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R156. Commerce, Occupational and
Professional Licensing.
[R156-17a. Pharmacy
Practice Act Rules.
R156-17a-101. Title.
These rules are known
as the "Pharmacy Practice Act Rules".
R156-17a-102. Definitions.
In addition to the
definitions in Title 58, Chapters 1 and 17a, as used in Title 58, Chapters 1
and 17a or these rules:
(1) "Dispense", as defined in
Subsection 58-17a-102(9), does not include transferring medications for a
patient from a legally dispensed prescription for that particular patient into
a daily or weekly drug container to facilitate the patient taking the correct
medications.
(2) "NAPLEX"
means North American Pharmacy Licensing Examination.
(3) "NABP" means the National
Association of Boards of Pharmacy.
(4) "Qualified continuing education"
as used in these rules, means continuing education that meets the standards set
forth in Section R156-17a-313.
(5) "Unprofessional conduct", as
defined in Title 58, Chapters 1 and 17a, is further defined, in accordance with
Subsection 58-1-203(5), in Section R156-17a-502.
R156-17a-103. Authority -
Purpose.
These rules are adopted
by the division under the authority of Subsection 58-1-106(1) to enable the
division to administer Title 58, Chapter 17a.
R156-17a-104. Organization -
Relationship to Rules R156-1.
The organization of
this rule and its relationship to Rule R156-1 is as described in Section
R156-1-107.
R156-17a-301. Licensure -
Pharmacist - Pharmacy Internship Standards.
In accordance with
Subsection 58-17a-302(1)(d), the standards for the internship required for
licensure as a pharmacist include the following:
(1) The internship shall consist of at least
1500 hours obtained in Utah, in another state or territory of the United
States, or in Utah and another state or territory of the United States.
(a) Internship hours completed in Utah shall
include at least 360 hours but not more than 900 hours in a college coordinated
practical experience program as an integral part of the curriculum which shall
include a minimum of 120 hours in each of the following practices:
(i) community pharmacy;
(ii) hospital pharmacy; and
(iii) another pharmacy setting.
(b) Internship hours completed in another state
or territory of the United States shall be accepted based on the approval of
hours by the state pharmacy board of that jurisdiction.
(2) Evidence of completed internship hours shall
be documented to the division by the pharmacy intern at the time application is
made for a Utah pharmacist license or at the completion of the Utah internship,
if not seeking Utah licensure.
R156-17a-302. Licensure -
Pharmacist - Examinations.
In accordance with
Subsection 58-17a-302(1)(e), the examinations which must be successfully passed
by applicants for licensure as a pharmacist are:
(1) the NAPLEX with a passing score as
established by the NABP;
(2) the Multistate Pharmacy Jurisprudence
Examination with a minimum passing score as established by the NABP.
R156-17a-303. Licensure - Pharmacist
by Endorsement.
In accordance with
Subsections 58-1-203(2) and 58-1-301(3), an applicant for licensure as a
pharmacist by endorsement shall apply through the "Licensure Transfer
Program" administered by NABP.
R156-17a-304. Licensure -
Pharmacy Technician - Education Standards.
(1) In accordance with Subsection
58-17a-302(4)(e), the standards for the program of education and training which
is a requirement for licensure as a pharmacy technician shall include:
(a) The program shall consist of at least 300
hours of combined didactic and clinical training to include at a minimum the
following topics:
(i) legal aspects of pharmacy practice such as
laws and rules governing practice;
(ii) hygiene and aseptic technique;
(iii) terminology, abbreviations and symbols;
(iv) pharmaceutical calculations;
(v) identification of drugs by trade and generic
names, and therapeutic classifications;
(vi) filling of orders and prescriptions
including packaging and labeling;
(vii) ordering, restocking, and maintaining drug
inventory; and
(viii) computer applications in the pharmacy.
(b) The program of education and training shall
be outlined in a written plan and shall include a final examination covering at
a minimum the topics listed in Subsection (1)(a) above.
(2) The written outline of the training program
including the examination shall be available to the division and board upon
request.
R156-17a-305. Licensure -
Pharmacy Technician - Examinations.
(1) In accordance with Subsection
58-17a-302(4)(e)((ii)(B), the examinations which must be passed by all
applicants applying for licensure as a pharmacy technician are:
(a) the Utah Pharmacy Technician Law and Rule
Examination with a passing score of at least 75; and
(b) the National Pharmacy Technician
Certification Examination with a passing score as established by the Pharmacy
Technician Certification Board.
R156-17a-306. Licensure -
Pharmacy Intern - Education.
(1) In accordance with Subsection
58-17a-302(5)(a)(i), the approved program is one which is accredited by the
American Council on Pharmaceutical Education.
(2) In accordance with Subsection
58-17a-302(5)(b), the preliminary educational qualifications are as defined in
Subsection 58-17a-302(5)(b).
(3) In accordance with Subsection
58-17a-302(5)(b), a recognized college or school of pharmacy is one which has a
pharmacy program accredited by the American Council on Pharmaceutical
Education.
R156-17a-307. Licensure -
Preceptor Approval.
In accordance with
Subsection 58-17a-102(45), the requirements which must be met by a licensed
pharmacist to be approved as a preceptor are:
(1) hold a Utah pharmacist license that is
active and in good standing;
(2) have been engaged in active practice as a
licensed pharmacist for not less than two years immediately preceding the
application for approval as a preceptor, except if employed as a professional
experience program coordinator in a pharmacy program accredited by the American
Council on Pharmaceutical Education; and
(3) have not been under any sanction at any time
which sanction is considered by the division or board to have been of such a
nature that the best interests of the intern and the public would not be served
by approving the licensee as a preceptor.
R156-17a-308. Licensure -
Administrative Inspection.
In accordance with
Subsections 58-1-203(2), 58-1-301(3), 58-17a-303(4)(d) and Section 58-17a-103,
an administrative inspection may be:
(1) an onsite inspection; or
(2) a self-report inspection completed by the
pharmacist-in-charge on an audit form supplied by the division.
R156-17a-309. Licensure - Meet
with the Board.
In accordance with
Subsections 58-1-203(2) and 58-1-301(3), an applicant for licensure under Title
58, Chapter 17a may be required to meet with the State Board of Pharmacy for
the purpose of evaluating the applicant's qualifications for licensure.
