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Tamper Resistant Prescription Drug Pad Program

• Overview
• Schedule of Drugs
• How the Tamper Resistant Prescription Drug Pad Works
• Prescription Pad Ordering and Security
• Completing a Prescription
• Schedule I – Drugs Required to be Written on Tamper Resistant Pads
• Facsimile Transmission of Prescriptions for Community Pharmacies
• Order Forms

Overview

The Department of Health and Community Services, in partnership with the College of Physicians and Surgeons of Newfoundland and Labrador, Newfoundland and Labrador Medical Association, Newfoundland and Labrador Pharmacy Board, Pharmacists’ Association of Newfoundland and Labrador, Newfoundland and Labrador Dental Board, Newfoundland and Labrador Dental Association, Newfoundland and Labrador College of Veterinarians, and the Royal Newfoundland Constabulary, has established a tamper resistant prescription drug pad program.

The purpose of tamper resistant prescription drug pads is to reduce prescription drug abuse and diversion by reducing the likelihood for prescription forgeries and/or alterations. The tamper resistant prescription pads contain a number of security features that make it difficult to duplicate or alter. These features assist prescribers to fulfill their professional responsibilities by allowing appropriate access of these medications to patients who require them, while being vigilant against some of the factors that facilitate drug abuse and drug diversion.

Under this program, prescriptions for the drugs listed in the attached Schedule of Drugs will no longer be accepted via telephone at pharmacies.

Faxed prescriptions will be allowed but will require the use of the tamper resistant prescription drug pad. In extenuating circumstances, where the use of the tamper resistant prescription pad is not possible, the spirit of section 5(c) of the Standards of Pharmacy Practice for the Facsimile Transmission of Prescriptions for Community Pharmacies will apply (appended).

It is important to note that the tamper resistant drug pad program is not a monitoring program. It is in response to the issue of prescription drug abuse and concerns regarding the diversion of certain prescription drugs, some of which is the result of prescription forgeries and alterations.

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Schedule of Drugs

The Schedule of Drugs provided with this document is complete for the active ingredients of the drugs that require the use of the tamper resistant prescription pad. Due to the fact that drug names vary over time and new drugs are added to the market, this list will be updated periodically to advise prescribers and pharmacists of the additions. Prescribers should note that benzodiazepines are NOT included in this schedule of drugs, and therefore are NOT required to be written on the tamper resistant prescription pads.

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How the Tamper Resistant Prescription Drug Pad Works

Participation: Participation of all physicians, dentists, and veterinarians is mandatory. Changes have been made to the Regulations to the Pharmacy Act and the Medical Act, and have been endorsed by the College of Physicians and Surgeons of Newfoundland and Labrador, the Newfoundland and Labrador Dental Board, and the Newfoundland and Labrador College of Veterinarians, indicating that the prescription drugs listed in the Schedule of Drugs must be completed according to the guidelines contained in this document. This also applies to prescriptions that are faxed to pharmacies.

Schedule of Drugs: All drugs specified in the attached Schedule of Drugs must be prescribed using the tamper resistant drug pad.

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Prescription Pad Ordering and Security

Personalized Prescription Pad Ordering: With few exceptions, an initial supply of five (5) pads of 50 prescriptions will be provided to all practicing physicians in the province. Dentists will be provided with two (2) pads, veterinarians with one (1) pad. Further supplies of prescription pads may be ordered from the Department of Health and Community Services by sending a re-order form (appended) by fax or mail to the Pharmaceutical Services Division, Department of Health and Community Services. Prescribers should note that the maximum number of pads that can be ordered at any one time is 10, to avoid security issues which may arise due to the storage of excess supplies in their offices.

New Registrants and Locum tenens: New registrants and Locum tenens will receive an initial supply of generic prescription pads, using the tamper resistant features that they will be required to use. These tamper resistant prescription pads will not be monogrammed and the new registrants and locum tenens will be required to fill in this information. The College of Physicians and Surgeons of Newfoundland and Labrador will facilitate this distribution.

Hospital Prescription Pads: A supply of pads has been printed with the names and addresses of hospitals and clinics on them. Arrangements have been made with the Medical Directors of Emergency Rooms (for larger centers) and Hospital Medical Directors (where the former do not exist), for distribution, storage, and re-ordering of these pads. These pads will be supplied to hospitals for use in their Emergency Rooms and other areas as deemed appropriate by the Medical Directors, or their designates.

