4.2 Required Prescription Elements, Oral & Faxed Orders, and Alterations

4.2 Required Prescription Elements, Oral & Faxed Orders, and Alterations

Blueprint items 2.1 (issuing non-controlled and controlled prescriptions) and 3.1 (legitimacy) turn on whether a prescription is complete and properly transmitted.

Minimum elements of every Utah prescription (§ 58-17b-602(1))

1. The prescriber's name, address, and telephone number, plus, for a controlled substance, the patient's age and the prescriber's DEA number.
2. The patient's name and address, or for an animal, the owner's name and the species. The address must be a physical address, not a P.O. box (R156-17b-612(12)).
3. The date of issuance.
4. The name of the drug or device and dispensing instructions, if needed.
5. Directions for use, and any refill, special labeling, or other instructions.
6. The prescriber's signature on a written order, or the electronic signature on an electronically transmitted order. A hard copy generated from electronic media may carry an electronic or manual signature.

The prescriber elements in item 1 do not apply to inpatient hospital orders when the prescriber is on staff and the order is in the medical record (§ 58-17b-602(2)). Expedited partner therapy prescriptions need not identify the partner (§ 58-1-501.3).

Additional controlled substance requirements (§ 58-37-304(4))

Except in emergencies defined by DOPL, a controlled substance prescription must be signed in ink or indelible pencil, or with an electronic signature DOPL authorizes. It must contain:

• the prescriber's name, address, and registry (DEA) number;
• the patient's name, address, and age;
• the date of issuance; and
• the drug name, quantity, and specific directions for use.

A prescription for a CS may not be issued or dispensed without specific instructions on how and when to use the drug (R156-37-603(7)). If the prescriber leaves refills blank on a CIII–V prescription, no refills are authorized (R156-37-603(4)). A rubber-stamped signature does not meet the "ink, indelible pencil, or electronic signature" requirement for a controlled substance.

Oral and electronic orders

• An oral prescription (other than Schedule II) may be dispensed only if it is promptly reduced to writing (§ 58-17b-602(3)).
• Electronically transmitted non-controlled prescriptions must include the § 58-17b-602 elements, the transmission date and time (and, for a fax, the sender's encoded date, time, and fax number), and the name of the intended pharmacy. They must go to the pharmacy of the patient's choice. A prescription the patient transmits electronically to the pharmacy may not be filled. The prescriber or agent must provide voice verification when the pharmacist requests it (R156-17b-613).
• Wholesalers, manufacturers, pharmacists, and pharmacies may not supply prescribers with equipment for transmitting prescriptions, and a prescriber–pharmacy agreement may not require all electronic prescriptions to go to that pharmacy (R156-17b-613(5), (7)).
• Controlled substance electronic prescriptions follow 21 CFR 1304.06 and Part 1311. In Utah most CS prescriptions must be electronic (see Section 4.3).

Alterations (§ 58-17b-602(4))

A pharmacist or intern may not dispense or compound a prescription that shows alteration, erasure, or addition by anyone other than the prescriber. The pharmacist or intern may alter or add to a prescription after receiving the prescriber's permission, and may make entries required by law or needed for compounding and dispensing.

DOPL's July 8, 2024 Schedule II clarification

DEA's October 2022 guidance (DEA-DC-063) told pharmacists to follow state policy on Schedule II changes until DEA issues new rules. DOPL and the board responded that after consulting the prescriber, a pharmacist may add or change:

1. the patient's name (to correct the legal name);
2. the patient's physical address;
3. the dosage form;
4. the drug strength;
5. the drug quantity; and
6. the directions for use.

Each change must be noted on the prescription, or in the pharmacy system for an e-prescription, as verified with the prescriber. A pharmacist may add or change patient information such as address and date of birth after verifying it. The pharmacist may annotate the prescriber's DEA number if it is on file. If it is not on file, the pharmacist must get it from the prescriber, and the prescription cannot be filled if the DEA number cannot be identified. Changes to the drug name or the prescriber's signature are not on the list.

Faxed Schedule II prescriptions (21 CFR 1306.11)

A faxed CII prescription usually serves only to prepare the drug in advance. The original signed prescription must be presented before dispensing. A fax may serve as the original in three cases:

1. a Schedule II narcotic compounded for direct administration by parenteral, IV, IM, subcutaneous, or intraspinal infusion (home infusion);
2. any Schedule II drug for a resident of a long-term care facility; and
3. a Schedule II narcotic for a patient enrolled in a hospice program certified or paid for by Medicare or licensed by the state, with the practitioner noting that the patient is a hospice patient.

In Utah these fax pathways operate alongside the EPCS mandate. Prescriptions for residents of long-term care and assisted living facilities are exempt from mandatory EPCS (§ 58-37-302(1)(a)).

CMS tamper-resistant prescription pads (Medicaid)

Federal law (42 U.S.C. § 1396b(i)(23)) requires written outpatient prescriptions billed to Medicaid to be on paper with at least one feature from each of three categories: one to prevent unauthorized copying, one to prevent erasure or modification, and one to prevent counterfeit pads. Electronic, faxed, and telephoned prescriptions are exempt. CMS guidance lets a pharmacy fill a non-compliant written prescription in an emergency if it obtains a compliant prescription (or verbal, fax, or electronic confirmation) within 72 hours.