R156-17a-310. Licensure -
Out-of-state Mail Order Pharmacy.
In accordance with
Subsections 58-1-203(2), 58-1-301(3), 58-17a-303(2)(e) and 58-17a-303(4)(d),
the application for licensure as an out-of-state mail order pharmacy shall
supply sufficient information concerning the applicant's standing in its state
of domicile to permit the division and the board to determine the applicant's
qualification for licensure in Utah.
Such information shall include the following:
(1) a certified letter from the licensing
authority of the state in which the pharmacy is located attesting to the fact
that the pharmacy is licensed in good standing and is in compliance with all
laws and regulations of that state;
(2) an affidavit affirming that the applicant
will cooperate with all lawful requests and directions of the licensing
authority of the state of domicile relating to the shipment, mailing or
delivery of dispensed legend drugs into Utah; and
(3) a copy of the most recent state inspection
showing the status of compliance with laws and regulations for physical
facility, records, and operations.
R156-17a-311. Licensure - Branch
Pharmacy.
In accordance with
Subsections 58-1-203(2), 58-1-301(3) and Section 58-17a-614, the qualifications
for licensure as a branch pharmacy include the following:
(1) The division in collaboration with the board
shall designate the location of each branch pharmacy. The following shall be considered in granting such designation:
(a) the distance between or from nearby alternative
pharmacies and all other factors affecting access of persons in the area to
alternative pharmacy resources;
(b) the availability at the location of
qualified persons to staff the pharmacy consistent with Section R156-17a-609 of
these rules;
(c) the availability and willingness of a parent
pharmacy and supervising pharmacist to assume responsibility for the branch
pharmacy;
(d) the availability of satisfactory physical
facilities in which the branch pharmacy may operate; and
(e) the totality of conditions and circumstances
which surround the request for designation.
(2) A branch pharmacy shall be licensed as a
retail pharmacy branch of an existing retail, hospital, or institutional
pharmacy licensed by the division.
(3) The application for designation of a branch
pharmacy shall be submitted by the licensed pharmacy seeking such
designation. In the event more than one
licensed pharmacy makes application for designation of a branch pharmacy
location at a previously undesignated location, the division in collaboration
with the board, shall review all applications for designation of the branch
pharmacy and, if the location is approved, shall approve for licensure the
applicant determined best able to serve the public interest.
(4) The application shall include the following:
(a) complete identifying information concerning
the applying parent pharmacy;
(b) complete identifying information concerning
the designated supervising pharmacist employed at the parent pharmacy;
(c) address and description of the facility in
which the branch pharmacy is to be located;
(d) a specific formulary to be stocked
indicating with respect to each prescription drug the name, the dosage strength
and dosage units in which the drug will be prepackaged;
(e) complete identifying information concerning
each person located at the branch pharmacy who will dispense prescription drugs
in accordance with the approved protocol; and
(f) protocols under which the branch pharmacy
will operate and its relationship with the parent pharmacy to include the
following:
(i) the conditions under which prescription
drugs will be stored, used, and accounted for;
(ii) the method by which the drugs will be
transported from parent pharmacy to the branch pharmacy and accounted for by
the branch pharmacy;
(iii) a description of how records will be kept
with respect to:
(A) formulary;
(B) changes in formulary;
(C) record of drugs sent by the parent pharmacy;
(D) record of drugs received by the branch
pharmacy;
(E) record of drugs dispensed;
(F) periodic inventories; and
(G) any other record contributing to an
effective audit trail with respect to prescription drugs provided to the branch
pharmacy.
R156-17a-312. Licensure -
Pharmaceutical Wholesaler/Distributor and Pharmaceutical Manufacturer.
In accordance with
Subsections 58-1-203(2), 58-1-301(3), and 58-17a-303(2)(h) and (i), the
requirements for licensure as a pharmaceutical wholesaler/distributor or
pharmaceutical manufacturer are defined, clarified, or established as follows:
(1) Each applicant for licensure as a
pharmaceutical wholesaler/distributor or pharmaceutical manufacturer shall
provide the following information:
(a) the name, full business address and
telephone number;
(b) identification of all trade and business
names used by the applicant;
(c) addresses, telephone number and the names of
contact persons at all locations in the state in which prescription drugs are
located, stored, handled, distributed or manufactured;
(d) a full description of the ownership of the
applicant including business type/form, names and identifying information
concerning owners, partners, stockholders if not a publicly held company, names
and identifying information concerning company officers, and directors and
management; and
(e) other information necessary to enable the
division in collaboration with the board to evaluate the requirements in
Subsection (2) below.
(2) In considering whether to grant a license to
an applicant as a pharmaceutical wholesaler/distributor or pharmaceutical
manufacturer, the division shall consider the public interest by examining:
(a) any convictions of the applicant under any
federal, state or local laws relating to the distribution or manufacturing of
prescription drugs, drug samples, controlled substances or controlled substance
precursors;
(b) any convictions of a criminal offense or a
finding of unprofessional conduct which when considered with the activity of
distributing or manufacturing prescription drugs indicates there is or may
reasonably be a threat to the public health, safety or welfare if the applicant
were to be granted a license;
(c) the applicant's past experience in the
distribution or manufacture of prescription drugs including controlled
substances to determine whether the applicant might reasonably be expected to
be able to engage in the competent and safe distribution and manufacture of
prescription drugs;
(d) whether the applicant has ever furnished any
false or misleading information in connection with the application or the past
activities of the applicant in connection with the distribution or manufacture
of prescription drugs;
(e) whether the applicant has been the subject
of any action against any license to engage in distribution or manufacture of
prescription drugs;
(f) compliance with licensing requirements under
any previously granted license to engage in distribution or manufacture of
prescription drugs;
(g) compliance with requirements under federal,
state or local law to make available to any regulatory authority those records
concerning distribution or manufacture of prescription drugs; and
(h) any other factors upon which a reasonable
and prudent person would rely to determine the suitability of the applicant to
safely and competently engage in the practice of distributing or manufacturing
prescription drugs.
(3) The responsible officer or management
employee who is responsible for the supervision of the applicant consistent
with Section R156-17a-612 shall be identified on the application.
R156-17a-313. Continuing
Education - Pharmacist.
(1) In accordance with Subsections 58-1-203(7)
and 58-1-308(3)(b), there is created a continuing education requirement as a
condition for renewal or reinstatement of pharmacist licenses issued under
Title 58, Chapter 17a.
