Doctors, pharmacists compromise on method of substitution instructions for written and electronic prescriptions

After three weeks of discussions and negotiations, a single bill emerged from the House Insurance Committee dealing with how a doctor signs a prescription to note if substitutions are allowed.

Doctors would no longer have to use the same exact wording in their instructions to pharmacists on written prescriptions under HB69 by Rep. Arnold Mooney, R-Birmingham, as amended. Written prescriptions would still have two signature lines, each with its own option. Those options would be 1) indicate a brand name drug is to be dispensed or 2) indicate product selection is allowed.

The bill also makes it clear that the two-signature lines requirement doesn’t apply to phone or modern prescription methods. Under the bill, the process for electronic prescriptions and e-faxes would be the same as prescriptions called into a pharmacist. On an electronic prescription or e-fax, doctors would include dispensing instructions for the pharmacist just as a doctor would do if calling in a prescription into a pharmacy.

Pharmacists will continue to have to seek documentation from doctors of a medical necessity for dispensing a brand drug when a generic is available.

After a Tuesday public hearing, the Senate Health Committee approved legislation that would set standards for substitutions used for biologic medicines in Alabama. The committee amended SB245 to give pharmacists 24 hours, rather than 72 hours, to provide the prescribing doctor with the name and manufacturer of a biological product dispensed, if that product was substituted for the biologic prescribed by the doctor. The bill now goes to the full Senate for consideration.

The Alabama House of Representatives voted Thursday for compromise legislation to allow licensed Alabama pharmacists and physicians to enter into collaborative practice agreements. Collaborative agreements are used to integrate pharmacists into team-based patient care.

By Oct. 1, the Alabama Board of Pharmacy and the Alabama Board of Medical Examiners are each to draw up rules to govern the agreements, under HB35 by Rep. Ron Johnson, R-Sylacauga. The examiners will be responsible for the rules related to doctors, and the Pharmacy Board for those related to pharmacists. Each of the licensing boards also are to administer and collect any fees related to the agreements. The fees can be up to $300.

Other pharmacy-related bills that saw action this week or may next week include:

  • HB34 /SB108, legislation that allows a pharmacy technician to be reinstated by paying a maximum of five years’ worth of unpaid penalties and fees without having to be reexamined by the Alabama Board of Pharmacy. The maximum would apply no matter how long a technician had not paid their fees. The House approved its bill Tuesday, sending it to the Senate Governmental Affairs Committee. The Senate Health Committee approved SB108 on April 10, sending it to the full Senate for consideration.
  • HB7, which allows appeals of Alabama State Board of Pharmacy orders to be filed in the county the board’s headquarters are located, currently Jefferson County. The Senate Judiciary Committee will consider the House-passed bill next week. A similar bill – SB148 – awaits consideration by the same committee.

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