The future of telemedicine has become a hot topic in the health care industry nationwide, and the momentum seems to be in telemedicine’ s favor. Indeed, the North Carolina Medical Board recently issued revised policy statements that loosened restrictions on prescribing medication through a telemedicine encounter.
Although the Medical Board’s position represented a major sea change, an existing regulation applicable to pharmacists licensed in North Carolina has made those changes difficult to implement. Specifically, North Carolina Rule 21 NCAC 46.1801 bars a pharmacist, except in limited circumstances, dispensing prescription drugs if the pharmacist has knowledge that the prescriber has not conducted a physical examination of the patient. Although, as a practical matter, a pharmacist would likely not know whether a physical examination has occurred, there have been several reported cases of pharmacists refusing to dispense medication after learning from their customers that the orders were obtained from a telemedicine encounter.
It now appears that the Board of Pharmacy is ready to lift this restriction based on a recently proposed amendment to 21 NCAC 46.1801. The proposed regulation, which was published in the April 15, 2015 edition of the North Carolina Register, replaces the prohibition on dispensing medication without a physical examination with new language that allows pharmacists to use their professional judgment to refuse to fill a prescription in cases in which the order’s accuracy, validity, or authenticity or the patient’s safety is at issue. The revised regulation also states that a prescription order is valid if it is a lawful order, made for a legitimate medical purpose, and in the course of legitimate professional practice “as recognized by the occupational licensing board governing the health care provider.” This proposed change is important because it expressly incorporates the North Carolina Medical Board’s new position that orders for prescriptions that result from telemedicine examinations are not prohibited but must meet appropriate standards of care.
The proposed effective date of the new regulation is August 1, 2015. A public hearing on the proposed revision to 21 NCAC 46.1801 will be conducted by the North Carolina Board of Pharmacy on June 16, 2015 at 9:00 a.m. Further, comments to this proposed regulation may be directly submitted to the Board of Pharmacy. Given the current tenor of the telemedicine debate in North Carolina and elsewhere, it is likely that the new regulation will be adopted. On August 1, 2015 North Carolina will take one more step to embracing what many see as the future of health care.