(2) Continuing education shall consist of 24
hours of qualified continuing professional education in each preceding renewal
period.
(3) The required number of hours of qualified continuing
professional education for an individual who first becomes licensed during the
two year period shall be decreased in a pro-rata amount equal to any part of
that two year period preceding the date on which that individual first became
licensed.
(4) Qualified continuing professional education
shall consist of:
(a) institutes, seminars, lectures, conferences,
workshops, various forms of mediated instruction, and programmed learning
courses presented by an institution, individual, organization, association,
corporation, or agency that has been approved by the American Council on
Pharmaceutical Education (ACPE);
(b) programs accredited by other nationally
recognized healthcare accrediting agencies; and
(c) educational meetings sponsored by the Utah
Pharmaceutical Association or Utah Society of Health-System Pharmacists.
(5) Credit for qualified continuing professional
education shall be recognized in accordance with the following:
(a) a minimum of eight hours shall be obtained
through attendance at lectures, seminars or workshops; and
(b) a minimum of six hours shall be in drug
therapy or patient management.
(6) A licensee shall be responsible for
maintaining competent records of completed qualified continuing professional
education for a period of four years after close of the two year period to
which the records pertain. It is the
responsibility of the licensee to maintain such information with respect to
qualified continuing professional education to demonstrate it meets the
requirements under this section.
R156-17a-314. Continuing
Education - Pharmacy Technician.
(1) In accordance with Subsections 58-1-203(7)
and 58-1-308(3)(b), there is created a continuing education requirement as a
condition for renewal or reinstatement of pharmacy technician licenses issued
under Title 58, Chapter 17a.
(2) Continuing education shall consist of eight
hours of qualified continuing professional education in each preceding renewal
period.
(3) The required number of hours of qualified
continuing professional education for an individual who first becomes licensed
during the two year period shall be decreased in a pro-rata amount equal to any
part of that two year period preceding the date on which that individual first
became licensed.
(4) Qualified continuing professional education
shall consist of:
(a) institutes, seminars, lectures, conferences,
workshops, various forms of mediated instruction, and programmed learning
courses sponsored or approved by an institution, individual, organization,
association, corporation, or agency that has been approved by the American
Council on Pharmaceutical Education (ACPE);
(b) programs accredited by other nationally
recognized healthcare accrediting agencies; and
(c) educational meetings sponsored by the Utah
Pharmaceutical Association or the Utah Society of Health-System Pharmacists.
(5) Documentation of current Pharmacy Technician
Certification Board certification will count as meeting the requirement for continuing
education.
(6) Credit for qualified continuing professional
education shall be recognized in accordance with the following:
(a) a minimum of four hours shall be obtained
through attendance at lectures, seminars or workshops.
(7) A licensee shall be responsible for
maintaining competent records of completed qualified continuing professional
education for a period of four years after close of the two year period to
which the records pertain. It is the responsibility
of the licensee to maintain such information with respect to qualified
continuing professional education to demonstrate it meets the requirements
under this section.
R156-17a-315. Renewal Cycle -
Procedures.
(1) In accordance with Subsection 58-1-308(1),
the renewal date for the two-year renewal cycle applicable to licensees under
Title 58, Chapter 17a is established by rule in Section R156-1-308.
(2) Renewal procedures shall be in accordance
with Section R156-1-308.
R156-17a-502. Unprofessional
Conduct.
"Unprofessional
conduct" includes:
(1) violating any provision of the American
Pharmaceutical Association Code of Ethics, October 1994, which is hereby
incorporated by reference;
(2) failing to comply with the Food and Drug
Administration Compliance Policy Guideline 460.200, March 16, 1992, which is
hereby incorporated by reference;
(3) failing to comply with the continuing
education requirements set forth in these rules;
(4) failing to provide the division with a
current mailing address within a reasonable period of time following any change
of address;
(5) defaulting on a student loan;
(6) failing to abide by all applicable federal
and state law regarding the practice of pharmacy; and
(7) failing to comply with administrative
inspections.
R156-17a-601. Operating
Standards - Pharmacy Technician - Scope of Practice.
In accordance with
Subsection 58-17a-102(42), the scope of practice of a pharmacy technician is
defined as follows:
(1) The pharmacy technician may perform any task
associated with the physical preparation and processing of prescription and
medication orders including:
(a) receiving written prescriptions;
(b) taking refill orders;
(c) entering and retrieving information into and
from a database, or patient profile;
(d) preparing labels;
(e) retrieving medications from inventory;
(f) counting and pouring into containers;
(g) placing medications into patient storage
containers;
(h) affixing labels;
(i) compounding; and
(j) other non-judgmental tasks.
(2) The pharmacy technician shall not receive
new oral prescriptions or medication orders nor perform drug utilization
reviews.
(3) The licensed pharmacist on duty can at his
discretion provide general supervision as defined in Subsection 58-17a-102(17)
to no more than three pharmacy technicians, only one of which can be an
unlicensed technician, who are actually on duty at any one time.
R156-17a-602. Operating
Standards - Pharmacy Intern - Scope of Practice.
In accordance with
Subsections 58-17a-102(41) and 58-17a-102(41), the scope of practice of a
pharmacy intern includes the following:
(1) If a pharmacy intern ceases to meet all
requirements for intern licensure, he shall surrender his pharmacy intern
license to the division within 60 days unless an extension is requested and
granted by the Division in collaboration with the Board.
(2) A pharmacy intern may act as a pharmacy
intern only under the supervision of an approved preceptor as set forth in
Subsection 58-17a-102(45) and Section R156-17a-603.
R156-17a-603. Operating
Standards - Approved Preceptor.
In accordance with
Subsection 58-17a-601(1), the following shall apply to an approved preceptor:
(1) He may supervise more than one intern,
however, a preceptor may supervise only one intern actually on duty in the
practice of pharmacy at any one time.
(2) He shall maintain adequate records to
demonstrate the number of internship hours completed by the intern and an
evaluation of the quality of the intern's performance during the internship.
(3) The preceptor shall complete the preceptor
section of a "Utah Pharmacy Intern Experience Affidavit:"at the
conclusion of the preceptor/intern relationship regardless of the time or
circumstances under which that relationship is concluded and provide that
affidavit to the division.
