Our online help team has received many questions about recent changes in how doctors issue prescriptions. Traditionally, doctors would print and validate prescriptions for patients to take to a pharmacy or fax to us. Now, with the shift to paperless systems, virtual prescriptions are becoming the norm, reducing paperwork and streamlining the process.
While virtual prescriptions offer many benefits, the lack of a physical copy can sometimes create challenges for customers. The main question we’re hearing is whether patients can insist on a printed copy of their prescription when doctors prefer virtual prescriptions that can only be filled by pharmacies within the same system.
This isn’t a simple question, and there is no single answer that can handle all of the possibilities, but we have done a fair amount of digging into the regulations that govern this new development and are happy to share our findings with you here.
First, let’s look at how it used to work.
Issuing a printed prescription
Until fairly recently, the only way patients could purchase registered medication from a druggist was by having a properly printed and validated copy of their doctor’s prescription. This was meant to protect both the patient and the general population. With a signed prescription, the patient could be sure that the pharmacist would understand precisely what medicine is needed, and the pharmacist would dispense it in the format ordered, along with any special information such as dosing instructions and anything else the doctor ordered for this patient. In turn, society could be assured that the issuing of powerful and potentially harmful drugs was happening only under the control of doctors, who are the only people authorized to permit the use of these substances.
People of a certain age will be able to recall hackneyed gag lines that made fun of the difficulty that even the most experienced druggist could have in trying to decipher a doctor’s hasty scribble of a prescription on their tiny pads that had to fit into their coat pockets. My favorite is probably a true answer from a doctor who was asked why he had such awful handwriting, and he replied, “Because if I write neatly, pharmacists will think my prescription is a forgery!”
In part, the difficulties that problems like these could cause were part of the rationale for digitizing the whole process of prescription handling, which came in parallel to the spread of computers throughout the patient practice and retail pharmacy world.
Issuing a virtual prescription
Most doctors now have sophisticated practice management systems running throughout their consulting rooms. In almost all cases, these systems are logged into a network that interconnects with the World Wide Web. After consulting with a patient, doctors can now enter their prescriptions directly into the computer, in the process now called e-prescribing. That prescription can be accessed by anyone with proper credentials, including pharmacists, when the patient asks them to fulfill the prescription.
On the positive side, e-prescribing, by leveraging technology, streamlines the process of prescribing medication and significantly enhances the safety, quality, and efficiency of healthcare delivery. The new process has multiple benefits.
Enhanced patient safety
- E-prescribing minimizes errors associated with handwriting, interpretation, or miscommunication of drug names, dosages, or instructions.
- Systems with advanced features may be able to automatically check for drug-drug interactions, allergies, and contraindications, providing alerts to prescribers.
Increased efficiency
- The process from prescription to dispensing is faster without the need for the physical handling of prescriptions.
- Prescriptions can be sent directly to pharmacies and prepared before pickup, reducing the delay patients might face in getting their medications.
Better record keeping
- In the new system, all prescriptions are documented electronically, improving the accuracy of patient medical records.
- Historical data available online makes for easier access to a patient’s prescription history for better continuity of care.
Compliance with regulations
- Digital systems help in better tracking and reporting of controlled substances, aiding in compliance with laws like the Controlled Substances Act. Controlled substance management has been one of the driving forces behind the whole move to electronic prescribing.
- In some states, e-prescribing is becoming mandatory for controlled medications, making control easier and more efficient.
Cost reduction
- Electronic prescribing reduces the need for paper, printing, mailing, and manual processing of prescriptions.
- E-prescriptions can’t be lost or stolen, which means patients never have to call back for re-issue.
- Digital prescriptions can be interfaced directly with patients’ policies inside insurance systems to check for coverage or to reduce the cost of medications for patients by suggesting generic alternatives.
Improved patient experience
- Patients can manage their medications through online portals, where they can view, refill, or transfer prescriptions.
- They can receive notifications when prescriptions are ready or when refills are due, enhancing the overall experience.
Enhanced security
- Digitally signed documents and secure transmission reduce the risk of prescription fraud or misuse.
- Electronic records provide a clear audit trail for each prescription, which is good for both legal and quality control purposes.
Enables specialty care
- It becomes easier to manage complex medication regimens, especially for chronic conditions or specialty care where multiple medications might be involved.
Integrates directly into Telemedicine
- Digital prescribing integrates seamlessly with telehealth services, making it possible to prescribe medications during remote consultations without the need for physical presence.
The downside of e-prescribing
The effectiveness of the new method of prescribing is built on the adoption of compatible systems across the full spectrum of healthcare providers, insurers, and pharmacies. The whole process is still a work-in-progress, and although the benefits are undeniable, until all the features are available everywhere, for everyone, it is necessary for there to be alternatives that allow individual patients to satisfy their own specific needs without having to sacrifice any of the features that were common in the older systems. The most common issues we have encountered relate to a doctor’s unwillingness or inability to issue printed prescriptions when asked, so let’s deal with that side of the case first.
