—
(i) may be filled; and
(ii) shall be filled not later than 30 days after the date on which the prescription is written
Describe the dispensing and prescribing requirements for new opioid prescriptions in TN as a result of TN Together (TCA 63-1-164). What are the exceptions to the dispensing opioid limits?
- 3 days or less and no more than 180 MME
a. No additional documentation requirements
b. No CSMD checking requirements - Rx in exempt category
a. Check CSMD
b. NO MEE limit
c. ICD-100 and “exempt” on Rx - Surgery OR Medical Necessity
a. Check CSMD
b. Up to 30 DS
c. 1200 MME Limit
d. ICD-10 code, “SURGERY” or “MEDICAL NECESSITY” on Rx - If FDA-approved to tx upper respiratory symptoms or cough AND 14 days or less
a. No additional documentation requirements
b. No CSMD checking requirements - 10 days and 500 MME
a. Check CSMD
b. Up to 10 day supply
c. 500 MME limit
d. ICD-10 code on Rx - When to Check CSMD:
a. Initial dispensing for opioids and BZD
b. Every 6 months while therapy is active - ICD-10 codes must be written on Rx when
a. More than 3 days
b. More than 180 MME - Partial Fill (NOT required)
a. Only if requested by patient or physician - 3 day or cough exception
a. NO CSMD check required IF
(i) Up to 3 days AND less than 180 MME
(ii) OR prescriptions for cough for up to 14 days - MME / DS limits
a. General limit: 10 days and 500 MME
b. Surgery: 30 days and 1200 MME
c. Medical Necessity: 30 days and 1200 MME
d. Must have written on prescription:
(i) ICD-10
(ii) “Surgery” or “Medical Necessity” - EXEMPT prescriptions – NO MME maximum; must have written on prescription ICD-10 & “Exempt”
a. Active or or palliative cancer
b. Hospice or palliative care
c. Sickle cell disease
d. Licensed health care facility
e. Pain management specialist
f. Chronic pain
g. Medication-assisted treatment with methadone, BUP, or naltrexone
h. Severe burns or major physical trauma
i. Serious illness
What are the controlled substance CE requirements for pharmacists authorized to prescribe such drugs?
“…. All prescribers who hold a current federal DEA license and who prescribe controlled substances shall be quired to complete a minimum of two (2) hours of continuing education related to controlled substance prescribing biennially to count toward the licensees’ mandatory CE”
Who has prescriptive authority in the State?
- Physician
- Certified physician assistant
- Authorized nurse under supervision of physician (nurse practitioner, advance practice nurse)
- Pharmacist under CPA
- Dentist
- Optometrist
- “other allied medical practitioner”
Where can nonprescription drugs be sold? What are the exceptions?
- Can be sold in any retail setting if in original package
- EXCEPT: behind the counter items and insulin
Can nonprescription drugs be maintained in patient profiles with prescription drugs? Is a prescription required to enter the nonprescription drug in the patient profile?
- Pharmacists can execute prescription orders for nonprescription drugs and devices to maintain a complete med profile without prescriber authorization
- NOT tax exempt