(4) The preceptor shall be responsible for the
intern's acts related to the practice of pharmacy while practicing as a
pharmacy intern under his or her supervision.
(5) The preceptor shall
use "The Internship Experience, A Manual for Pharmacy Preceptors and
Interns", August 1980, published by the NABP or an equivalent manual while
providing the intern experience for the intern.
R156-17a-604. Operating
Standards - Supportive Personnel.
(1) In accordance with Subsection 58-17a-102(50)(a),
the duties of supportive personnel are further defined as follows:
(a) Supportive personnel may assist in any tasks
not related to drug preparation or processing including:
(i) stock ordering and restocking;
(ii) cashiering;
(iii) billing;
(iv) filing;
(v) housekeeping; and
(vi) delivery.
(b) Supportive personnel shall not enter
information into a patient profile nor accept refill information.
(2) In accordance with Subsection
58-17a-102(50)(b), the supervision of supportive personnel is defined as
follows:
(a) All supportive personnel shall be under the
supervision of a licensed pharmacist.
(b) The licensed pharmacist shall be present in
the area where the person being supervised is performing services and shall be
immediately available to assist the person being supervised in the services
being performed.
(3) In accordance with Subsection 58-17a-601(1),
a pharmacist, pharmacy intern, or pharmacy technician whose license has been
revoked or is suspended shall not be allowed to provide any support services in
a pharmacy.
R156-17a-605. Operating
Standards - Medication Profile System.
In accordance with
Subsections 58-17a-601(1) and 58-17a-604(1), the following operating standards
shall apply with respect to medication profile systems:
(1) Patient profiles, once established, shall be
maintained by a pharmacist in a pharmacy dispensing to patients on a recurring
basis for a minimum of one year from the date of the most recent prescription
filled or refilled; except that a hospital pharmacy may delete the patient
profile for an inpatient upon discharge if a record of prescriptions is
maintained as a part of the hospital record.
(2) Information to be included in the profile
shall be determined by a responsible pharmacist at the drug outlet but shall
include as a minimum:
(a) full name of patient, address, telephone
number, date of birth or age and gender;
(b) patient history where significant, including
known allergies and drug reactions, and a comprehensive list of medications and
relevant devices;
(c) a list of all prescription drugs obtained by
the patient at the pharmacy including;
(i) name of prescription drug;
(ii) strength of prescription drug;
(iii) quantity dispensed;
(iv) date of filling or refilling;
(v) charge for the prescription drug as
dispensed to the patient; and
(d) any additional comments relevant to the
patient's drug use.
(3) Patient medication profile information shall
be recorded by a pharmacist, pharmacy intern, or pharmacy technician.
R156-17a-606. Operating
Standards - Patient Counseling.
In accordance with
Subsection 58-17a-601(1), standards for patient counseling established in
Section 58-17a-612 include the following:
(1) Patient counseling shall include when
appropriate the following elements:
(a) the name and description of the prescription
drug;
(b) the dosage form, dose, route of
administration, and duration of drug therapy;
(c) intended use of the drug and expected
action;
(d) special directions and precautions for
preparation, administration, and use by the patient;
(e) common severe side or adverse effects or
interactions and therapeutic contraindications that may be encountered,
including their avoidance, and the action required if they occur;
(f) techniques for self-monitoring drug therapy;
(g) proper storage;
(h) prescription refill information;
(i) action to be taken in the event of a missed
dose;
(j) pharmacist comments relevant to the
individual's drug therapy, including any other information peculiar to the
specific patient or drug; and
(k) the date after which the prescription should
not be taken or used.
(2) Patient counseling shall not be required for
inpatients of a hospital or institution where other licensed health care
professionals are authorized to administer the drugs.
(3) A pharmacist shall not be required to
counsel a patient or patient's agent when the patient or patient's agent
refuses such consultation.
(4) The offer to counsel shall be documented and
said documentation shall be available to the division and the board.
R156-17a-607. Operating
Standards - Prescriptions.
In accordance with
Subsection 58-17a-601(1), the following shall apply to prescriptions:
(1) A prescription issued by an authorized
licensed practitioner, if communicated by an agent or employee of that
practitioner upon that practitioner's specific instruction and authorization,
may be accepted by a pharmacist or pharmacy intern.
(2) Prescription files, including refill
information, shall be maintained for a minimum of five years by either a manual
filing of written prescriptions or by permanent electronic record.
(3) Prescriptions having a remaining
authorization for refill may be transferred by the pharmacist at the outlet
holding the prescription to a pharmacist at another outlet upon the
authorization of the patient to whom the prescription was issued. The transferring pharmacist and receiving
pharmacist shall act diligently to ensure that the total number of authorized
refills is not exceeded.
(4) Prescriptions for terminal patients in
licensed hospices, home health agencies, or nursing homes may be partially
filled if the patient has a medical diagnosis documenting a terminal illness.
R156-17a-608. Operating
Standards - Pharmacist-in-charge.
All drug outlets,
except pharmaceutical manufacturers and pharmaceutical wholesaler/distributors,
and all pharmaceutical administration facilities shall have a
pharmacist-in-charge.
R156-17a-609. Operating Standards - Branch Pharmacy.
In accordance with Section
58-17a-614, the operating standards for branch pharmacies include the
following:
(1)
Branch pharmacies may be staffed only by the following persons holding
current licenses to practice:
(a)
physicians and surgeons;
(b)
osteopathic physicians and surgeons;
(c)
advanced practice registered nurses; and
(d)
physician assistants.
(2)
Prescription drugs supplied to the branch pharmacy by the parent
pharmacy shall be prepackaged having a label affixed to the container by a
licensed pharmacist at the parent pharmacy.
The label shall contain all information required by law on a
prescription label except the date dispensed, identifying information
concerning the patient, specific dosage instructions and identification of the
dispensing person. Excepted information
shall be added to the label by a branch pharmacy person in one of the licensure
classifications listed above at the time the prescription drug is dispensed.
(3)
The branch pharmacy shall be personally visited by the supervising
pharmacist or his designee who is also a licensed Utah pharmacist not less than
once in each month for the purpose of auditing the prescription drug inventory
and branch pharmacy procedures against the approved protocol. A record of each visit and the findings
shall be maintained at the branch pharmacy and at the parent pharmacy.
