[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.
Interestingly, I asked in a March 16 email to the NYS Board of Pharmacy how one shops around for the best prices after learning that written prescriptions were no longer permitted in NYS. Here is their e-mailed response to me:
“Actually, almost all pharmacies will provide price quotes via phone. And you may ask your prescriber to hold the prescription in a queue until you decide where you want it transmitted.
New York State Board of Pharmacy
89 Washington Ave., 2nd Floor West
Albany, NY 12234
Phone: 518-474-3817 ext. 130
Fax: 518-473-6995
Email: pharmbd@nysed.gov
Web: http://www.op.nysed.gov”
Clearly, the person who sent this response hasn’t had to shop around for medications. No pharmacy will give you a price quote until they run it through your insurance, which they can’t/won’t do without a prescription in hand! Haven’t yet had a reason to get an Rx filled recently, but now dread having to figure out how to easily get one filled should my physician refuse to give me a written Rx under threat of a fine. THis needs to be fixed!
This is obviously a reaction to the growth of online shopping, to prevent New York residents from buying their medications online from Canada, Mexico or Europe for example, where the same medication is often 1/4 the price.
Limiting the customer to a selected pharmacy creates myraid problems: if the pharmacy is near your office, but you’re unwell and at home, you’re screwed. As you are when the pharmacy tells you on a Friday that they haven’t filled your refill and will need to order it for Monday – you can’t do the normal thing and try the pharmacy in the next block.
NYS law no longer requires any notification to state for hand written prescriptions
As of 2/2019 from NYS website:
“Practitioner Notification Process – Use of an Electronic Prescribing Exception
There are a number of exceptions to the electronic prescribing mandate which allow a practitioner to issue an Official New York State Prescription (ONYSRx) form, an oral prescription or a facsimile of a manually signed ONYSRx in lieu of an electronic prescription.
Use of an exception to the e-prescribing mandate no longer requires a notification to the New York State Department of Health. However, the prescribing practitioner must indicate in the patient’s health record when they issue a non-electronic prescription for one of the approved exceptions below:
•Temporary technological failure;
•Temporary electrical failure;
•To be dispensed by a pharmacy located outside the state, outside the country…”
https://www.health.ny.gov/professionals/narcotic/electronic_prescribing/practitioner_notification_requirement.htm
Thank you for the valuable information! We’ll be updating our blog about this topic soon.