Security: Tamper resistant prescription pads should be kept in a secure location, preferably under lock and key.

Transfer of Personalized prescription pads: Personalized prescription pads cannot be transferred between prescribers.

Loss or theft: Loss or theft of the tamper resistant prescription pad must be reported immediately to the Newfoundland and Labrador Pharmacy Board (NLPB) at 709-753-5877, or toll free at 1-877-453-5877, located at 488 Water Street and to the Pharmaceutical Services Division of the Department of Health and Community Services at 709-758-1557. The NLPB will issue an alert to all pharmacies in the province regarding the missing pads. Prescribers should also notify the local police at 729-8000 (Royal Newfoundland Constabulary) or 1-800-709-7267 (Royal Canadian Mounted Police).

Fraud: Prescriptions presented that are suspected of being fraudulent should be reported to the local police at 729-8000 (Royal Newfoundland Constabulary) or 1-800-709-7267 (Royal Canadian Mounted Police).

Destruction of the tamper resistant prescription pad: The prescriber is responsible for returning, via a secure method, any extra copies of the tamper resistant prescription pads to the Department of Health and Community Services, at the following address:

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Completing a Prescription

Use of Prescription Pad: Prescriptions must be written on the approved prescription pad, even when being faxed to pharmacies. Faxed prescriptions must be written on the approved tamper resistant prescription pad in accordance with the Standards of Pharmacy Practice for the Facsimile Transmission of Prescriptions for Community Pharmacies. All information required on the approved prescription pad must be transmitted to the pharmacy in order to have a prescription filled.

According to the Standards of Practice for faxed prescriptions, the following must be adhered to:

• The prescription cannot be faxed by the patient, it must come from the prescriber.
• The original must not be given to the patient, but must be invalidated or destroyed by the prescriber (to avoid potential double dispensing).
• The faxed prescription must include the name of the pharmacy to which it is being faxed (to avoid potential double dispensing).

Please note: Failure to complete all sections of the prescription pad entirely and accurately will result in the pharmacist refusing to fill the prescription.

Quantities, duration and dosage: Quantities and dosage must be entered in both alpha and numerical format. (e.g. 40 and forty). This is considered best practice for all written prescriptions as a safeguard against tampering. Indication of the duration [e.g. 30 (thirty) days supply] is an acceptable alternative to alpha numeric number of units/quantity in writing a prescription for a drug in the attached schedule.

Medical Care Plan (MCP) Number: Include the patient's Medical Care Plan (MCP) number on all prescriptions (with the exception of veterinary patients). For out of province patients, use their provincial health insurance plan number. For members of the Canadian Forces and the RCMP, use their service number or regimental number. Pharmacists should enter only the Medical Care Plan (MCP) number in their computer files.

Physicians Office Supply: The approved prescription form is required for the purchase of narcotics and controlled drugs that are to be used by the prescriber in the normal conduct of his/her practice. The prescriber should complete the prescription in his/her own name and use his/her license number in place of the Medical Care Plan (MCP) number. The form should be annotated “For Office Use”. This is in accordance with the requirements outlined by Health Canada in the Controlled Drugs and Substances Act.

Refills and part refills: Refills are not permitted for narcotic prescriptions. For part fills, the total quantity, the quantity of each fill, and the time interval between fills must be specifically indicated both on the prescription and in the pharmacist’s patient’s files. An example of an appropriately written part fill is as follows:

MS Contin 60mg (sixty mg)
i p.o. Q12h
supply 180 (one hundred and eighty) tablets
in lots of 60 (sixty)
at intervals of 30 (thirty) days

Prescription Pad security features: Below you will see a representation of what the Tamper Resistant Pad will look like. The first sample shows a personalized pad, the second sample shows a hospital pad.

Numerous security features are incorporated into the pad, the details of which will be provided to you by the Printer when you receive your initial supply. Most of these features are not visible in the representation provided in this document.

     

Instructions for completion of the Tamper Resistant Prescription: Provide complete name and address: the Medical Care Plan (MCP) number must be entered by the prescriber (with the exception of prescriptions issued for veterinary patients). For out of province patients, members of the Canadian Forces and the RCMP, enter their provincial health insurance plan number or service number as appropriate. Pharmacist should enter only the Medical Care Plan (MCP) number on their computer files.

