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Document Citation:
22 TAC § 291.29
Header:
TEXAS ADMINISTRATIVE CODE
TITLE 22. EXAMINING BOARDS
PART 15. TEXAS STATE BOARD OF PHARMACY
CHAPTER 291. PHARMACIES
SUBCHAPTER A. ALL CLASSES OF PHARMACIES
Date:
03/17/2014
Document:
§ 291.29. Professional Responsibility of Pharmacists
(a) Pharmacist shall exercise sound professional judgment with respect to the accuracy and authenticity of any prescription drug order dispensed. If the pharmacist questions the accuracy or authenticity of a prescription drug or-der, the pharmacist shall verify the order with the practitioner prior to dispensing.
(b) A pharmacist shall make every reasonable effort to ensure that any prescription drug order, regardless of the means of transmission, has been issued for a legitimate medical purpose by a practitioner in the course of medical practice. A pharmacist shall not dispense a prescription drug if the pharmacist knows or should have known that the order for such drug was issued without a valid pre-existing patient-practitioner relationship as defined by the Texas Medical Board in 22 Texas Administrative Code (TAC) § 190.8 (relating to Violation Guidelines) or without a valid pre-scription drug order.
(1) A prescription drug order may not be dispensed or delivered by means of the Internet unless pursuant to a valid prescription that was issued for a legitimate medical purpose in the course of medical practice by a practitioner, or practitioner covering for another practitioner, who has conducted at least one in-person medical evaluation of the patient.
(2) A prescription drug order may not be dispensed or delivered if the pharmacist has reason to suspect that the prescription drug order may have been authorized in the absence of a valid patient-practitioner relationship, or oth-erwise in violation of the practitioner's standard of practice to include that the practitioner:
(A) did not establish a diagnosis through the use of acceptable medical practices for the treatment of patient's condition;
(B) prescribed prescription drugs that were not necessary for the patient due to a lack of a valid medical need or the lack of a therapeutic purpose for the prescription drugs; or
(C) issued the prescriptions outside the usual course of medical practice.
(3) Notwithstanding the provisions of this subsection and as authorized by the Texas Medical Board in 22 TAC § 190.8, a pharmacist may dispense a prescription when a physician has not established a professional relationship with a patient if the prescription is for medications for:
(A) sexually transmitted diseases for partners of the physician's established patient; or
(B) a patient's family members if the patient has an illness determined by the Centers for Disease Control and Prevention, the World Health Organization, or the Governor's office to be pandemic.
(c) If a pharmacist has reasons to suspect that a prescription was authorized solely based on the results of a ques-tionnaire and/or in the absence of a documented patient evaluation including a physical examination, the pharmacist shall ascertain if that practitioner's standard of practice allows that practitioner to authorize a prescription under such circumstances. Reasons to suspect that a prescription may have been authorized in the absence of a valid pa-tient-practitioner relationship, or in violation of the practitioner's standard of practice, include:
(1) the number of prescriptions authorized on a daily basis by the practitioner;
(2) a disproportionate number of patients of the practitioner receive controlled substances;
(3) the manner in which the prescriptions are authorized by the practitioner or received by the pharmacy;
(4) the geographical distance between the practitioner and the patient or between the pharmacy and the patient;
(5) knowledge by the pharmacist that the prescription was issued solely based on answers to a questionnaire;
(6) knowledge by the pharmacist that the pharmacy he/she works for directly or indirectly participates in or is otherwise associated with an Internet site that markets prescription drugs to the public without requiring the patient to provide a valid prescription order from the patients practitioner; or
(7) knowledge by the pharmacist that the patient has exhibited doctor-shopping or pharmacy-shopping tendencies.
(d) A pharmacist shall ensure that prescription drug orders for the treatment of chronic pain have been issued in accordance with the guidelines set forth by the Texas Medical Board in 22 TAC § 170.3 (relating to Guidelines), prior to dispensing or delivering such prescriptions.
(e) A prescription drug order may not be dispensed or delivered if issued by a practitioner practicing at a pain management clinic that is not in compliance with the rules of the Texas Medical Board in 22 TAC §§ 195.1 - 195.4 (re-lating to Pain Management Clinics).
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