Prescription Processing, Dispensing, and Labeling
Valid prescription
A prescription must be issued for a legitimate medical purpose by a prescriber acting in the usual course of practice. Core elements include patient identification, drug name/strength/quantity, directions, date, prescriber identification, and refills. Controlled-substance prescriptions need the prescriber’s DEA number and must meet additional federal/NC rules. Pharmacists must screen for therapeutic duplication, interactions, allergies, and dose appropriateness before dispensing.
Substitution and labeling
North Carolina permits generic substitution of a therapeutically equivalent product unless the prescriber has indicated “dispense as written” or the patient insists on the brand. The label must identify the pharmacy, prescription number, date, patient, prescriber, drug name and strength, quantity, directions, and required warnings. Auxiliary labels and beyond-use dates must be accurate. Refills may not exceed the prescriber’s authorization or the legal limit.
Worked example
A prescriber writes for a brand-name statin and does not write “dispense as written.” The pharmacy has a less expensive AB-rated generic. The pharmacist may substitute, but must label the actual product dispensed, record the substitution, and tell the patient the generic is being supplied. If the prescriber had written “dispense as written,” the pharmacist could not substitute without contacting the prescriber.
Traps
Dispensing a controlled substance without a DEA number; refilling a Schedule II prescription; assuming “no substitution” can be added after the fact by staff; missing auxiliary labels; and transferring a prescription without the required pharmacist-to-pharmacist communication and documentation.