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NY State Authorizes Paper Prescriptions to Fill in Foreign Pharmacies

Good news for New Yorkers who want freedom of choice to fill their prescriptions at pharmacies located where they are more affordable: in other countries. There is now an explicit exception to the electronic prescription (e-prescribing) law in New York that permits paper prescriptions to be filled in other countries. I’m sorry we didn’t catch this earlier, but here it is now. As of January 2017, according to the NY State Department of Health, one exception to e-prescribing, which allows a provider to write a paper prescription, is when the medicine is: 

“…dispensed by a pharmacy located outside the state, outside the country, or on federal property, including and not limited to the following examples; Veterans Administration, West Point, Fort Drum, and Indian Reservations;”

When e-prescribing became mandatory in NY, people had a hard time obtaining paper prescriptions. This was not just an inconvenience. It was a threat to their access to affordable medicine. In our country, it’s sometimes imperative to shop around and find the pharmacy that charges the lowest price in our neighborhood – or in another country. This development should be very helpful to people looking to shop around.

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Getting a Paper Prescription from Your Doctor in Florida. PharmacyChecker Answers.

Question: My doctor in Florida insists that all prescriptions be sent electronically to the pharmacy. I prefer to have a paper prescription in order to shop around for the best price. What can I do?

Answer: While most states have provisions allowing electronic prescribing, and some have extremely strict requirements mandating their use, all have exceptions that allow consumer choice. PharmacyChecker.com CEO Tod Cooperman, MD, wrote about this issue in an earlier blog post as it relates to electronic prescribing in the State of New York. But what about Florida?

Here’s the good news! Florida law stateselectronic prescribing shall not interfere with a patient’s freedom to choose a pharmacy.”

The main reason that states have adopted rules to encourage electronic prescribing is to prevent the abuse of prescription narcotics, which is a national epidemic.

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How to Get a Paper Prescription When e-Prescribing Is Required

[For a 2019 update on this issue, visit our blog post: NY State Authorizes Paper Prescriptions to Fill in Foreign Pharmacies]

To save money on prescription drugs, it is often necessary to have a prescription in hand to send to an international online pharmacy or shop around at local pharmacies to compare their prices and discounts. However, some U.S. states, like New York, now require that most health professionals write prescriptions electronically, without giving you a paper prescription.

So are you out of luck if you need a paper prescription?

Fortunately, not.

The rules, for example, in New York (where e-prescribing becomes mandatory on March 27, 2016) provide exceptions to allow written prescriptions. One of these is when the prescription is “to be dispensed by a pharmacy located outside the state.” Therefore, in New York, a doctor can still legally hand you a prescription if you intend to have it filled outside of New York. (You can read this for yourself in paragraph (c)(5) of Title 10 NYCRR Section 80.64).

The New York law also says that a doctor who gives you a written prescription is supposed to report the issuance of that prescription to the New York Department of Health within 48 hours. However, the law does not explain how this to be done, so I asked the Department of Health. My question was forwarded to a pharmacist consultant with the department who called me back this morning. He told me that if a written prescription is given to a patient under one of the exceptions, “there is currently no functionality for reporting that to the Department of Health.” Instead, he said “the fact that a written prescription was given should just be noted in the patient’s chart.”

I also asked the pharmacist if a doctor can give a patient a written prescription so they can shop it around to find an affordable price or discount. He said that that is acceptable “if it’s deemed necessary by the doctor.” Again, he said that this should be noted in the patient’s chart.

UPDATE: Shortly after publishing this blog post, the Department of Health updated its FAQ about e-Prescribing, changing its advice on this topic. It has created an email address (erx@health.ny.gov) to which a practitioner should send a message if a written prescription is given (see details in the FAQ in answers to Q139 to Q143). It would seem prudent to also make a note in the patient’s chart for the reason for the written prescription.

E-prescribing is practiced to some degree in all 50 states and 60% of all NY prescribers already e-prescribe. Minnesota has adopted a comprehensive e-prescribing program. But only NY, as of March 27th, will issue fines to prescribers who don’t follow the rules.

The e-prescribing laws were originally enacted to cut down on improper dispensing of controlled substances but are being extended to all prescriptions. The reasons given in New York are “to minimize medication errors” and “the integration of prescription records directly into the patient’s electronic medical record.” In addition, “Electronic prescribing has the potential to reduce prescription theft and forgery.” That’s all well and good, but it is also important that it does not interfere with the overall delivery of good medical care — which includes making sure that patients are able to afford their medicine.

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