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Prescription Review Program

Drugs

To: All Practising Physicians in Saskatchewan

Effective June 2, 2006 the Minister of Health has approved a new bylaw that replaces the existing triplicate prescription bylaw.

The main changes to the existing program are the following:

  1. The name has been changed to the "Prescription Review Program"

  2. The list of drugs covered by the program has been expanded. In addition to the drugs previously covered by the triplicate program, the program applies to the following:

    AMPHETAMINES - in all dosage forms (previously only dextroamphetamine was within the triplicate program)
    ANABOLIC STEROIDS - the program did previously not cover these
    BARBITURATES- the program did previously not cover these
    BENZODIAZEPINES - in all doses and forms - the program did previously not cover these
    CHLORAL HYDRATE - the program did previously not cover this

  3. There is no need to use special prescription forms for the drugs covered by the program. The College will no longer issue triplicate pads when the existing supply has been sent to those requesting them. However, physicians can continue to use triplicate prescription pads for drugs covered by the program as long as physicians have a supply of the prescription pads on hand.

  4. The prescribing requirements for the present triplicate drugs have not changed. However the requirements apply to the new drugs on the plan as well. Prescriptions for amphetamines, anabolic steroids, barbiturates, benzodiazepines and chloral hydrate will have to meet the new standard. These drugs can no longer be prescribed verbally. The prescriptions must contain the information described in the next paragraph.

  5. All prescriptions for all drugs covered by the program must include the following information:

    1. A statement that the prescription is only valid for three days; (As of February 2, 2007 this is not required)
    2. The patient's date of birth;
    3. The patient's address;
    4. The total quantity of medication prescribed, both numerically and in written form;
    5. the patient's health services number; and,
    6. the prescriber's name and address.

  6. If a physician intends that there be part fills of medications falling within the Prescription Review Program, the physician must include the following information in the prescription:

    1. The total quantity;
    2. The amount to be dispensed each time; and
    3. The time interval between fills.

All physicians should become aware of the details of the program in order to ensure that pharmacists will fill the prescriptions that they write. Writing prescriptions that meet the program's requirements will also mean fewer interruptions for physicians. It will minimize the number of inquiries from patients or pharmacists for the information that is required by the bylaw.

We recommend that physicians have pre-printed forms available to ensure compliance with this bylaw. The College of Physicians and Surgeons, in consultation with the College of Pharmacists and others, intends to prepare a sample form that physicians may wish to consider having available for drugs covered by this program. It will save physicians a great deal of time in writing prescriptions, and will remind physicians of the information that needs to be included in the prescription.

If more than one physician will be using the prescription forms, the physician's name and address could be hand written by the physician each time. It may be easier for the physician to have his/her name and address pre-printed on the prescription form.

Questions and Answers:

Question:

Why did the College decide to abolish the triplicate prescription pad requirement?

Answer:

After consulting with the profession and others, the College concluded that the value of "sober second thought" which may cause physicians to be more careful if they are required to use a special form for these medications is outweighed by concerns about under treatment of pain because physicians do not have the special forms easily available. There is also a considerable cost to having these forms printed and distributed to physicians which, we believe, does not result in an equivalent benefit in assisting physicians to prescribe appropriately.

Question:

Why did the College decide to include amphetamines, anabolic steroids, barbiturates, benzodiazepines and chloral hydrate in the program?

Answer:

After consultation, and considering the information from the Pharmaceutical Information Program regarding the drugs with the greatest abuse potential, prescriptions for amphetamines, anabolic steroids, barbiturates, benzodiazepines and chloral hydrate were identified the prescriptions that should be subject to greater scrutiny.

Question:

Do electronic prescriptions meet the requirements of the program for "written" prescriptions?

Answer:

Electronic prescriptions are not yet approved by the Government of Canada and issues remain relating to authentication of signatures, etc.

However, if electronic prescriptions are approved by the Government of Canada, there is nothing in the bylaw that will limit their use, provided the electronic prescription contains the required data elements, namely,

  1. A statement that the prescription is only valid for three days;
  2. The patient's date of birth;
  3. The patient's address;
  4. The total quantity of medication prescribed, both numerically and in written form;
  5. the patient's health services number; and,
  6. the prescriber's name and address.

an electronic prescription meets the requirements.

Question:

Are physicians limited to one drug per prescription?

Answer:

The College encourages physicians to limit their prescriptions to one drug covered by the program per prescription, but there is no requirement that physicians do so.

