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Pharmacy Technician Career Environments. Retail Pharmacy - PowerPoint PPT Presentation

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Pharmacy Technicians Course. LaGuardia Community College

Pharmacy Technician Career EnvironmentsRetail PharmacyRetail pharmacy, also know as community based pharmacy or community pharmacy, is a very common environment in which pharmacy technicians are employed. These pharmacies provide prescription services and an outlet for the sales of commonly purchased good and services.Retail pharmacies consists of independent pharmacies and chain pharmacies.In general, the major benefit of retail pharmacies is accessibility. Often the patient will go to see the pharmacist at a retail store first before seeking medical attention for which they may have limited access to or no insurance to help cover the costs.Independent PharmacyOwned as a sole proprietorship by one or a few owners.Provide prescription filling along with other ancillary services (surgical supplies, vitamins, hallmark)Often provide personal services Major benefit: familiarity of the pharmacists with the customersDisadvantage: may not have the pricing power of larger chain stores.Chain Drug StoresNational franchises like Walgreens, CVS, Rite Aid, and Duane Reade (east coast) have many stores around the US and/or in a regional areaOffer convenience with many stores operating 24/7Major advantages: pricing power, convenience, and accessibility.Disadvantages: lack of personalized service between pharmacist and patient.Retail StaffSupervising pharmacist: a full time pharmacist who is in charge of the legal and administrative aspect of the pharmacyStore Manager: a person, who may or may not be a pharmacist, that is in charge of the operation of the store in generalTypically the store is divided into front end and back end.Front end deals with OTC issues and other non medication issues a customer may haveBack end contains the pharmacy Stores the legend medicationsStores other restricted meds and higher priced devicesBlood glucose strips, blood pressure monitors, Plan B, and products that contain pseudoephedrine.Combat Methamphetamine epidemic act of 2005 requires removal of pseudoephedrine products from the public area and mandates record keeping with the per transaction limit of 3.6 grams per patient.Regulatory AgenciesState Boards of Pharmacy regulates the practice of pharmacy which in NYS are contained in the education law of the board of regents article 137, the public health law article 33 for controlled substances, and the NYSRR title 10 among others. SBOP conducts inspections of pharmacy facilities.Centers for Medicare and Medicaid Services: CMS regulates the federal programs of Medicare and Medicaid along others. CMS conducts inspections to ensure compliance with federal regulations.Third Party Payers: Third party insurance companies also may conduct inspects of pharmacy establishments to determine if contractual agreements are kept between insurance payer and the pharmacy.The Prescription The pharmacy technician is often the first person to examine the patients prescription for completeness and other issues.Due to this it is very important that a pharmacy technicians understands the basic elements of the prescription to save time and to ensure customer satisfaction. This is probably the technicians primary function in the retail setting.

The Elements of the PrescriptionPatients name, address, and age.Prescribers name, address and phone. Date it was writtenName, strength, and quantity of drugDirections for useSignature of the prescriber (very important)Route of administrationProduct selection permitted (if brand or generic permitted)

Probably the most important element on the prescription is the signature of the prescriber. Whether electronic or hard copy the signature must be there for the prescription to be valid.In NYS, according to article 137 of the education law 6802 electronic prescriptions are allowed in NYS. An electronic prescription is a prescription that is created and generated by the prescriber and sent electronically (E prescribing). Prescriptions for controlled substances are not permitted to be electronically generated in NYS; however under federal law CIII-CV can be sent electronically. In all cases CII cant e-prescribedSection 6810 states that in addition to the signature, the stamped or imprint name of the prescriber must be on the prescriptionIn NYS, the pharmacist is permitted to clarify and enter data on the prescription to include all information with the exception of the signature. If a prescription is filled without the signature the pharmacist will be guilty of professional misconduct under Part 29.7 of the board of regents. In addition, the date cant be added on an Rx for a controlled substanceIf the patients information and/or the prescribers information is readily retrievable in the pharmacy computerized records, the physical presence of this information on the prescription is not necessary The face of the prescription must be signed or initialed by the pharmacist with the date filled; refills must be documented on the back with the date filled along with the Pharmacists initials. Records of refills may be stored electronically (NYS)Remember, CII cant be refilled. CIII can be refilled 5 times or 6 monthsCIV and CV for 11 refills or one year.