(4)
The parent pharmacy shall notify the division in writing and receive
approval for any change in branch pharmacy licensure qualifications or
operating standards.
R156-17a-610. Operating
Standards - Drug Outlets.
In accordance with
Subsection 58-17a-601(1), standards for the operations of drug outlets include
the following:
(1) Any drug outlet licensed under the Pharmacy
Practice Act, Title 58, Chapter 17a, shall be well lighted, well ventilated,
clean and sanitary.
(2) The dispensing area, if any, shall have a
sink with hot and cold culinary water separate and apart from any rest room
facilities.
(3) The drug outlet shall be equipped to permit
the orderly storage of prescription drugs and devices in a manner to permit
clear identification, separation, and easy retrieval of products, and an
environment necessary to maintain the integrity of the product inventory.
(4) The drug outlet shall be equipped to permit
practice within the standards and ethics of the profession as dictated by the
usual and ordinary scope of practice to be conducted within that facility.
(5) The drug outlet shall be stocked with the
quality and quantity of product necessary for the facility to meet it's scope
of practice in a manner consistent with the public health, safety and welfare.
(6) The drug outlet shall be equipped with a
security system to permit detection of entry at all times when the facility is
closed.
(7) Drug outlets engaged in extensive
compounding activities shall be required to maintain proper records and
procedure manuals and establish quality control measures to ensure stability,
equivalency where applicable and sterility.
(8) The drug outlet shall have recent editions
of the following reference publications in such quantity and in such places as
to make them readily available to facility personnel:
(a) the Utah Pharmacy Practice Act;
(b) the Utah Pharmacy Practice Act Rules;
(c) the Utah Controlled Substance Act;
(d) the Utah Controlled Substance Act Rules;
(e) Code of Federal Regulations (CFR) 21, Food
and Drugs, Part 1300 to end or equivalent such as the USPDI;
(f) current FDA Approved Drug Products (orange
book);
(g) any other general drug references necessary
to permit practice dictated by the usual and ordinary scope of practice to be
conducted within that facility; and
(h) "The Intern Experience, A Manual for
Pharmacy Preceptors and Interns", August 1980, published by the National
Association of Boards of Pharmacy, if pharmacy interns are present.
(9) The drug outlet shall post in view of the
public the license of the facility and the license or a copy of the license of
each pharmacist, pharmacy intern, and pharmacy technician who is employed in
the facility, but may not post the license of any pharmacist, pharmacy intern,
or pharmacy technician not actually employed in the facility.
(10) Drug outlets initially licensed or
substantially remodeled on or after September 1, 1992, shall have a counseling
area to allow for confidential patient counseling, when appropriate.
(11) If the pharmacy is located within a larger
facility such as a grocery or department store, and a licensed Utah pharmacist
is not immediately available in the facility, the pharmacy shall not remain
open to pharmacy patients and shall be locked in such a way as to bar entry to
the public or any non-pharmacy personnel.
(12) All pharmacies located within a larger
facility shall be locked and enclosed in such a way as to bar entry to the
public or any non-pharmacy personnel when the pharmacy is closed.
(13) Only a licensed Utah pharmacist or his
designee shall have access to the pharmacy when the pharmacy is closed.
R156-17a-611. Operating
Standards - Nuclear Pharmacy.
In accordance with
Subsections 58-17a-303(4)(d) and 58-17a-601(1), the operating standards for
nuclear pharmacies include the following:
(1) A nuclear pharmacy shall have the following:
(a) a current Utah Radioactive Materials
License; and
(b) adequate space and equipment commensurate
with the scope of services required and provided.
(2) Nuclear pharmacies shall only dispense
radiopharmaceuticals which comply with acceptable standards of quality
assurance.
(3) Nuclear pharmacies shall maintain a library
commensurate with the level of radiopharmaceutical service to be provided.
(4) A licensed Utah pharmacist shall be
immediately available on the premises at all times when the facility is open or
available to engage in the practice of pharmacy.
(5) In addition to Utah licensure, the
pharmacist shall be currently certified by the Board of Pharmaceutical
Specialties in Nuclear Pharmacy or have equivalent classroom and laboratory
training and experience as required by the Utah Radiation Control Rules.
(6) This rule does not prohibit:
(a) a licensed pharmacy intern or technician
form acting under the direct supervision of an approved preceptor who meets the
requirements to supervise a nuclear pharmacy; or
(b) a Utah Radioactive Materials licensee from
possessing and using radiopharmaceuticals for medical use.
(7) A hospital nuclear medicine department or an
office of a physician/surgeon, osteopathic physician/surgeon, veterinarian,
podiatric physician, or dentist that has a current Utah Radioactive Materials
License does not require licensure as a nuclear pharmacy.
R156-17a-612. Operating
Standards - Pharmaceutical Wholesaler/Distributor and Pharmaceutical
Manufacturer located in Utah.
In accordance with
Subsection 58-17a-601(1), the operating standards for pharmaceutical
wholesaler/distributor and pharmaceutical manufacturer licensee includes the
following:
(1) A separate license shall be obtained for each
separate location engaged in the distribution or manufacturing of prescription
drugs.
(2) A separate license shall be obtained for
wholesale distribution activity and manufacturing activity.
(3) The licensee need not be under the
supervision of a licensed pharmacist, but shall be under the supervision of a
responsible officer or management employee.
(4) There has not been established minimum
requirements for persons employed by persons engaged in the distribution or
manufacture of prescription drugs; however, this does not relieve the person
who engages in the distribution of prescription drugs within the state or in
interstate commerce into or from the state, or those engaged in the manufacture
of prescription drugs in the state or in interstate commerce into or from the
state from ensuring that persons employed by them have appropriate education,
experience, or both to engage in the duties to which they are assigned and do
so in a manner which does not jeopardize the public health, safety or welfare.
(5) All facilities associated with the
distribution or manufacture of prescription drugs shall:
(a) be of suitable size and construction to
facilitate cleaning, maintenance and proper operations;
(b) have storage areas designed to provide
adequate lighting, ventilation, sanitation, space, equipment and security
conditions;
(c) have the ability to control temperature and
humidity within tolerances required by all prescription drugs and prescription
drug precursors handled or used in the distribution or manufacturing activities
of the applicant or licensee;
(d) provide for a quarantine area for storage of
prescription drugs and prescription drug precursors that are outdated, damaged,
deteriorated, misbranded, adulterated, opened or unsealed containers that have
once been appropriately sealed or closed, or in any other way unsuitable for
use or entry into distribution or manufacture;
(e) be maintained in a clean and orderly
condition, and
(f) be free from infestation by insects,
rodents, birds, or vermin of any kind.
