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Should you dispense to M.D.s who self-prescribe?


 

Rx Legal Q&A

Should you dispense to M.D.s who self-prescribe?

If you have a practice-related legal question, please e-mail it to drug.topics@medec.com.

Q: Are there any federal or state laws prohibiting a physician from self-prescribing? Also, do any laws apply to prescribing to family members?

A: A few years ago, two pharmacists working in a Midwest chain pharmacy began to question the number of prescriptions a local physician was writing for a hydrocodone cough preparation for himself. The quantities were indeed small, one to two ounces on each prescription, but the frequency was a concern. The pharmacists mentioned their concern to chain superiors, who relayed the information to state police officers.

Following a lengthy investigation, the physician pleaded guilty to a medical board infraction. His medical license was suspended and he was admitted to a treatment program for his addiction. Both pharmacists were charged with multiple counts of violation of a board of pharmacy regulation prohibiting the dispensing of inordinate quantities of controlled substance used to sustain an addiction.

Federal and state laws placed a "corresponding" burden on the pharmacists to refuse to fill scheduled prescriptions not used for a legitimate medical purpose. The prosecutors claimed that the pharmacists should have known that the purpose was for addiction because the physician wrote the prescriptions for himself. The pharmacists were found not guilty of the charges, but the lesson was loud and clear—self-prescribed medications, especially controlled substances, deserve a second look.

Under federal rules, a controlled-substance prescription is valid only if it is "issued for a legitimate medical purpose by a practitioner acting in the usual course of sound professional practice." A physician may not write a controlled-substance prescription for office use or for "medical bag." What constitutes "sound professional practice" is left to state law.

Several states—for example, Arizona and Iowa—have board of medicine regulations placing severe limitations on physician self-prescribing. The Iowa regulation also restricts prescribing for family members. Interestingly, Iowa has no corresponding board of pharmacy regulation restricting the filling of such prescriptions. Check with your state pharmacy board to determine whether your state medical board has a similar regulation. Also check to see whether there are other regulations restricting a prescriber's practice.

Regulations recently passed in response to Internet pharmacy practices may also cover prescriptions for family members. In addition, many states have laws or regulations restricting prescribing to the areas of practice of the person prescribing, such as a dentist, who may prescribe only within the field of dentistry. Several pharmacists have mentioned seeing a prescription for a birth control drug written by a dentist for his wife or the dentist herself.

If a prescription is not valid, of course, it cannot be filled. But is such a prescription for a prescriber or a family member of the prescriber invalid only for that reason? A physician's prescription that violates a medical board regulation may subject the physician to discipline, including suspension of license, but does it make the prescription invalid? Perhaps not—it depends on the wording of the regulation and the circumstances.

A self- or family-member-prescribed controlled substance should also raise a red flag, but what if it is an emergency situation for a noncontrolled substance? There are 50 sets of rules and 50 sets of answers to the question. The answer may depend upon how the pharmacy board interprets the medical board's authority and rules. Every such prescription should raise questions worthy of investigation and inquiry by the pharmacist. When such questions are asked, they should also be documented, along with the answers on the back of the prescription, just in case someone later wants to know, "Why did you fill it—or not fill it?"

By Ken Baker, R.Ph., J.D.

Ken Baker, R.Ph., J.D., is a VP and general counsel at Pharmacists Mutual Insurance Co.

Disclaimer: This article discusses general principles of law and risk management. It is not intended as legal advice but is designed to promote discussion. Pharmacists should consult their own attorney for specific advice. Pharmacists should be familiar with the policies and procedures of their employers and with the laws in their state and act accordingly.

 

Ken Baker. Should you dispense to M.D.s who self-prescribe? Drug Topics Nov. 17, 2003;147:57.

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