The Government, on Friday the 3rd of April 2020, signed amended prescription legislation to support patients , prescribers , pharmacists and pharmacy technicians during this SARSCOV-2 pandemic facing the world.
These amendments will give extra support to pharmacy staff and prescribers to enable patients to enjoy a longer duration of continuation of medicinal supply and reduce the amount of time they spend having to travel and chase up scripts.
This article is divided into two parts, the first part summarises the changes the second part goes into details of the changes
Part 1 – Summary (TL;DR)
Electronic Transfer of a Prescription
The electronic transfer of a prescription via healthmail is now legal and valid. The prescription has to be sent ONLY via healthmail and this can be used for all prescription medicine types. Read more
The maximum validity has been temporarily increased from 6 months to 9 months from the date the prescription was written.
This applies to all prescriptions medicines excluding CD2 and CD3 medicines.
This is only to be used when the pharmacist is satisfied continued treatment is required and it is safe and appropriate to make an additional supply. Read More
Number of repeats allowed to be made
The number of times a prescription may be repeated has been increased for both S1A and S1B medicines . It must be noted that the extension to the number of repeats varies depending on the scenario. Read More
Emergency supply – At the request of the prescriber (rx furnished within 72 hours)
A pharmacist can now dispense up to 5 days emergency supply of a CD2, CD3 or CD4 in defined circumstances at the request of the prescriber.
A prescriber can now also request and emergency supply of the CD4Part1 medicines midazolam, clobazam and clonazepam for the purpose of treating epilepsy . This is now in-line with non-CD S1A and S1B medicines and in this case there is no limit on the number of days that may be given. Read More
Emergency Supply – At the request of the patient
A pharmacist can now dispense up to 10 days emergency supply of a prescription only medicine at therequest of a patient and this includes CD4Part1 medicines midazolam ,clobazam and clonazepam for epilepsy.
A pharmacist can dispense up to 5 days emergency supply of a CD2,CD3 or CD4 medicine in defined circumstances at the request of the patient. Read More
If the prescription that is being dispensed has been sent to the PCRS for claiming, the pharmacist is exempt from endorsing the prescription but they will need to record the reasons on the daily audit for making the supply.
Pharmacists will need to print any prescriptions sent via healthmail and this is the piece of paper to be endorsed as we normally would a prescription. Read More
Part 2 – Detailed Explanation
This section is broken into 6 main parts which signify the different changes which the amendment has brought
- Electronic Prescription Transfer Now Legal
- Prescription Validity Increased
- Repeat Supply Changes
- Emergency supply at the request of the prescriber
- Emergency supply at the request of the patient
- Record Keeping Changes
1. Electronic Prescription Transfer Now Legal
1a. Brief Information
- It must be sent from the GP’s @healthmail.ie account to your pharmacy’s healthmail.ie email account.
- This includes prescriptions for CD2, CD3 and CD4 medicines, so ALL prescriptions may be sent via healthmail.
- The following criteria must be met for it to be legally valid:
- Be in electronic form
- Be transmitted via healthmail
- Clearly indicate the date of issue
- Clearly indicate the professional registration number of the prescriber
- Be traceable electronically back to the prescriber.
- All other prescription requirements under the relevant legislation must still be met
1b. Dispensing an Electronic prescription
- You must print a copy of the prescription as transmitted and treat this now as the original prescription for all intents and purposes. This includes re-imbursement and endorsements.
- There is no need to request the paper version of the prescription from the prescriber.
- You are not allowed to dispense prescriptions that are not sent via healthmail.ie email accounts as electronic transfer prescriptions. In those cases, you may need to treat them as emergency supply at the request of the prescriber and ask them to furnish you with the original prescription.
- You are allowed to forward this prescription via healthmail to another pharmacy for subsequent dispensing.
- For CD2 and CD3 prescriptions that are sent via healthmail the prescription writing requirements still apply BUT the requirement for things to be the in the prescriber’s own handwriting are waived. So it is similar to the CD4-Part 1 prescriptions requirements which do not have to be handwritten.
2. Prescription Validity Increased
- Length of time for prescriptions to be valid is now 9 months rather 6 months as previous.
- This is only meant to be used ,where the pharmacist after using her professional judgement ( i.e consulting with patient and/or prescriber) can ascertain that continued treatment is both required and safe to continue.
- There are no changes to CD2 and CD3 validity , the 14 day rule still applies.
- Additional supplies may be made against prescriptions that had been dispensed in full prior to Covid-19 Emergency provisions.
