Role of Authorized Agents in Communicating Controlled Substance Prescriptions to Pharmacies, 61613-61617 [2010-25136]
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Federal Register / Vol. 75, No. 193 / Wednesday, October 6, 2010 / Rules and Regulations
this rule effective within less than 30
days.
List of Subjects in 14 CFR Part 91
Air traffic control, Aircraft, Airmen,
Airports, Aviation safety.
The Amendment
In consideration of the foregoing, the
Federal Aviation Administration
amends Chapter I of Title 14, Code of
Federal Regulations, as follows:
■
PART 91—GENERAL OPERATING AND
FLIGHT RULES
1. The authority citation for part 91
continues to read as follows:
■
Authority: 49 U.S.C. 106(g), 1155, 40103,
40113, 40120, 44101, 44111, 44701, 44704,
44709, 44711, 44712, 44715, 44716, 44717,
44722, 46306, 46315, 46316, 46504, 46506–
46507, 47122, 47508, 47528–47531, articles
12 and 29 of the Convention on International
Civil Aviation (61 Stat. 1180).
2. Amend Appendix D to Part 91 by
revising section 1 introductory text to
read as follows:
■
Appendix D to Part 91—Airports/
Locations: Special Operating
Restrictions
Section 1. Locations at which the
requirements of § 91.215(b)(2) and
§ 91.225(d)(2) apply. The requirements of
§§ 91.215(b)(2) and 91.225(d)(2) apply below
10,000 feet MSL within a 30-nautical-mile
radius of each location in the following list.
*
*
*
*
*
Issued in Washington, DC, on October 1,
2010.
Pamela Hamilton-Powell,
Director, Office of Rulemaking.
[FR Doc. 2010–25102 Filed 10–5–10; 8:45 am]
BILLING CODE 4910–13–P
DEPARTMENT OF JUSTICE
21 CFR Part 1306
[Docket No. DEA–339S]
Role of Authorized Agents in
Communicating Controlled Substance
Prescriptions to Pharmacies
Drug Enforcement
Administration, Department of Justice.
ACTION: Statement of policy.
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AGENCY:
The Drug Enforcement
Administration (DEA) is issuing this
statement of policy to provide guidance
under existing law regarding the proper
role of a duly authorized agent of a
DEA-registered individual practitioner
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Legal Authority
DEA implements and enforces Titles
II and III of the Comprehensive Drug
Abuse Prevention and Control Act of
1970, often referred to as the Controlled
Substances Act (CSA) and the
Controlled Substances Import and
Export Act (CSIEA) (21 U.S.C. 801–971),
as amended. DEA publishes the
implementing regulations for these
statutes in title 21 of the Code of Federal
Regulations (CFR), parts 1300 through
1321. These regulations are designed to
ensure that there is a sufficient supply
of controlled substances for legitimate
medical, scientific, research, and
industrial purposes and to deter the
diversion of controlled substances to
illegal purposes. Controlled substances
are drugs that have a potential for abuse
and dependence; these include
substances classified as opioids,
stimulants, depressants, hallucinogens,
anabolic steroids, and drugs that are
immediate precursors of these classes of
substances. The CSA mandates that
DEA establish a closed system of control
for manufacturing, distributing, and
dispensing controlled substances. Any
person who manufactures, distributes,
dispenses, imports, exports, or conducts
research or chemical analysis with
controlled substances must register with
DEA (unless exempt) and comply with
the applicable requirements for the
activity.
Background
Drug Enforcement Administration
SUMMARY:
in connection with the communication
of a controlled substance prescription to
a pharmacy.
FOR FURTHER INFORMATION CONTACT:
Mark W. Caverly, Chief, Liaison and
Policy Section, Office of Diversion
Control, Drug Enforcement
Administration, 8701 Morrissette Drive,
Springfield, VA 22152; telephone (202)
307–7297.
SUPPLEMENTARY INFORMATION:
Under longstanding Federal law,
controlled substances are strictly
regulated to ensure a sufficient supply
for legitimate medical, scientific,
research, and industrial purposes and to
deter diversion of controlled substances
to illegal purposes. The substances are
regulated because of their potential for
abuse and likelihood to cause
dependence when abused and because
of their serious and potentially unsafe
nature if not used under proper
circumstances. To minimize the
likelihood that pharmaceutical
controlled substances would be diverted
into illicit channels, Congress
established under the CSA a closed
system of drug distribution for
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61613
legitimate handlers of controlled
substances. The foundation of this
system is the concept of registration.