(6) In regard to security, all facilities used
for wholesale drug distribution or manufacturing of prescription drugs shall:
(a) be secure from unauthorized entry;
(b) limit access from the outside to a minimum
in conformance with local building and life/safety codes, and control access of
persons to ensure unauthorized entry is not made;
(c) limit entry into areas where prescription
drugs or prescription drug precursors are held to authorized persons who have a
need to be in those areas;
(d) be well lighted on the outside perimeter;
(e) be equipped with an alarm system to permit
detection of entry and notification to appropriate authorities at all times
when the facility is not occupied for the purpose of engaging in distribution
or manufacture of prescription drugs; and
(f) be equipped with security measures, systems
and procedures necessary to provide reasonable security against theft and
diversion of prescription drugs or alteration or tampering with computers and
records pertaining to prescription drugs or prescription drug precursors.
(7) In regard to storage, all facilities shall
provide for storage of prescription drugs and prescription drug precursors in accordance
with the following:
(a) all prescription drugs and prescription drug
precursors shall be stored at appropriate temperature, humidity and other
conditions in accordance with labeling of such prescription drugs or
prescription drug precursors or with requirements in the United States
Pharmacopeia/National Formulary (USP/NF), 2003 edition, which is official from
January 1, 2004 through Supplement 2, dated August 1, 2003, which is hereby
incorporated by reference;
(b) if no storage requirements are established
for a specific prescription drug or prescription drug precursor, the products
shall be held in a condition of controlled temperature and humidity as defined
in the USP/NF to ensure that its identity, strength, quality, and purity are
not adversely affected; and
(c) there shall be established a system of
manual, electromechanical or electronic recording of temperature and humidity
in the areas in which prescription drugs or prescription drug precursors are
held to permit review of the record and ensure that the products have not been
subjected to conditions which are outside of established limits.
(8) In regard to examination of materials, each
facility shall provide that:
(a) upon receipt, each outside shipping
container containing prescription drugs or prescription drug precursors shall
be visually examined for identity and to prevent the acceptance of prescription
drugs or prescription drug precursors that are contaminated, reveal damage to
the containers or are otherwise unfit for distribution; and
(b) each outgoing shipment shall be carefully
inspected for identity of the prescription drug products and to ensure that
there is no delivery of prescription drugs that have been damaged in storage or
held under improper conditions.
(9) In regard to returned, damaged, and outdated
prescription drugs, each facility shall provide that:
(a) prescription drugs or prescription drug
precursors that are outdated, damaged, deteriorated, misbranded, adulterated,
or in any other way unfit for distribution or use in manufacturing shall be
quarantined and physically separated from other prescription drugs or
prescription drug precursors until they are appropriately destroyed or returned
to their supplier;
(b) any prescription drug or prescription drug
precursor whose immediate sealed or outer secondary sealed container has been
opened or in any other way breached shall be identified as such and shall be
quarantined and physically separated from other prescription drugs and
prescription drug precursors until they are appropriately destroyed or returned
to their supplier; and
(c) if the condition or circumstances
surrounding the return of any prescription drug or prescription drug precursor
cast any doubt on the product's safety, identity, strength, quality, or purity,
then the drug shall be appropriately destroyed or returned to the supplier,
unless examination, testing, or other investigation proves that the product
meets appropriate and applicable standards related to the product's safety,
identity, strength, quality, and purity.
(10) In regard to record keeping, pharmaceutical
wholesaler/distributors and pharmaceutical manufacturers shall establish and
maintain records of all transactions regarding the receipt and distribution or
other disposition of prescription drugs and prescription drug precursors and
shall make inventories of prescription drugs and prescription drug precursors
and required records available for inspection by authorized representatives of
the federal, state and local law enforcement agencies in accordance with the
following:
(a) there shall be a record of the source of the
prescription drugs or prescription drug precursors to include the name and
principal address of the seller or transferor, and the address of the location from
which the drugs were shipped;
(b) there shall be a record of the identity and
quantity of the prescription drug or prescription drug precursor received,
manufactured, distributed or shipped, or otherwise disposed of by specific
product and strength;
(c) there shall be a record of the dates of
receipt and distribution or other disposal of any product;
(d) there shall be a record of the identity of
persons to whom distribution is made to include name and principal address of
the receiver, and the address of the location to which the products were
shipped;
(e) inventories of prescription drugs and
prescription drug precursors shall be made available during regular business
hours to authorized representatives of federal, state and local law enforcement
authorities;
(f) required records shall be made available for
inspection during regular business hours to authorized representatives of
federal, state and local law enforcement authorities, and such records shall be
maintained for a period of two years following disposition of the products; and
(g) records that are maintained on site or
immediately retrievable from computer or other electronic means shall be made
readily available for authorized inspection during the retention period; or if
records are stored at another location, they shall be made available within two
working days after request by an authorized law enforcement authority during
the two year period of retention.
(11) In regard to written policies and
procedures, pharmaceutical wholesaler/distributors and pharmaceutical
manufacturers shall establish, maintain, and adhere to written policies and
procedures which shall be followed for the receipt, security, storage,
inventory, manufacture, distribution or other disposal of prescription drugs or
prescription drug precursors, including policies and procedures for
identifying, recording, and reporting losses or thefts, and for correcting all
errors and inaccuracies in inventories.
In addition, the policies shall include the following:
(a) a procedure whereby the oldest approved
stock of a prescription drug or precursor product is distributed or used first,
with a provision for deviation from the requirement if such deviation is
temporary and appropriate;
(b) a procedure to be followed for handling
recalls and withdrawals of prescription drugs adequate to deal with recalls and
withdrawals due to:
(i) any action initiated at the request of the
Food and Drug Administration of other federal, state or local law enforcement
or other authorized administrative or regulatory agency;
(ii) any voluntary action by the pharmaceutical
wholesaler/distributor or pharmaceutical manufacturer to remove defective or
potentially defective drugs from the market; or
(iii) any action undertaken to promote public
health, safety or welfare by replacing of existing product with an improved
product or new package design;
(c) a procedure to ensure that a pharmaceutical
wholesaler/distributor or pharmaceutical manufacturer prepare for, protect
against, and handle any crisis that affects security or operation of any
facility in the event of strike, fire, flood, or other natural disaster, or
other situations of local, state or national emergency;
(d) a procedure to ensure that any outdated
prescription drugs or prescription drug precursors shall be segregated from
other drugs or precursors and either returned to the manufacturer, other
appropriate party or appropriately destroyed;
(e) a procedure providing for documentation of
the disposition of outdated, adulterated or otherwise unsafe prescription drugs
or prescription drug precursors and the maintenance of that documentation
available for inspection by authorized federal, state, or local authorities for
a period of two years after disposition of the product.
