Texas pharmacists should take note of a new Rule recently adopted by the Texas State Board of Pharmacy which places increased responsibility on the licensee to ensure that dispensed medications were prescribed for a valid medical purpose and pursuant to a proper patient-physician relationship. The Rule, which can be found at §291.29 in Title
A combination of increased competition from large chain brick-and-mortar pharmacies, mail-order refills, and the rise of the internet as a medium for both legal and illegal activity have driven many unsuspecting pharmacists into the dangerous world of “internet pharmacy.” Since at least 1999, various federal agencies led by the Drug Enforcement Agency and the FDA have combined efforts with state law enforcement and state licensing boards to crackdown on internet pharmacies. The result has been the revocation of professional licenses, stiff fines, and long prison sentences. Many of the pharmacists victimized by this legal dragnet have been severely prosecuted simply because they failed to exercise enough caution when entering the minefield of internet pharmacy.
The target of these law enforcement and regulatory efforts follows a typical pattern of organization and prescription/dispensing process. Oftentimes pharmacists and physicians will be approached by a “facilitator”, which may be in the form of a corporation or other entity who are seeking licensed medical personnel to participate. Fees are often paid on a per prescription basis and can be supplemented with generous handling fees for the pharmacists and consulting fees for the doctors. Such facilitators will point to doctors and pharmacists who have already signed on to give their business plan a deeper air of legitimacy and better induce the medical professional(s) to join.
Once the internet pharmacy contracts the necessary professionals, the prescription and dispensing of controlled substances begins. The patient, who may or may not be legitimate, first tries to order a drug online and is then asked to fill out a preliminary questionnaire which will be viewed by a physician. This doctor, who usually never sees the patient and often lives in a different state, reviews the questionnaire and prescribes the requested medication. The prescription is then transmitted to the pharmacist, who can be in yet another state, who fills it and ships it to the patient. Unfortunately, this process, especially the absence of a proper examination and diagnosis, violates most States’ regulatory rules and exposes all participants to administrative and criminal action.