9.1 Patient Counseling Requirements (Rule 6800.0910)

9.1 Patient Counseling Requirements (Rule 6800.0910)

Quick Answer: Under Minnesota Rule 6800.0910, licensed pharmacies must maintain a written patient consultation procedure. On a new prescription, after reviewing the patient record, a pharmacist shall personally initiate discussion of matters that will enhance or optimize drug therapy with the patient or caregiver. That is stricter than a bare OBRA ’90 “offer to counsel.” Support staff may not decide which new Rxs need counseling or convert the duty into “Do you want to talk to the pharmacist?” Refills are counseled when the pharmacist’s judgment requires it. Mail/delivery still demands consultation via written information, pharmacist availability, and a toll-free number for long-distance calls.

Counseling sits in NABP Area 2 (Pharmacist Practice) and is one of the clearest places Minnesota raises the federal floor. OBRA ’90 and Medicaid DUR rules create a national expectation that patients can access pharmacist counseling. Minnesota’s rule names the pharmacist as the actor who starts the conversation on new prescriptions and ties counseling to a documented pharmacy procedure and a profile-informed review.

Written Consultation Procedure (Subpart 1)

Every Minnesota pharmacy required to provide counseling under this part must develop and maintain a written patient consultation procedure. The procedure must provide for direct oral communication between the patient and the pharmacist, designed to improve the patient’s understanding of and compliance with drug therapy and to enhance or optimize outcomes.

Exam reflexes:

1. Counseling is not “whatever the cashier says at the drive-through.”
2. The PIC/pharmacy needs a written process the Board can inspect—not only ad-hoc habits.
3. The design goal is therapeutic outcome, not customer-service theater.

New Prescriptions: Pharmacist-Initiated Discussion (Subp. 2.A)

When dispensing a filled prescription, a pharmacist must consult with the patient (or agent/caregiver) and inquire about the patient’s understanding of the drug’s use, according to the rule. The high-yield new-Rx standard is:

Upon receipt of a new prescription, following a review of the patient’s record, a pharmacist shall personally initiate discussion of matters that, in the pharmacist’s professional judgment, will enhance or optimize drug therapy with each patient or the patient’s agent or caregiver.

Unpack every phrase for MPJE stems:

Minnesota vs. “offer to counsel”

Many candidates import a weaker mental model: “offer counseling; if they say no, done.” Minnesota’s new-Rx language is personally initiate discussion after record review. A technician or clerk who asks, “Do you have any questions for the pharmacist?” or who triages which new Rxs “deserve” counseling is not performing the pharmacist’s duty. Support staff may facilitate logistics (call the patient to the counseling window, hand written leaflets after pharmacist counseling is arranged), but they may not:

• Determine which new prescriptions need counseling
• Substitute an offer-to-speak for pharmacist-initiated counseling on a new Rx
• Conduct the required professional counseling as if they were the pharmacist

Refusals: the rule recognizes that a patient or agent may express a desire not to receive the consultation. When counseling is not provided (or is materially varied), document the fact and circumstances on the prescription, in the patient record, or in a specially developed log. Direct refusals into the pharmacist’s process—do not let a clerk “check the box” for a new Rx without pharmacist involvement.

Required Counseling Elements (Use Judgment, Cover the Core)

The discussion shall include appropriate elements of patient counseling. The rule lists:

1. Name and description of the drug
2. Dosage form, dose, route, and duration of therapy
3. Intended use and expected action
4. Special directions and precautions for preparation, administration, and use
5. Common severe side effects, adverse effects, or interactions and therapeutic contraindications—including avoidance and action if they occur
6. Techniques for self-monitoring
7. Proper storage
8. Prescription refill information
9. Action if a dose is missed
10. Pharmacist comments relevant to the patient’s drug therapy, including information peculiar to that patient or drug

You will not recitation-read all ten for every vignette, but exam answers often hinge on whether counseling was content-rich and patient-specific versus a generic handoff.

Refills, Variation, Documentation (Subp. 2.B)

For a refilled prescription, the pharmacist must counsel if deemed necessary under professional judgment, in person whenever applicable. The pharmacist may vary or omit information if, in judgment, the variation or omission best serves the patient because of individual circumstances. If there is a material variation from the minimal information, or if consultation is not provided, note that fact and the circumstances on the Rx, patient record, or special log.

Special Settings and Mail Delivery

Personal communication is not required for:

• Inpatients of a hospital or other institution (for example a licensed nursing home) where other licensed health care professionals are authorized to administer the drugs, or
• Situations where the patient/agent/caregiver has expressed a desire not to receive consultation

When a new filled prescription—or a refill for which counseling is required—is mailed or delivered by common carrier or delivery service, consultation must still be provided. It may be accomplished by:

1. Written information about the medication,
2. Notice of the pharmacist’s availability to answer questions, and
3. A toll-free phone number for long-distance calls

Nothing in the rule prohibits charging for counseling services.

Link to Profiles and the Rest of This Chapter

Counseling after record review only works if the pharmacy maintains usable patient profiles (Rule 6800.3110) and electronic systems with alert-handling procedures (Rule 6800.3950). The next section turns that profile into prospective DUR. Returns and reuse (Rule 6800.2700) protect a different safety surface: integrity of the drug product after it leaves (or does not leave) pharmacy control.

Study Checklist

1. Quote the new-Rx, personally initiate standard of 6800.0910.
2. Contrast it with a pure offer-to-counsel model.
3. List major counseling elements and the documentation rule for omissions/refusals.
4. Know inpatient administration and mail/delivery exceptions/adaptations.
5. Keep tech/clerk limits cold—they are classic Minnesota traps.