(12) In regard to responsible persons,
pharmaceutical wholesaler/distributors and pharmaceutical manufacturers shall
establish, maintain and make available for inspection by authorized federal,
state and local law enforcement authorities, lists of all officers, directors,
managers, and other persons in charge of wholesale drug distribution,
manufacture, storage, and handling, which lists shall include a description of
their duties and a summary of their background and qualifications.
(13) In regard to compliance with law,
pharmaceutical wholesalers/distributors and pharmaceutical manufacturers shall:
(a) operate in compliance with applicable
federal, state and local laws and regulations;
(b) permit the state licensing authority and
authorized federal, state, and local law enforcement officials, upon
presentation of proper credentials, to enter and inspect their premises and
delivery vehicles, and to audit their records and written operating policies
and procedures, at reasonable times and in a reasonable manner, to the extent
authorized by law; and
(c) obtain a controlled substance license from
the division and register with the Drug Enforcement Administration (DEA) if
they engage in distribution or manufacture of controlled substances, and shall
comply with all federal, state and local regulations applicable to the
distribution or manufacture of controlled substances.
(14) In regard to salvaging and processing,
pharmaceutical wholesalers/distributors and pharmaceutical manufacturers shall
be subject to and shall abide by applicable federal, state and local laws that
relate to the salvaging or reprocessing of prescription drug products.
(15) A person who is engaged in the wholesale
distribution or manufacturing of prescription drugs but does not have a
facility located within Utah in which prescription drugs are located, stored,
distributed or manufactured is exempt from Utah licensure as a pharmaceutical
wholesaler/distributor or a pharmaceutical manufacturer, if said person is
currently licensed and in good standing in each state of the United States in
which that person has a facility engaged in distribution or manufacturing of
prescription drugs entered into interstate commerce.
R156-17a-613. Operating
Standards - Animal Euthanasia Agency.
In accordance with
Subsection 58-17a-601(1), operating standards for an animal euthanasia agency
concerning the use of prescription drugs shall include:
(1) A veterinarian licensed in Utah shall
supervise the use of prescription drugs used for animal euthanasia.
(2) The veterinarian shall be responsible for:
(a) identifying each euthanasia drug for which
authorization is requested;
(b) identifying the location where euthanasia
drugs and records will be maintained;
(c) identifying each person to be authorized to
purchase, possess, or administer euthanasia drugs;
(d) describing the training program for each
person authorized to purchase, possess, or administer euthanasia drugs as well
as attesting to be responsible for that training; and
(e) maintaining euthanasia drug records.
R156-17a-614. Operating
Standards - Analytical Laboratory.
In accordance with
Subsection 58-17a-601(1), operating standards for an analytical laboratory
concerning the use of prescription drugs shall include:
(1) the supervising laboratory director is
identified; and
(2) the protocols describing how authorized
prescription drugs will be purchased, stored, used, and accounted for are
available for division inspection.
R156-17a-615. Operating
Standards - Pharmaceutical Researcher.
In accordance with
Subsection 58-17a-601(1), operating standards for a pharmaceutical researcher
concerning the use of prescription drugs shall include:
(1) requesting and receiving authorization for
each drug to be bought or used; and
(2) the protocols describing how authorized
prescription drugs will be purchased, stored, used, and accounted for are
available for division inspection.
R156-17a-616. Operating
Standards - Pharmaceutical Dog Trainer.
In accordance with Subsection
58-17a-601(1), operating standards for a pharmaceutical dog trainer concerning
the use of prescription drugs shall include:
(1) affiliation with a law enforcement official
from a Utah law enforcement agency who is responsible for the purchase, storage,
and use of the authorized prescription drugs;
(2) requesting and receiving authorization for
each drug to be bought or used; and
(3) the protocols describing how authorized
prescription drugs will be purchased, stored, used, and accounted for are
available for division inspection.
R156-17a-617. Operating
Standards - Issuing Prescription Orders by Electronic Means.
In accordance with
Subsection 58-17a-102(46), prescription orders may be issued by electronic
means of communication according to the following:
(1) Prescription orders for Schedule II - V
controlled substances received by electronic means of communication shall be
handled according to the rules of the federal Drug Enforcement Administration.
(2) Prescription orders for noncontrolled
substances received by electronic means of communication may be dispensed by a
pharmacist or pharmacy intern only if all of the following conditions are
satisfied:
(a) All electronically transmitted prescription
orders shall include the following:
(i) all information that is required to be
contained in a prescription order pursuant to Section 58-17a-602;
(ii) the time and date of the transmission, and
if a facsimile transmission, the electronically encoded date, time, and fax
number of the sender; and
(iii) the name of the pharmacy intended to receive
the transmission.
(b) The prescription order shall be transmitted
by an authorized prescriber or his designated agent.
(c) The pharmacist shall exercise professional
judgment regarding the accuracy and authenticity of the transmitted
prescription. The pharmacist is
responsible for assuring that each electronically transferred prescription
order is valid and shall authenticate a prescription order issued by a licensed
prescriber which has been transmitted to the dispensing pharmacy before filling
it, whenever there is a question.
(d) An electronically transmitted prescription
order that meets the requirements above shall be deemed to be the original
prescription.
(3) This section does not apply to the use of
electronic equipment to transmit prescription orders within inpatient medical
facilities.
(4) No agreement between a prescriber and a
pharmacy shall require that prescription orders be transmitted by electronic
means from the prescriber to only that pharmacy.
(5) Wholesalers, distributors, manufacturers,
pharmacists and pharmacies shall not supply electronic equipment to any
prescriber for transmitting prescription orders.
