Should Pharmacists Refill a Prescription if the Prescriber's License is Inactive?

States have the primary responsibility to regulate and enforce prescription drug practice. The right to prescribe is granted through a license to practice. State and federal regulations identify a valid prescription as an order from a licensed practitioner authorized by state law to prescribe drugs based on a practitioner-patient relationship.

A prescription issued by an individual without an active license granting prescriptive authority cannot be filled according to regulation. Most state pharmacy regulations do not specifically require verification of the prescriber’s license prior to dispensing but do require that the practitioner is currently licensed.

The pharmacist has a responsibility to ensure that a prescription has been issued by an appropriately licensed practitioner. Accreditation standards require organizations to have a mechanism to ensure that orders are only accepted from currently credentialed practitioners.

Verification of current state licensure for new prescribers via the internet is cumbersome but manageable, even with the often simultaneous need for Office of Inspector General exclusion, National Provider Identifier and Drug Enforcement Agency status. The larger task is understanding the verification requirement and then knowing the status of all the prescribers in your database over time.

If the prescriber license must be current, what is the rule when the prescriber’s license becomes inactive after the initial fill but before the prescription expires? Researching that question via the internet across all 50 states and the District of Columbia created more questions than answers.

The terminology used to declare the ongoing licensure requirement varies across the states, so searches were multiphasic. An email exchange with the National Association of Boards of Pharmacy (NABP) produced a list of state regulations from the NABPLAW Online database for Idaho, Louisiana, Maine, Michigan, Mississippi, Missouri, and Tennessee.

No written requirement was found in more than half of states, necessitating calls to the individual boards of pharmacy. Those calls had a consistent theme based on not depriving patients of their medication while re-establishing a patient-practitioner relationship as soon as possible.

The database provided the written and verbal responses from each board of pharmacy paraphrased to capture the intent and to demonstrate the trend across states. Seven states allow no refills if the prescriber’s license is inactive.

Twenty-one states have limits on the number of refills that may be dispensed once the prescriber’s license becomes inactive. Given the limitations on initial prescription fills and refills, an efficient, consistent, and cost-effective method to verify prescriber license status is necessary.

Speed is important on initial fills and for subsequent verification when the prescriber database is large. That speed must not be derived from a static database infrequently updated, but from a prime source verification website with immediate feedback. Automated systems are most effective and will provide hard copy proof of the verification.

Note: The system that provides immediate and direct verification of prescriber licensure is Modio Health. It does not operate from a static database and is not integrated into the pharmacy dispensing system. License verification is done simultaneously with prescription entry. It is possible to move data between systems using an API to avoid duplicate data entry.