Attention: test the sidewide alert

Valid Patient-Practitioner Relationships (Resolution No. 105-3-09)

May 19, 2009

Topics: Practitioner Prescriber, Resolutions

Resolution No. 105-3-09
Title: Valid Patient-Practitioner Relationships
Action: Passed

Whereas, NABP is aware of an increase in concern and actual deaths resulting from orders for prescription drugs being issued and dispensed without a valid patient-practitioner relationship; and

Whereas, data compiled by NABP and other groups indicate that the majority of Internet drug outlets violate state and federal laws and regulations by, including but not limited to, dispensing prescription medications without a valid patient-practitioner relationship based solely on online questionnaires or cyberspace consultations; and

Whereas, pharmacists are responsible for and assume a significant role in ensuring the safe and proper use of medications; and

Whereas, federal and state laws and regulations, as well as the US Drug Enforcement Administration (DEA), indicate that on an online consultation or questionnaire does not constitute a valid patient-practitioner relationship and any resultant prescription drug order is not legitimate; and

Whereas, the Model State Pharmacy Act and Model Rules of the National Association of Boards of Pharmacy (Model Act) currently contains language that reflects this concept, reading as follows:

“Prescription Drug Order” means a lawful order from a Practitioner for a Drug or Device for a specific patient, including orders derived from Collaborative Pharmacy Practice, where a valid Patient-Practitioner relationship exists, that is communicated to a Pharmacist in a licensed Pharmacy.

“Valid Patient-Practitioner Relationship” means the following have been established:
(1) a Patient has a medical complaint;
(2) a medical history has been taken;
(3) a face-to-face physical examination adequate to establish the medical complaint has been performed by the prescribing practitioner or in the instances of telemedicine through telemedicine practice approved by the appropriate Practitioner Board; and
(4) some logical connection exists between the medical complaint, the medical history, and the physical examination and the Drug prescribed.

A valid patient-practitioner relationship includes a relationship with a consulting practitioner or a practitioner, to which a patient has been referred, or a covering practitioner, or an appropriate practitioner-board-approved telemedicine practitioner providing that a physical examination has been performed by the patient’s primary practitioner.

Whereas, there are limited instances where a face-to-face physical examination should not be required to establish a valid patient-practitioner relationship and legislative and regulatory language should indicate such;

THEREFORE BE IT RESOLVED that the following language be added to the Model Act:
A face-to-face physical examination is not required to establish a valid patient- practitioner relationship if:

a) the prescribing practitioner is issuing a prescription or dispensing a legend drug in accordance with expedited partner therapy in the management of sexually transmitted diseases guidance document issued by the United States Centers for Disease Control and Prevention; or
b) the prescription, administration, or dispensing is through a public health clinic or other distribution mechanism approved by the state health authority in order to prevent, mitigate, or treat a pandemic illness, infectious disease outbreak, or intentional or accidental release of a biological, chemical, or radiological agent.

BE IT FURTHER RESOLVED that NABP urge its member jurisdictions to aggressively pursue pharmacists and pharmacies engaged in the distribution of prescription drugs without a valid patient-practitioner relationship in order to further protect the public health.

(Resolution passed at the NABP 105th Annual Meeting, Miami, FL)