(6) An electronically transmitted prescription
order shall be transmitted to the pharmacy of the patient's choice and shall be
directed at the option of the patient.
(7) Prescription orders electronically
transmitted to the pharmacy by the patient shall not be filled or dispensed.
(8) A prescription order may be transferred between
pharmacies by computer but not by facsimile transmission. A prescription must be transmitted by
facsimile from the site of origination to the dispensing pharmacy. Transmission by facsimile between pharmacies
is not allowed except that a branch pharmacy may fax to its parent pharmacy.
R156-17a-618. Operating
Standards - Sterile Pharmaceuticals.
In accordance with
Subsection 58-17a-601(1), the following applies with respect to sterile
pharmaceuticals:
(1) Pharmacies in general acute hospitals as
defined in Title 26 that prepare sterile pharmaceuticals shall conform to the
Joint Commission on Accreditation of Healthcare Organization standards, the
American Society of Health-System Pharmacists guidelines, or other standards
approved by the board and division.
(2) The following standards shall apply to all
other pharmacies preparing sterile pharmaceuticals:
(a) Pharmacies are responsible for correct
preparation of sterile products, notwithstanding the location of the
patient. All sterile products must be
prepared according to the current standards and ethics of the profession.
(b) As a minimum each pharmacy preparing
parenteral products shall:
(i) prepare and maintain a policy and procedure
manual for the compounding, dispensing and delivery of sterile pharmaceutical
prescription drug orders including lot numbers of the components used in
compounding sterile prescriptions except for large volume parenterals;
(ii) have a laminar flow hood certified at least
annually by an independent contractor;
(iii) have appropriate disposal procedures and
containers;
(iv) have biohazard cabinetry when cytotoxic drug
products are prepared;
(v) have temperature-controlled delivery
container;
(vi) have infusion devices, if appropriate;
(vii) have supplies and other necessary resources
adequate to maintain an environment suitable for the aseptic preparation of
sterile products;
(viii) have sufficient current reference materials
related to sterile products to meet the needs of pharmacy staff; and
(ix) have written procedures requiring sampling
for microbial contamination.
(c) The pharmacist-in-charge of each pharmacy
preparing parenteral products shall assure that any compounded sterile
pharmaceutical be shipped or delivered to a patient in appropriate
temperature-controlled delivery containers with appropriate monitors and stored
appropriately in the patient's home. If
appropriate, the pharmacist must demonstrate or document the patient's or
patient's agent's training and competency in managing this type of therapy
provided by the pharmacist to the patient in the home environment. A pharmacist must be involved in the
patient's or patient's agent's training process in any area that relates to
drug compounding, labeling, storage, stability, or incompatibility. The pharmacist must be responsible for
seeing that the patient's or patient's agent's competency in the above areas is
reassessed on an ongoing basis.
R156-17a-619. Operating
Standards - Pharmaceutical Administration Facility.
In accordance with
Subsection 58-17a-601(1), the following applies with respect to prescription
drugs which are held, stored, or otherwise under the control of a
pharmaceutical administration facility for administration to patients:
(1) The licensed pharmacist shall provide
consultation on all aspects of pharmacy services in the facility; establish a
system of records of receipt and disposition of all controlled substances in
sufficient detail to enable an accurate reconciliation; and determine that drug
records are in order and that an account of all controlled substances is
maintained and periodically reconciled.
(2) Authorized destruction of all prescription
drugs shall be witnessed by the medical or nursing director or a designated
physician or registered nurse employed in the facility and the supervising
pharmacist and must be in compliance with DEA regulations.
(3) Prescriptions for patients in the facility
can be verbally requested by a licensed medical practitioner and may be entered
as the physician's order; but, the practitioner must personally sign the order
in the facility record within 72 hours, if a Schedule II controlled substance,
and within 30 days if another prescription drug. The physician's verbal order may be copied and forwarded to a
pharmacy for dispensing and may serve as the pharmacy's record of the
prescription order.
(4) Prescriptions for controlled substances for
patients in pharmaceutical administration facilities shall be dispensed
according to the Utah Controlled Substance Act, Title 58, Chapter 37, and the
Controlled Substance Rules of the Division of Occupational and Professional
Licensing, R156-37.
(5) Emergency drug kit.
(a) An emergency drug kit may be used by
pharmaceutical administration facilities.
The emergency drug kit shall be considered to be a physical extension of
the pharmacy supplying the emergency drug kit and shall at all times remain
under the ownership of that pharmacy.
(b) The contents and quantity of drugs and
supplies in the emergency drug kit shall be determined by the Medical Director
or Director of Nursing of the pharmaceutical administration facility and the
pharmacist-in-charge of the pharmacy.
(c) A copy of the approved list of contents
shall be conspicuously posted on or near the kit.
(d) The emergency kit shall be used only for
bona fide emergencies and only when medications cannot be obtained from a
pharmacy in a timely manner.
(e) Records documenting the receipt and removal
of drugs in the emergency kit shall be maintained by the facility and the
pharmacy.
(f) The pharmacy shall be responsible for
ensuring proper storage, security and accountability of the emergency kit and
shall ensure that:
(i) the emergency kit is stored in a locked area
and is locked itself; and
(ii) emergency kit drugs are accessible only to
licensed physicians, physician assistants, and nurses employed by the facility.
(g) The contents of the emergency kit, the
approved list of contents, and all related records shall be made freely
available and open for inspection to appropriate representatives of the
division and the Utah Department of Health.
R156-17a-620. Operating
Standards - Pharmacist Administration - Training.
(1) In accordance with Subsection 58-17a-502(9),
appropriate training for the administration of a prescription drug includes:
(a) having current BCLS certification; and
(b) having successfully completed a training
program which includes at a minimum:
(i) didactic and practical training for
administering injectable drugs;
(ii) the current Advisory Committee on
Immunization Practices (ACIP) of the United States Center for Disease Control
and Prevention guidelines for the administration of immunizations; and
(iii) the management of an anaphylactic reaction.
(2) Sources for the appropriate training
include:
(a) ACPE approved programs;
(b) curriculum-based programs from an ACPE
accredited college of pharmacy; and
(c) state or local health department programs.
KEY: pharmacists, licensing,
pharmacies*
February 19, 2004
Notice of Continuation April 26, 2001
58-17a-101
58-37-1
58-1-106(1)(a)
58-1-202(1)(a)]
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