3. Repeat Supply Changes
- Number of times a prescription may be repeated has been increased. These exclude CD2/CD3 and for CD4-part 1 medicines the repeats that are set by the prescriber must be followed.
- CD2/ CD3 medicines still can not be repeated!
- CD4 medicines must still only be repeated the number of times that were specified by the prescriber and cannot be changed or increased by the pharmacist.
For the purpose of clarity in the examples below;
- number of occasions in this document is meant to mean the number of repeats or the number of dispensings ( repeat x 5 , rpt x5 , x6/12 etc)
- Intervals are meant to mean if the prescriber states a prescription should be dispensed monthly, weekly , fortnightly etc. )
3a. S1A rules (Repeat Supply)
3a(i) Scenario 1:
- A prescription that does not state the number of occasions nor the intervals may be dispensed one additional time if the pharmacist decides it is appropriate. (see example below)
- Total dispensings = 2.
- Change : used to be 1 dispensing
3a(ii) Scenario 2:
- A prescription that is on a health (PCRS) based prescription (think of these as the prescriptions we usually have to submit for claims) may be dispensed up to 3 additional times, where it is the opinion of the pharmacist that is is appropriate and necessary to do so. (see example below)
- Total dispensings = 4.
- Change: used to be only able to use these prescriptions once.
- This is in-line with the new PCRS guidelines on claim submissions for prescriptions due to COVID-19
3a(iii) Scenario 3:
- A prescription that states the intervals but NOT the number of occasions can be dispensed on up to 4 occasions.
- Total dispensings = 4.
- Change : used to be up to 3 occasions.
3a(iv) Scenario 4:
- A prescription that states the number of occasions that a medicine can be supplied but omits the intervals may be dispensed at appropriate intervals the pharmacist deems appropriate except now the prescription validity is increased to 9 months.
- Change : used to be for six months.
3a(v) Scenario 5 :
- A prescription where the number of occasions specified on the prescription has been reached ( the prescription has been fully dispensed) it may be dispensed on 3 further occasions.
- Change : previously this was not allowed.
3. S1B rules (Repeat Supply)
3b(i) Scenario 1:
- A prescription that does not state the number of occasions nor the intervals ( can now be supplied by a pharmacist for up to 9 months.
- Change : used to be 6 months
3b(ii) Scenario 2:
- A prescription that states the intervals but not the number of occasions it may be dispensed, can be supplied at the appropriate intervals as written on the prescription for up to 9 months.
- Change : the validity of the prescription has changed from 6 months to 9 months
3b(iii) Scenario 3:
- A prescription where the number of occasions specified on the prescription has been reached (i.e the prescription has finished), The prescription may be dispensed a further 3 times where in the opinion of the pharmacist it is appropriate to and necessary for the continuation of treatment.
- Change : previously the prescription would have been deemed finished.
4. Emergency supply at the request of the prescriber.
- A prescriber can usually request a pharmacist to supply medicines to a patient and they must undertake to provide a prescription to the pharmacy within 72 hours, this used to exclude medicines classified under the CD regulations.
- Now prescribers can request an emergency supply for CD2/CD3 and CD4 medicines in the following circumstances
- It is unreasonable at the time of supply , for the patient to obtain a new prescription
- It is in the opinion of the pharmacist that it is safe
- A maximum of 5 days treatment is supplied.
- If the product happens to be the CD4-part 1 medicines ( midazolam , clobazam or clonazepam ) for the treatment of epilepsy , it can be treated as a regular emergency supply, at the request of the prescriber.
5. Emergency supply at the request of the patient
- A pharmacist may dispense an emergency supply of up to 10 days’ supply of a prescription only medicines where the treatment has been prescribed for the patient before except controlled drugs which are a maximum of 5 days
- CD2, CD3 and CD4 medicines can now be supplied but a maximum of 5 days.
- If the product happens to be one of the following CD4-part 1 medicines(midazolam , clobazam or clonazepam) for the treatment of epilepsy up to 10 day’s supply may be dispensed.
6. Record Keeping Changes
- If the physical piece of paper prescription that is being used as a reference to dispense has been sent to the PCRS for claiming, the pharmacist is exempt from endorsing the prescription but they will need to record the reasons and information on the daily audit for making the supply. ( I suggest using photocopies /scans as well)
- Pharmacists will need to print any prescriptions sent via healthmail and this is the piece of paper to be endorsed and this is done as normal.
- The printout of the electronic prescription as well as the original prescription sent via healthmail must be retained for a period of two years in the pharmacy. The retention period beings from the date on which the medicinal product was supplied or for repeat prescriptions the date from the last dispensing