Question:

What use will the College make of the prescribing information?

Answer:

The College's role in dealing with information from the prescription review program will not change. The primary purpose will be to provide information to assist physicians to prescribe appropriately. While we encourage physicians to enroll in the Pharmaceutical Information Program, and have direct access to their patients' prescribing information, the College will continue to provide profiles to physicians on request. Those profiles are likely to be significantly larger than in the past due to the additional drugs that are included in the program.

The College will continue to alert physicians when the College has information that indicates that a physician's patients may be inappropriately receiving prescriptions from more than one prescriber.

The College will continue to deal with concerns about proper prescribing by asking physicians to explain the rationale for their prescribing, where appropriate. Physicians are required to respond to requests from the College for explanations about prescriptions for drugs on the Prescription Review Program.

Question:

Will the College engage in any special programs as a result of the College's access to information about the additional panel of drugs?

Answer:

The Council has identified improving the prescribing of benzodiazepines in Saskatchewan as one of its priorities. It is likely to take some time to have the tools to analyze benzodiazepine prescribing data. When the analysis is done, that will likely lead to a program to improve benzodiazepine prescribing in Saskatchewan.

Question:

Are there practice guidelines or other information to assist physicians to prescribe benzodiazepines appropriately?

Answer:

Yes, we recommend the Ashton Manual at http://www.benzo.org.uk/manual/index.htm

Question:

Why did the College consider it necessary to require physicians to include their addresses in the prescriptions for these drugs?

Answer:

There are a number of Saskatchewan physicians who have very similar, or even identical, names. The physician's address is one piece of public information that helps to identify who the prescriber is.

Question:

Why did the College consider it necessary to require physicians to include a statement that the prescription is only valid for three days, the patient's date of birth, the patient's address, the total quantity of medication prescribed, both numerically and in written form and the patient's health services number?

Answer:

The main purpose of the program is to limit diversion and inappropriate use of drugs of abuse. Drug-seeking patients may impersonate other patients, or provide false names or false addresses. Some drug-seeking patients will alter prescriptions to change the quantity prescribed or the dosage of the medication.

The College accepted that all of this information will make it more difficult for patients to inappropriately obtain drugs of potential abuse, and will make it more likely that prescribing information in the database will be accurate.

Question:

Who can I contact at the College for further information about the Prescription Review Program?

Answer:

Amanda Lee is the College employee who deals with the program on a day-to-day basis. She can be reached at:

Telephone 306-244-8778
Fax 306-244-0090
Email leea@shin.sk.ca

Dr. Dennis Kendel has overall responsibility for the program. He has the responsibility to review physician profiles and to ask for explanations from physicians where there are issues of concern relating to a particular physician's prescribing. Dr. Kendel can be reached at:

Telephone 306-244-7355
Fax 306-244-2600
Email kendeld@shin.sk.ca

Bryan Salte is also familiar with the program. He can be reached at:

Telephone 306-244-7355
Fax 306-244-0090
Email salteb@shin.sk.ca

Question:

What is the Pharmaceutical Information Program, and how does it differ from the College's Prescription Review Program?

Answer:

The Pharmaceutical Information Program is a program controlled and operated by the government of Saskatchewan. It operates independently of the College. It allows physicians to directly access information about the drugs their patients been prescribed. All prescriptions after January 1, 2005 are included in the database. It is not limited to drugs of abuse. Unlike physicians, who can access information about all drugs that have been prescribed to their patients, the College does not have general access to the information in the Pharmaceutical Information Program. It only has access to prescribing information pertaining to drugs in the Prescription Review Program (narcotics, benzodiazepines, etc.).

General information about the Pharmaceutical Information Program is available at the Saskatchewan Health website, and particularly at http://www.health.gov.sk.ca/pip/

We enclose an invitation to Physicians from the Pharmaceutical Information Program to participate in the program.

The College strongly encourages physicians to do so.