Can a doctor refuse to issue a printed prescription?
With some exceptions, how doctors issue their prescriptions is entirely a matter of their choice or preference. The main exception that applies pretty much nationwide relates to prescriptions for controlled substances, which are drugs falling within the schedule of the Federal government’s Controlled Substances Act. This mainly refers to drugs that have actual or relative potential for abuse. At the moment, other than a very small number of States, doctors have to issue e-prescriptions for any controlled drug listed in Schedule II to V of the act. The reasons for this are obvious: it creates a full digital record of these medicines’ usage from prescribing to dispensing.
Although in strictly legal terms, doctors have complete control over their decisions in prescribing, they are also encouraged by ethical practice and simple good manners to try and give their patients the choice between digital and printed prescriptions. It would take a very extreme set of circumstances in which a doctor would be able to justify refusing the simple request for a printout of the prescription.
Reasons to give for requesting a printed prescription
If it comes to the point that the doctor asks what is the reason that you insist on a printout of the prescription, here are a few valid reasons that we have gathered from our customers’ queries:
- There can be shortages of the prescribed medicine, and pharmacies may be out of stock. This happens quite frequently since the COVID-19 pandemic played such havoc with supply chains and also in the case of extremely popular drugs like Ozempic, Mounjaro, and Wegovy. In such cases, it may be necessary to shop around between many locations to find a druggist with stock, and this can be done faster and easier with a printout.
- If you are planning to travel, the destination may not be connected to the issuing doctors’ network, so the e-prescription may not be visible to the pharmacy. This is especially the case if you are going to be travelling in another country. Even inside the US, the rules vary between states, and it may be necessary to get a doctor in the new location to issue another prescription, which they can only do so when they see the original. This is the case in Florida and several other states.
- A printed prescription allows you to shop between pharmacies for the best price. When sourcing medication online, it’s best practice to choose a pharmacy that only accepts orders accompanied by a valid prescription.
- With an e-prescription, getting the prescription filled restricts your choice to participating pharmacies. Filling the script can be interrupted by technical breakdowns, network interruptions, and many other factors that are completely out of your control.
- The laws about virtual prescriptions are changing all the time, but printed prescriptions are still universally accepted by pharmacies not only in all US states, but all over the world. So, it’s better to be safe and have the printed prescription as a backup, even if you are planning to fill the e-prescription.
- States can have different regulations about digital records, which means e-prescriptions can be invalid in different States. However, we haven’t identified any instances where printed prescriptions have specific restrictions based on their origin. In some states, only prescriptions issued by doctors licensed by the State Board can be dispensed by local pharmacies, but there are usually ways around this. This is undoubtedly the case for any prescriptions sent to us at IsraelPharm since it is standard practice for us to have a locally registered doctor review the prescription and issue a back-to-back prescription that meets the strict requirements of local medical and dispensing laws.
In summary, while you may not have the legal right to demand a prescription printout, it is usually treated as a reasonable request, and doctors will agree unless they have some overwhelming reason not to. In some states, there is legislation that requires a doctor to only issue an e-prescription when the medication is a controlled substance as defined in the Federal Government’s Controlled Substances Act. In any case, since we are not permitted to supply any controlled drugs, it’s not an issue when ordering from IsraelPharm.
Frequently Asked Questions
What is an e-prescription in the US?
Electronic prescribing (e-prescribing) is intended to improve the safety and quality of dispensing. Instead of being hand-written or printed in the doctor’s office, an e-prescription is generated electronically and can then be accessed from any registered pharmacy. The transmission of the prescription is instantaneous ,and no paper is wasted.
Is e-prescribing mandatory?
There are no federal rules for the whole country. The laws differ from state to state. Most states have laws that require e-prescribing for controlled substances. These are dangerous drugs and the purpose of e-prescribing in these States is to limit drug abuse. In some states this also is the law for all prescription For example, in California prescribers must e-prescribe prescriptions of both controlled and non-controlled substances and pharmacists can only dispense against an e-prescription, or face to disciplinary action.
What is a virtual Rx?
The virtual Rx is an prescription that was sent by a doctor directly to a pharmacy without the patient necessarily having been in the doctor’s rooms. It is more common these days in the practice of telemedicine.
How long does it take for an e-prescription to be ready?
The creation of an e-prescription is instantaneous, but does not have to be dispensed immediately. Not all insurance schemes tie you down to specific pharmacies, which means that you can select your own pharmacy, or order online from IsraelPharm with a printed copy of the prescription.
