CVS Health appreciates the opportunity to submit comments regarding the proposed Notice of Intended Regulatory Action (NIORA) regarding 18VAC110-20, Regulations Governing the Practice of Pharmacy. The goal of this communication is to provide the Board of Pharmacy (the “Board”) with additional information regarding 18VAC110-20-240 and 18VAC110-20-280 for consideration and incorporation into the final proposal.

Comments:

18VAC110-20-240(C), Manner of maintaining records, prescriptions, inventory records. The Board proposes to add language to clarify subsection (C) that chart orders used in long term care facilities must include a quantity or duration of treatment.

CVS Health recommends the proposed change to 18VAC110-20-240(C) be removed from the proposal to afford the pharmacist the opportunity to continue leveraging good professional judgment as well as the guidance noted in 110-35. Pursuant to the Virginia Board of Pharmacy Guidance Documents 110-35, a chart order should contain directions for use as it relates to the quantity to be dispensed or authorized duration of therapy that the pharmacist can reference in calculating the quantity of medication to be dispensed to the patient. CVS Health believes that this guidance coupled with professional judgment provides pharmacists the best opportunity to serve the elderly population residing in long-term care facilities.

18VAC110-20-280(A)(4)(C), Transmission of a prescription order by facsimile machine. The Board is considering whether there is value in the allowance for residents of long term care facilities and provider pharmacies or if it should be removed.

CVS Health strongly opposes any consideration which would remove the ability for practitioners’ authorized agents to transmit a written prescription from a long-term care facility to a pharmacy provider. Transmission of prescription information by a practitioner’s authorized agent is a long-standing and commonly accepted pharmacy practice and legal principle recognized by the healthcare industry.

The current rule language in 18VAC110-20-280(A)(4)(C) is critical for long-term care facilities to successfully transmit chart orders to provider pharmacies and promotes the most expeditious dispensing and medication delivery model for the facility. The majority of long term care facilities in the state of Virginia still primarily rely on facsimile because more advanced technological solutions may be unattainable due to cost, available resources, IT integration challenges, or other operational barriers. Placing further restriction on the manner in which long term care facilities transmit prescription medication orders will create a significant burden on long term care facility providers, practitioners, and pharmacies.  Removal of the facsimile transmission process by practitioners’ authorized agents in the long-term care facility may lead to unintended consequences such as delays in processing chart orders, delays in medication administration, and jeopardize timely initiation of drug therapy.

As a leader in the long term care pharmacy industry and an advocate for increased patient access to prescription medication, CVS Health recommends the Board reconsider the proposal to 18VAC110-20-280(C) and allow the current language to remain as written.

In closing, CVS Health appreciates the opportunity to provide these comments to the Board of Pharmacy for their review and consideration regarding this proposal and look forward to a favorable outcome for the patients of the Commonwealth of Virginia.

Sincerely,

Bill Irvin, R.Ph.

Director, Pharmacy Regulatory Affairs

CVS Health

13 Commerce Avenue

Londonderry, NH 03053

(603) 339-7846

William.irvin@omnicare.com