1. Print the drug name, strength as well as dosage and specific instructions for use.
2. Enter the quantity and dosage in both written and numerical form.
3. Only two drugs may be entered on each prescription form. If writing a prescription for narcotics, other drugs can be included.
4. Sign and date using the format: DD/MM/YY.
5. Print your license number.
6. Approved prescription pads contain a preprinted serial number and prescriber identification (i.e. doctor’s name, address, and phone number).

While not mandatory (unless faxed), indicating the Pharmacy to dispense is recommended. Choice of pharmacy should follow discussion by prescriber and patient. Once chosen, no other pharmacy can dispense without contacting the physician (verbal confirmation of pharmacy site is acceptable). At a minimum, written prescriptions for patients with whom prescribers have a contract in place that requires adherence to one pharmacy should have the name of that pharmacy indicated on the prescription.

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Schedule I – Drugs Required to be Written on Tamper Resistant Pads

• Schedule of Drugs (64 KB)

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Facsimile Transmission of Prescriptions for Community Pharmacies

Background

In November 1997, the National Association of Pharmacy Regulatory Authorities’ Council approved the "Report on the Transfer of Authority to Fill Prescriptions by Facsimile Transmission" which was developed by the Provincial Pharmacy Registrars in conjunction with what was then the Health Protection Branch (HPB). The Report's recommendations have been widely accepted as the standards that pharmacists must meet in order for prescriptions to be legally dispensed pursuant to receiving a prescription order by fax from a prescriber in this province as well as most others.

The Registrars of NAPRA's Inter-Provincial Pharmacy Regulatory Committee recently reviewed the 1997 document for relevance to current practices. Through this review process a number of amendments were identified. The revised model policy was approved by NAPRA Council in November 2001 and is incorporated into this document.

Facsimile Transmission of Prescriptions

"Facsimile transmission" means transmission of the exact visual image of a document by way of electronic equipment. Prescription drug orders may be transmitted by facsimile by a prescriber to a pharmacy, provided that the following requirements are met: (Amended April 14, 2002)

1. The prescription must be sent only to pharmacy of the patient's choice with no intervening person having access to the prescription drug order.
2. The prescription must be sent directly from the prescriber's office, directly from a health institution for a patient of that institution, or from another location, provided that the pharmacist is confident of the prescription's legitimacy. (Amended April 14, 2002)
3. The equipment for the receipt of the facsimile prescription must be located within a secure area to protect the confidentiality of the prescription information. (Amended April 14, 2002)
4. The prescription must include the:
   • Date of issue
   • Patient's name and address
   • Name of the drug or ingredient(s) and strength where applicable
   • Quantity of the drug which may be dispensed
   • Dosage instructions for use by the patient which shall include a specific frequency or interval or maximum daily dose
   • Refill authorization where applicable, which shall include the number of refills and interval between refills
   • Prescriber's Name, address, telephone number, fax number and signature or unique identifier (as approved by the Pharmacy Regulatory Authority)
   • Time and date of transmission
   • Name and fax number of the pharmacy intended to receive the transmission
   • Signed certification that:
     1. the prescription represents the original of the prescription drug order,
     2. the addressee is the only intended recipient and there are no others, and
     3. the original prescription will be invalidated or retained so that it cannot be re-issued.
5. a) The pharmacist is responsible for verifying the origin of the transmission and the authenticity of the prescription.
   b) The pharmacist must specifically confirm the authenticity of a faxed prescription for a drug which by regulation must be written on a tamper resistant prescription blank, through contact between the pharmacist and a person at the site of transmission who can verify the transmission of that prescription.
   c) The pharmacist may use his/her professional judgment to dispense a short-term supply of a medication to an individual, when the pharmacist is not able to obtain verification of the faxed prescription within a reasonable time frame and the individual for whom the prescription is written will suffer undue hardship. (Amended May 29, 2004).
6. The prescription drug order must be maintained on permanent quality paper by the pharmacy.
7. Facsimile transmission may be accepted from any licensed practitioner with prescribing authority under the Pharmaceutical Association Act. (Amended April 14, 2002)
8. Pharmacist-to-pharmacist communication of prescription transfers (for other than narcotics and controlled drugs) may be completed by facsimile transmission. The transferring pharmacist must include his or her name and the address of the pharmacy with the other required documentation as required by federal and provincial legislation. The name of the pharmacist requesting the transfer must also be known and recorded on the document to be faxed. The receiving pharmacist must ensure the authenticity of the transmission. (Amended April 14, 2002)
9. A prescription received by facsimile transmission in accordance with these Standards may be considered by the pharmacist to be equivalent to a written prescription. (Amended April 14, 2002)

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