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Tamper Resistant Prescription Drug Pad Program

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, established a tamper resistant prescription drug pad program (TRPP).

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 cannot 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, veterinarians and nurse practitioners is mandatory in order to prescribe for the drugs listed in the attached Schedule of Drugs. Changes have been made to the Regulations to the Pharmacy Act, Medical Act Registered Nurses Act and endorsed by the College of Physicians and Surgeons of Newfoundland and Labrador, the Newfoundland and Labrador Dental Board, the Newfoundland and Labrador College of Veterinarians and the Association of Registered Nurses of Newfoundland and Labrador 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, pads containing 50 prescriptions can be obtained in quantities noted below to healthcare providers within the province of Newfoundland and Labrador:

Practicing physicians – a maximum reorder quantity at any one time of ten (10),
Dentists – a maximum reorder quantity at any one time of ten (10),
Veterinarians – a maximum reorder quantity at any one time of ten (10),
Nurse practitioners – a maximum reorder quantity at any one time of two (2) pads.

Supplies of prescription pads can be ordered from the Department of Health and Community Services by sending an order form (appended) by fax or mail to the Pharmaceutical Services Division, Department of Health and Community Services.

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

Hospital Prescription Pads: Supplies of pads have 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:

  1. The Newfoundland and Labrador Pharmacy Board (NLPB)
    488 Water Street
    709-753-5877, or toll free at 1-877-453-5877
    (The NLPB will issue an alert to ALL pharmacies in the province regarding the missing pads)


  2. AND

  3. The Pharmaceutical Services Division, Department of Health and Community Services,
    709-729-6507, or toll free at 1-888-222-0533.
  4. Prescribers should also notify the local police:
    Royal Newfoundland Constabulary 709-729-8000
    Royal Canadian Mounted Police 1-800-709-7267

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

Pharmaceutical Services Division
Department of Health and Community Services
45 Major’s Path
St. John's, NL A1A 4Z9
Tel: 709-729-6507
 

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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 these samples.

private doctors office      hospital pad

nstructions 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 prescriber (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

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Facsimile Transmission of Prescriptions and Personal Health Information

Introduction

Standards of Practice are minimum standards that all registrants are expected to meet. Regardless of position or practice environment, when a registrant performs a specific role, they must perform it to the level specified in the Standards of Practice and meet all of the standards associated with that role. These Standards describe the minimum expectations for pharmacists and pharmacy technicians in accepting prescriptions that have been transmitted to the pharmacy by facsimile from the prescriber as well as in sending patients’ personal health information to other custodians for the purposes of prescription transfer or continuity of care.

Requirements

  1. Prescriptions transmitted via fax must be sent only to a pharmacy of the patient's choice with no intervening person having access to the prescription.
  2. Prescriptions transmitted via fax must be sent directly from the prescriber's office, a health institution for a patient of that institution, or from another location, provided that the pharmacist is confident of the prescription's legitimacy.
  3. Prescriptions transmitted via fax must include all pertinent prescription details and should also include:
    1. Name and fax number of the pharmacy intended to receive the transmission
    2. Time and date of transmission
    3. Signed certification that:
      • the prescription represents the original of the prescription,
      • the addressee is the only intended recipient and there are no others, and
      • the original prescription will be invalidated or retained so that it cannot be re-issued.
  4. When receiving a prescription that was transmitted via fax, the pharmacist must be confident in the origin of the transmission and the authenticity of the prescription.
    1. Specifically, he or she must confirm the authenticity of faxed prescriptions for drugs subject to the Government of Newfoundland and Labrador’s Tamper Resistant Prescription Drug Pad Program, by contacting a person at the site of transmission who can verify the transmission of that prescription.
    2. 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.
  5. As outlined in the Standards of Pharmacy Operation, prescription transfers may be completed via fax as long as the transmitted document contains all information required for a transfer including:
    1. identity of the transferring pharmacist or pharmacy technician;
    2. name and address of the originating pharmacy;
    3. identity of the receiving pharmacist or pharmacy technician; and
    4. name and address of the receiving pharmacy.
  6. When sending prescriptions or other personal health information via fax, pharmacists and pharmacy technicians must be sure that the fax number being used is correct and that the transmission is being sent to the intended recipient. If a privacy breach was to occur and information was inadvertently transmitted to the incorrect recipient, this must be communicated to the patient, in accordance with the Personal Health Information Act (PHIA).
  7. A prescription received by facsimile transmission in accordance with these Standards may be considered to be equivalent to a written prescription.

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