PharmaAdvice: No prescriptions please

From time to time, dentists need a supply of prescription drugs in their practice for administration to patients as a treatment dose. Drugs typically used for this purpose include antibiotics for prophylaxis, anxiolytics, and emergency drugs. Unfortunately, the process for acquiring these drugs is not entirely clear. As a result, sometimes dentists obtain their stock by writing a ‘fake’ prescription and having it dispensed at a pharmacy.

These prescriptions for stock are ‘fake’ because a fake name is given in the patient’s name field on the script, such as the dentist, their spouse, a staff member or, at worst, a non-existent patient. Unfortunately, it is inconsistent with legislation to write a prescription in the name of someone for whom the medicine is not intended. In addition, if the cost of the prescription is claimed on the Pharmaceutical Benefits Scheme (PBS) for the fake patient i.e. for whom the script is not intended, this commits the offence of PBS fraud, which is a federal crime.

Even though you might think these fake prescriptions are no big deal, be aware that a medical GP in NSW was recently reprimanded and suspended by Ahpra for creating false documents (fake prescriptions) writing them in the names of staff members to obtain stock for his practice. (1)

Another inappropriate technique used to acquire stock for dental practices is to make the prescription out ‘for clinic use’ or ‘practice stock’. Although this is not illegal, it is unnecessary and a waste of prescription stationery since there is a more appropriate process you could follow without using a prescription. I know some pharmacists have instructed dentists to do this, but I’m afraid that’s just because they don’t know what the appropriate process is either. You may have to upskill them!

Readers may remember I wrote about this back in the May 2019 News Bulletin, but legislation in some states has changed since then. So please discard that old article and consider this an update.
 

What is the appropriate method for obtaining practice stock of prescription drugs?
 

Dental practices should acquire stock of prescription drugs in the same way their dental products are acquired i.e. by ordering them from a licensed wholesaler. If only a very small quantity of drugs is required, in most states these can be obtained from a pharmacy, but you do this by submitting an order form or a so-called ‘purchase order’, not a prescription.

In all Australian states and territories, dentists are legally permitted to acquire medicines for use in their practice. The regulations are laid out in state legislation, however as Drugs and Poisons legislation varies from state to state so the wording differs slightly. What they all agree on is that health professionals should order their stock from a licensed pharmaceutical wholesaler, not from a pharmacy. Just create an account with a licensed pharmaceutical wholesaler, e.g. Sigma, place your order, and off you go. Prescription drugs can be ordered from several dental product wholesalers now as well.
 

What’s wrong with ordering drugs from a pharmacy?
 

Acquisition of drugs for practice stock via a pharmacy is often difficult because pharmacies are not wholesalers and are unfamiliar with the process. Many pharmacists
have never received a stock order from a dentist, they don’t know whether its legal or how to process your request. Furthermore, some states such as Western Australia do not legally permit pharmacies to sell medicines on a wholesale basis without holding a wholesaler licence. In addition, in NSW pharmacies may only sell emergency drugs wholesale.
 

What document should be used instead of a prescription?
 

A prescription is a communication tool between a prescriber and a pharmacist to dispense medication for a specifically named patient. That’s why prescriptions are inappropriate for acquiring practice stock because no specific patient name is yet known. Instead of submitting a prescription, you should submit an order form for your drug stock. This document is referred to differently in each state. Two states refer to it as a ‘purchase order’, three refer to a ‘written order’, one simply stipulates an ‘order’, and one does not stipulate anything at all.

Table 1, (below), outlines each Australian state and territories legal specifications for ordering stock.

In New South Wales and South Australia, legislation stipulates that a signed and dated written order should be supplied to a pharmacy or wholesaler to acquire stock of scheduled medicines. (2,3) However, as mentioned above, in NSW prescribers are only allowed to order emergency drugs from a pharmacy. A recent published FAQ regarding this topic on the NSW Health website states the following:

In NSW, a pharmacy cannot supply [medicines] by wholesale. A pharmacy may only supply scheduled medicines to patients of that pharmacist for their personal treatment. A pharmacy may supply to doctors or similarly authorised practitioners for bona fide emergency treatment only. (4)

Another FAQ begins with the question: As a doctor, can I write a prescription in my own name to get supplies for surgery use from a community pharmacy?

