COVID-19 UPDATE SCHED II Prescribing 4/1/20204/1/2020
West Virginia Board of Pharmacy Current COVID-19 Update 4-1-2020
In response to the national public health emergency associated with the COVID-19 virus, the WV BOP is issuing the following information and reminders. As this is a rapidly developing situation, additional information will be available on our website, www.wvbop.com, as it becomes available.
These waivers will CEASE to be in effect when the WV State of Emergency related to the COVID-19 pandemic ends.
Changes to Schedule II Prescribing
On March 31, 2020 Governor Justice waived the requirement that for chronic pain patients there must be an in-person physical examination every 90 days prior to prescribing a refill for a Schedule II opioid medication to an existing patient for chronic pain treatment (WV Code §16-54-4(h)) provided that the provider utilizes other appropriate tools to evaluate the patient at these intervals, and assesses whether continuing the course of treatment would be safe and effective for the patient.
On March 30, 3030 the DEA provided the Guidance allowing two exceptions enabling greater flexibility for oral Schedule II prescribing. However, because WV rules contain the same language, before the DEA exceptions could be enacted, WV emergency rules had to be filed permitting the same exceptions. The exceptions are to §15-1-17.1.6.c and §15-2-8.9.2 and are as follows:
8.9.2. In the case of an emergency situation, a practitioner may communicate a prescription for a Schedule II controlled substance orally or by way of electronic transmission other than electronic prescribing, provided that if the prescribing practitioner is not known to the pharmacist, the pharmacist shall make a reasonable effort to determine that the oral authorization came from a registered practitioner, which may include a call-back to the practitioner using the practitioner’s phone number as listed in the telephone directory and other good faith efforts to insure his or her identity; and:
8.9.2.a. the quantity prescribed and dispensed is limited to the amount adequate to treat the patient during the emergency period. Dispensing beyond the emergency period shall be pursuant to a prescription issued in the normal course of practice as authorized in subsection 8.9.1. of this rule.
8.9.2.b. the orally communicated prescription is immediately reduced to writing by the pharmacist, or, if necessary, the prescription communicated by way of electronic transmission other than electronic prescribing is immediately reduced to a hard copy;
seven fifteen days after authorizing an emergency oral prescription, the practitioner delivers a valid paper or electronic prescription for the emergency quantity prescribed to the dispensing pharmacist. The practitioner may send the follow-up prescription to the pharmacy via facsimile, or take a photograph or scan of this follow-up prescription and send the photograph or scan to the pharmacy in place of the paper prescription. It is the responsibility of the practitioner to ensure that, whichever method the practitioner uses, the prescription contains all of the required information outlined in 21 CFR 1306.05 and 1306.11(d), including the statement that the prescription is “Authorization for Emergency Dispensing. The prescription shall have written on its face “Authorization for Emergency Dispensing” and the date of the orally or electronically transmitted prescription. The paper prescription may be delivered to the pharmacist in person or by mail, but if delivered by mail, it shall be postmarked within the seven fifteen day period; if sent by electronic prescription, it must be transmitted by the prescriber within the seven fifteen day period. Upon receipt, the dispensing pharmacist shall attach this written prescription to the emergency oral prescription which had earlier been reduced to writing or to the hard copy of the electronically transmitted prescription. The pharmacist shall notify the nearest office of the U.S. Drug Enforcement Administration and the Board if the prescribing practitioner fails to deliver a written prescription.
To summarize the changes:
- The DEA reiterates that there is not a defined time for “amount adequate to treat the emergency.” Please see further discussion on the DEA Guidance.
- The practitioner must speak to the pharmacist. This cannot be done via an agent of the physician. (See 8.9.2 above)
- The pharmacist must get an “original” prescription within FIFTEEN days, instead of the original seven.
- The “original” may come in one of four methods to be filed with the verbal prescription by the pharmacist: 1) paper prescription with a wet signature mailed within 15 days 2) sent via fax 3) sent as a photograph 4) sent as a scan
- The prescribing practitioner is responsible for ensuring that all of the information is on the prescription, including “Authorization for Emergency Dispensing” and maintaining the original prescription.
APRN Prescribing of Controlled Substances including Schedule IIs
Governor Justice has provided an Executive Order that permits the Board of Nursing, at their discretion, to temporarily suspend or modify the requirements for the authorization of prescriptive authority, prescriptive formulary limitations, prescriptive refill and supply limitations, and other prescriptive limitations. The WV BOP has contacted the BON for information on the BON’s plans. There is a BON meeting scheduled for April 3, 2020. Continue to watch for updates on the WV BOP website as this situation progresses.
WV Insurance Commissioner Update
The WV Insurance Commissioner has provided some waivers pertinent to pharmacy these can be found at https://www.wvinsurance.gov/Portals/0/pdf/pressrelease/20-EO-05%20-%20PBM%20Contracts.pdf?ver=2020-03-27-181054-723