The New College Bylaw Regulating prescribing of Drugs under the Prescription Review Program

40. The Prescription Review Program

  1. Panel of Monitored Drugs - The prescription review program shall apply to all dosage forms of the following drugs, except where indicated otherwise:

    ACETAMINOPHEN WITH CODEINE - in all dosage forms except those containing 8 mg or less of codeine
    ACETYLSALICYLIC ACID (ASA) WITH CODEINE - in all dosage forms except those containing 8 mg or less of codeine
    AMPHETAMINES - in all dosage forms
    ANABOLIC STEROIDS
    ANILERIDINE - in all dosage forms
    BARBITUATES
    BENZODIAZEPINES - in all doses and forms
    BUTALBITAL - in all dosage forms
    BUTALBITAL WITH CODEINE - in all dosage forms
    BUTORPHANOL
    CHLORAL HYDRATE
    COCAINE - in all dosage forms
    CODEINE - as the single active ingredient, or in combination with other active ingredients, in all dosage forms except those containing 20 mg per 30 ml or less of codeine in liquid for oral administration
    DIETHYLPROPION - in all dosage forms
    FENTANYL - in all dosage forms
    HYDROCODONE - DIHYDROCODEINONE - in all dosage forms
    HYDROMORPHONE - DIPHRYDROMORPHONE - in all dosage forms
    LEVORPHANOL - in all dosage forms
    MEPERIDINE - PETHIDINE - in all dosage forms
    METHADONE - in all dosage forms
    METHYLPHENIDATE - in all dosage forms
    MORPHINE - in all dosage forms
    NORMETHANDONE-P-HYDROXYEPHEDRINE - in all dosage forms
    OXYCODONE - as the single active ingredient, or in combination with other active ingredients in all dosage forms
    PANTOPON - in all dosage forms
    PENTAZOCINE - in all dosage forms
    PHENTERMINE - in all dosage forms
    PROPOXYPHENE - in all dosage forms

  2. Prescriptions for drugs covered by the Prescription Review Program shall be issued and dispensed according to the policies and procedures agreed to and amended from time to time by the College of Dental Surgeons of Saskatchewan, the College of Physicians and Surgeons of Saskatchewan, the Saskatchewan Registered Nurses Association and the Saskatchewan College of Pharmacists.

  3. In order to prescribe a drug to which the prescription review program applies, physicians shall complete a written prescription which meets federal and provincial legal requirements and includes the following:

    1. A statement that the prescription is only valid for three days;
    2. The patient's date of birth;
    3. The patient's address;
    4. The total quantity of medication prescribed, both numerically and in written form;
    5. The patient's health services number; and,
    6. The prescriber's name and address.

  4. Physicians shall only prescribe part-fills of medications to which the prescription review program applies if the following information is specified in the prescription:

    1. The total quantity;
    2. The amount to be dispensed each time; and
    3. The time interval between fills.

  5. The office of the Registrar may gather and analyze information pertaining to the prescribing of medications to which the prescription review program applies in Saskatchewan for the purpose of limiting the inappropriate prescribing and inappropriate use of such drugs. In order to fulfill that role, the office of the Registrar may, among other activities:

    1. generally, provide education to physicians in order to encourage appropriate prescribing practices by physicians registered by the College;
    2. alert physicians to possible inappropriate use of medications to which the prescription review program applies by patients to whom they have prescribed such drugs;
    3. alert physicians to possible inappropriate prescribing of medications to which the prescription review program applies;
    4. make recommendations to a physician with respect to the physician's prescribing of medications to which the prescription review program applies;
    5. require physicians to provide explanations for their prescribing of medications to which the prescription review program applies. In making requests for explanations, the office of the Registrar may require the physician to provide information about the patient, the reasons for prescribing to the patient, and any knowledge which the physician may have about other narcotics or controlled drugs received by the patient;
    6. cause information, concerns or opinions of general application to the profession to be communicated to the physicians registered by the College without identifying the particular physician to whom such information relates;
    7. provide information gathered in connection with the Prescription Review Program to another professional regulatory organization including, but not limited to, the College of Dental Surgeons of Saskatchewan, the Saskatchewan College of Pharmacists and the Saskatchewan Registered Nurses' Association where the information gathered is relevant to the regulatory responsibilities of that regulatory organization.

  6. Physicians shall respond to such requests for explanation, as described in paragraph 5(e) above, from the office of the Registrar within 14 days of receipt of such a request for information.

  7. The Registrar, Deputy Registrar, or Prescription Review Program Supervisor may extend the deadline for reply at their discretion, upon receipt of a written request for extension from the physician.

  8. All physicians who receive such a request for information will comply, to the best of their ability, fully and accurately with such request for information.

  9. Failure to comply with paragraphs 40(5)(e), 40(6) and 40(8) above is unbecoming, improper, unprofessional or discreditable conduct.