Answer: No. A doctor cannot buy wholesale quantities of scheduled medicines for general surgery use from a community pharmacy; the medicines should be purchased from a licensed wholesaler.

As a doctor, you can write an emergency drug order (not a prescription) to obtain small quantities of medicines from a community pharmacy for use in emergencies. For example, when it wouldn’t be practicable to give a patient a prescription for an urgently needed medicine to get it dispensed at a pharmacy. (5)

In Western Australia and the Northern Territory, (6,7) legislation stipulates that dentists can obtain scheduled medicines for use in their practice on provision of a written request. This request must be a signed document that specifies the medicine, strength, form and quantity required. The dentist must also be an authorised health professional or holder of a valid permit or poisons licence. Such a permit or licence is also required in South Australia if the practice is ordering the medicines.

Victorian legislation (8) authorises dentists to ‘obtain’ scheduled medicines for use in their practice by submitting an ‘order’. No other stipulations are given regarding the form or content of the order, which makes ordering scheduled medicines from an online provider a lot easier.
 
Tasmanian legislation (9) allows a dentist to purchase and possess S4 or S8 substances from a wholesaler of scheduled substances ‘without the need for a permit or licence’. No mention is made of any kind of order or how it should be presented. However, ordering from dental or pharmaceutical wholesalers always requires an order form.

In the ACT and Queensland, (10,11) the form is referred to as a ‘purchase order’ and each state’s legislation outlines the details required on the form. In Queensland, the purchase order must also carry a distinguishing purchase order number. The supplier of the goods will be looking for this number, so in Queensland be sure to assign a serial number to all purchase orders. A template (12) of a purchase order recommended by Queensland Health can be viewed here.
 

Why don’t doctors and nurse practitioners have to do this?
 

Medical doctors and nurse practitioners don’t have these problems because they have access to the PBS ‘Prescribers Bag’, which allows them to order prescription drugs from
a pharmacy using a ‘Prescribers Bag’ order form, the cost of which is covered by the PBS. Dentists have never had access to this scheme.

In summary, prescription drug stock should not be acquired by writing a fake prescription but, in most cases, by placing an order with a pharmaceutical wholesaler. If you must use a pharmacy, write up a detailed purchase order, on your letterhead, signed and dated by a registered dentist from the practice or the licensed person in your practice.

Be aware that some pharmacists have never seen a purchase order from a dentist, so you may have to educate them on its validity. If they remain uncertain, refer them to your state drugs and poisons legislation or your state health pharmaceutical services who are invariably extremely helpful over the phone.
 

References
 

1. Paola S. GP reprimanded and suspended. Aust J Pharm 15/01/19.

2. NSW Poisons and Therapeutic Goods Regulations. 2008 Last updated 29 Sep 2023.

3. South Australia Controlled Substances (Poisons) Regulations 2011. Version 1 July 2023.

4. NSW Health. Supply of medicines: frequently asked questions.

5. NSW Health. Medical practitioners – frequently asked questions.

6. WA Medicines and Poisons Regulations 2016. Last updated 16/03/19

7. Northern Territory of Australia: Medicines Poisons and Therapeutic Goods Regulations. 16/04/2014.

8. Victorian Drugs, Poisons and Controlled Substances Regulations 2017. Version 23/05/17

9. Tasmanian Poisons Regulations 2008. Last updated 17 December 2018

10. ACT Medicines, Poisons and Therapeutic Goods Regulation 2008. Effective: 21 December 2018.

11. Queensland Medicines and Poisons (Medicines) Regulation 2021. Last modified 17 September 2021

12. Medicines and Poisons Act 2019 purchase order template, background, and instructions for use. March 2022.

If you require any further information on this subject, please don’t hesitate to contact Geraldine on the PharmaAdvice Service: call 0419 752 528 or email pharma-advice@ada.org.au

This article was first published in the ADA's News Bulletin, December 2023.