Prescription Elements ContinuedOther elements on the prescription may includePrescribers license number and registration numberPrescribers DEA number (required to write a controlled substance prescription)Prescribers NPI or national providers identification number. This is required by medicare in the filling of surgical products.DEA NumbersAny entity handling controlled substances in the US from prescribing , dispensing and manufacturing requires registration with the DEA of the US Department of Justice.Consists of two letters A or B followed by the first letter of the prescribers last name following by a seven digit number. One way to determine if a DEA is fraudulent is the calculate the sum of digits 1,3, and 5 and add it to twice the sum of 2,4,and 6. The result will have a digit which should match the check digit of the DEA number, the last digit NPI numbersThe NPI is a ten digit number that was created by HIPAA act of 1996. The NPI is a unique identifier that is used by CMS to identify healthcare providers for the purposes of administrative issues and reimbursements.Often other third party payers utilize this number to file claims and payments to pharmacies.Often an adjudication is denied because of lack of prescribers NPI. The NPI for various providers can be found at: https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart

Who can write prescriptions?MDNPDODVMDPMOphthalmologistsDDSPA Physicians assistants can in general write for prescriptions so long as their primary supervising physician name, address, and registration number is on the prescription. Often the PA will use his/her physicians prescription blank so long as the PA signs the Rx and stamps his/her name on it with his registration number.Physician Assistants, as of 2007, can write for prescriptions for CII and other scheduled drugs. In this case he/she would use his own Rx blanks with their own DEA numbers. NYS Official Prescription ProgramPublic Health Law 21 requires all prescriptions for controlled drugs and other legend drugs to be issued on an official NYS prescription which contains all required information on it with the NYS seal, and a serialized number on the lower right hand corner.Issued in an attempt to discourage doctor shopping and to monitor prescription drug usage patterns in the state.When using electronic prescribing official Rx not required.Filing PrescriptionsMost states require hard copy Rx to be stored for a 5 year period.Further federal regulations require that controlled substance Rxs be filed in such a way as to be easily retrievable by law enforcement.Option 1: three separate cabinets for CII, CIII-CV, and other legend Rxs.Option 2: two drawer system: CII-CV with CIII-CV marked with a C in the lower right corner in one drawer and all other prescription in second drawer.Prescription TransfersA refill may be transferred from one pharmacy to another either in the same state or different states.A pharmacist is to handle Rx transfers.Some states allow transfer of all of patients Rx refills. In NY only one transfer at a time is allowed.Summary of the Retail Prescription Patient and Prescribers name and addressPrescribers license #, Registration # and/or NPI Drugs name, strength, quantity and directions from useRouteSpecific issues (DAW or not, easy caps, etc)Signature of prescriberIn some states, the imprinted name of prescriber must be on RxFederal Law on Retail PrescriptionFederal law provides many means to issues prescriptionsElectronically (even for controlled substance C3-C5, C2 can be filled but must have written script to release to patients)Fax copies of C3-C5 are acceptable as original (remember state law may be stricter)Controlled Substance Rx: Federal lawC2 No fax as original (exceptions: LTCF, Hospice, Infusion care)30 days onlyNo refillPartial fill ok with remainder to be fill in 72 hours. If cant fill balance in 72 hours, the balance is voided. (exception is LTCF or terminal ill patient)

C3-C430 days only5 refills in 6 monthsC5 (Federal Law)Depending on state law can be dispensed without a prescription Codeine containing cough syrup must be combined with other med and be no more than 2 mg/ml codeinePatient must be 21 or olderSale by pharmacistLog book maintainedMax of 120 ml in 4 daysOral Controlled Substances (Federal Law)Permitted on C3-CV (in NYS 5 days for C2, C3 and C5)C2 emergency oral RxFor the emergency period only ( 5 days in NY)Must reduce to writing by pharmacistNo alternative available72 hours MD must deliver hard copy To destroy controlled substancesMust notify DEA office and state narcotic office (NYS DOH Bureau of Narcotic Enforcement) of Day and time of destructionDEA 41 is used

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