Sent: Dec 4, 2006 12:32 AM
To: [redacted]

Subject: Fwd: WSR 06-23-079 Pharmacies Responsibilities

 Hi all--I am forwarding the attached proposed regulation to you for your input.  At this point, I believe what the Board needs to hear is real examples of situations this regulation will negatively impact. 

You can read the comments already sent.  The regulation is near the bottom of the list--primarily the 'pharmacy responsbility' is the one you should focus on. 

First, I believe the pharmacist's primary responsibility is to take care of the patient, including appropriate referral if he/she cannot fill a prescription for ANY reason.  (Read all of the law regarding a health care professionals 'right to refuse'--I believe the intent is clear that we still have a duty to refer.)  However, I think the proposed regulation goes too far in defining every day pharmacy practice.  Also, the BOP has had numerous comments about right to refuse, pro and con, and it is beginning to fall on deaf ears in my opinion, so let's focus on specific situations.

Two examples from my practice: 

Does the proposed reg allow us to refuse simple compounds--those not requiring 'special expertise or equipment.'   For example, we do quite a bit of a compound that combines three common ointments--requires a spatula and a clean space on the counter, basically!  However, it takes time and not all pharmacies choose to provide this service.

Second--we do a few clozapine RX's--requires obtaining lab work (sometimes hounding the lab...) and faxing the info to the manufacturer before dispensing.  Does this reg allow a pharmacy to refuse this service?  Again, we are all trained to look at a lab report.....

I also have concerns about the phrase products 'approved by the FDA restricted to distribution in pharmacies.'  I think this includes C-V cough syrups!  Do we all need to provide access to them now?

The Board has chosen to take only written comment, so your input is vital.  Most of the comments are pretty general--we need specifics in order to look at the practicality of this reg.  Understand that the groups behind this language (primarily Plannd Parenthood and NW Women's Law Center) were very clear in our meetings that the intent is for pharmacists to provide products--NOT to refer, even when we believe it is in the best interest of the patient!  The reg was written to address Plan B refusals, but it will apply to ALL settings and to ALL products.  (I have also expressed my concerns as to whether hospitals can restrict RX'ing of products to certain specialities under this reg.  I don't see that situation listed as an exception.)

The expectation is that a pharmacy will dispense a product--meaning, if one pharmacist cannot or will not dispense (refuse to fill), another pharmacist on staff will dispense the product.  I have concerns about this one, too--when I am on vacation, if my hard-to-find relief pharmacist refuses to fill, do I have to have someone on call to provide the RX?  What about pharmacies where only one pharmacist is on duty most or all of the time?  Does someone need to be on call at all times?

I just think this reg takes the wrong approach in trying to list the exceptions to the rule rather than flatly staing we have a duty to take care of the patient--and leave the means to do that up to the pharmacist.  But I have not been successful in that argument, so please add your experience and reality to the pot!

One last situation to look at--the regulation says we must transfer an RX if the patient requests.  First, the norm is for the receiving pharmacy to call, not vice-versa.  Second, I believe that while it does not say we have to find the product for the patient, most pharmacies will not accept the transfer if they do not have the product in stock.  Our Board lawyer says no 'reasonable' patient would require us to keep calling to find the product, but I for one have had one very anxious, adult child demand I find a product for his father!  (I eventually did, but only because the father was a long-time patient.)  Please relate any similar situations you have faced--while not 'reasonable,' they can be reality!

If you see other problems with the reg, please comment!  For instance, there have been many comments about 'lethal dose' vs a dose not recommended...

Please forward this to any other pharmacist you know.  This regulation is going to pass unchanged unless our profession speaks up.  If it seems OK to you in your practice, that feedback is important also, but I think there are too many real situations not addressed by this regulation.

Email me if you have any questions for me.  I am on vacation until Wednesday, so I might not have a lot of time to talk when I return to work, but I will respond to emails.

Thanks for all your help.



-----Original Message-----
From: Doreen.Beebe@DOH.WA.GOV
Sent: Wed, 29 Nov 2006 9.07PM
Subject: WSR 06-23-079 Pharmacies Responsibilities

Attached is the Proposal Statement of Inquiry filed on November 13, 2006 as WSR 06-23-079. This relates to establishing enforceable standards and responsibilities for pharmacies in the delivery of lawful drugs and devices.

A written public comment period was opened on November 9 and will close on December 11, 2006.  You may view the draft language and provide written comments by linking to the Department of Health's Public Comment webpage

Document title: DRAFT Text WAC 246-869-010 Pharmacies' Responsibilities.

You are receiving this e-mail because you have been identified as an interested party. You may leave this list at any time, or view the archives of messages that have been sent to this list, by going to

Doreen E. Beebe
Health Services Consultant
Health Professions Section Four   

PO Box 47863                                                                          
Olympia WA  98504-7863                                                                   
Phone 360/236-4834
Fax 360/586-4359

"The Department of Health works to protect and improve the health of the people of Washington State."