Please share this email with your members. I was recently advised that a third party provider declined to pay for several prescriptions because of the fact that the physician's DEA registration number was not written on the prescription by the physician. The amount in question was over $800 for the prescriptions. The pharmacy auditor's job is to find errors with a prescription in order for the third party provider to withdraw the payment for that prescription. That is their way of staying in business. In all cases, the third party provider will use the DEA regulations as a reason to deny payment for the prescription. The solution is very simple. Here is what DEA regulation Title 21, Code of Federal Regulations Section 1306.05 (a) Manner of Issuance of Prescription says.
"All prescriptions for controlled substances shall be dated as of, and signed on, the day when issued and shall bear the full name and address of the patient, the drug name, strength, dosage form, quantity prescribed, direction for use, and the name, address, and registration number of the practitioner"
The purpose of the label that is placed on the back of the prescription is to meet the requirement written in Title 21, Code of Federal Regulations Section 1306.14 (a) Labeling of Substances and Filling Prescriptions. Although the physician's DEA number is on the label, it is still required to be written on the prescription. Here is what the regulation on the use of the label says.
"The pharmacist filling a written or emergency oral prescription for a controlled substance listed in Schedule II shall affix to the package a label showing date of filling, the pharmacy name and address, the serial number of the prescription, the name of the patient, the name of the prescribing practitioner, and directions for use and cautionary statements, if any, contained in such prescription or required by law"
The next issue that a pharmacist needs to be aware of, because it is required by the DEA regulations, is the filling of a prescription before the date noted on the prescription. As you are aware, physicians are permitted to write a C-II 90-days supply by preparing three prescriptions with two indicating the earliest date it can be filled by the pharmacy. This also has been an issue that many pharmacies have had funds denied by the third party provider for filling before the date noted on the prescription. Again, the pharmacy auditors are using the DEA regulations. Title 21, Code of Federal Regulations Section 1306.14 (e) Labeling of Substances and Filling Prescriptions reads as follow.
"When a prescription that has been prepared in accordance with section 1306.12(b) contains instructions from the prescribing practitioner indicating that the prescription shall not be filled until a certain date, no pharmacist may fill the prescription before that date."
In some situations, the pharmacist can call the physician and advice the physician that there is a need to fill the prescription earlier than the date noted on the prescription. For example the date to be filled is a Sunday and the pharmacy is closed. If the physician concurs, the pharmacist needs to write that on the back of the prescription with the date and time the pharmacist spoke with the physician, the physician's concurrence, and your initials. My suggestion is for the pharmacist to make the call and note the back of the prescription.
MORE ON THIS TOPIC!!!!!!
I know this question comes up every so often. The DEA does not support the use of a DEA number as an identifier for non-controlled prescriptions. I encourage members to use the DEA Diversion website www.deadiversion.usdoj.gov They can scroll the "Info & Legal Resources Section" for the regulations. The 2010 version of the Pharmacist's Manual is also there which can be downloaded as a PDF file.
Question: Is it appropriate to provide a DEA registration number on prescriptions written for medications other than controlled substances?
Answer: DEA strongly opposes the use of a DEA registration number for any purpose other than the one for which it was intended, to provide certification of DEA registration in transactions involving controlled substances. The use of DEA registration numbers as an identification number is not an appropriate use and could lead to a weakening of the registration system. Although DEA has repeatedly made its position known to industries such as insurance providers and pharmacy benefit managers, there is currently no legal basis for DEA to prevent or preclude companies from requiring or requesting a practitioner’s DEA registration number.
The Centers for Medicare and Medicaid Services has developed a National Provider Identification (NPI) number unique to each healthcare provider. The Final Rule for establishment of the NPI system was published in the Federal Register (FR 3434, Vol. 69, No. 15) by the Department of Health and Human Services on January 23, 2004. The effective date of this Final Rule was May 23, 2005; all covered entities were to begin using the NPI in standard transactions by May 23, 2007. A contingency extension was provided to covered entities unable to meet the 2007 deadline. Contingency plans were to not extend beyond May 23, 2008.
Carlos M. Aquino
Compliance Consultant
PharmaDiversion LLC
1167 West Baltimore Pike, Suite 231
Media PA 19063-5127
"Contact us before DEA or ...."
PHONE: 610-487-4663
FAX: 484-480-8985
Email: carlos@pharmadiversion.com
Website: www.pharmadiversion.com
Editors Note ---
YOU STILL HAVE TO ABIDE BY PBM RULES ON THIS TOPIC - ALL SEEM TO ACCEPT NPI NUMBER FOR NON-SCHEDULED DRUGS - Make sure your settings within your computer are correct in reference to what is sent to PBM according to PBM rules who are paying. If you find any PBM's not abiding by Federal Law, please let us know.....