The only persons who may lawfully
manufacture, distribute and dispense
controlled substances under the CSA are
those who have obtained a DEA
registration authorizing them to do so.
21 U.S.C. 822. Thus, the prescribing of
controlled substances may be carried
out only by those practitioners who
have obtained a DEA registration
authorizing such activity.
To be eligible for a DEA registration
as a practitioner under the CSA, one
must be a physician, dentist,
veterinarian, hospital, or other person
licensed, registered, or otherwise
permitted by the United States or the
State in which he or she practices to
dispense controlled substances in the
course of professional practice. 21
U.S.C. 802(21), 823(f). Thus, State
licensure to prescribe controlled
substances is generally a prerequisite to
obtaining a DEA registration to do so.
The term ‘‘individual practitioner’’
excludes institutions such as hospitals,
which are themselves DEA registrants
and are permitted to administer and
dispense, but not prescribe, controlled
substances under their registration. 21
CFR 1300.01(b)(17).
By longstanding statutory
requirement, a valid prescription issued
by a DEA-registered practitioner is
required for dispensing a controlled
substance. To be effective (i.e., valid), a
prescription for a controlled substance
must be issued for a legitimate medical
purpose by a practitioner acting in the
usual course of professional practice.
United States v. Moore, 423 U.S. 122
(1975); 21 CFR 1306.04(a). Thus, the
practitioner must determine that a
prescription for a controlled substance
is for a legitimate medical purpose.
While the core responsibilities
pertaining to prescribing controlled
substances may not be delegated to
anyone else, an individual practitioner
may authorize an agent to perform a
limited role in communicating such
prescriptions to a pharmacy in order to
make the prescription process more
efficient. Nonetheless, it is important to
understand that any agency relationship
must also preserve the requirement that
medical determinations to prescribe
controlled substances be made by a
practitioner only, not by an agent.
Accordingly, this statement of policy
outlines DEA’s existing statutory and
regulatory requirements as to the proper
role of duly authorized agents of
individual practitioners. DEA
anticipates the utilization of electronic
prescribing by practitioners for
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controlled substance prescriptions will
reduce the role of agents over time.
prescribing practitioner cannot delegate
his or her signature authority.
Medical Determination of Need for a
Controlled Substance Prescription
Cannot Be Delegated
Role of Agent Under the CSA
As discussed above, the CSA does not
permit a prescribing practitioner to
delegate to an agent or any other person
the practitioner’s authority to issue a
prescription for a controlled substance.
A practitioner acting in the usual course
of his or her professional practice must
determine that there is a legitimate
medical purpose for a controlled
substance prescription; an agent may
not make this determination. Even
though the CSA established a closed
system in which all persons in the
distribution chain are required to be
registered and are held accountable for
every controlled substance transaction,
Congress recognized a role for agents
under the Act. The CSA exempts agents
of registrants, including practitioners,
from the requirement of registration. 21
U.S.C. 822(c)(1). The statute defines an
‘‘agent’’ as ‘‘an authorized person who
acts on behalf of or at the direction of
a manufacturer, distributor, or
dispenser. * * *.’’ 21 U.S.C. 802(3).
Likewise, DEA regulations
implementing the CSA specifically
permit a practitioner to use an
authorized agent to perform certain
ministerial acts in connection with
communicating prescription
information to a pharmacy. The
common means to communicate a
prescription to a pharmacy include
hand delivery, facsimile, phone call, or
an electronic transmission. As
explained below, the proper role of an
agent depends upon the schedule of the
controlled substance prescribed, the
circumstances of the ultimate user, and
the method of communication.
DEA regulations state: ‘‘A prescription
for a controlled substance to be effective
must be issued for a legitimate medical
purpose by an individual practitioner
acting in the usual course of his
professional practice. The responsibility
for the proper prescribing and
dispensing of controlled substances is
upon the prescribing practitioner, but a
corresponding responsibility rests with
the pharmacist who fills the
prescription.’’ 21 CFR 1306.04(a).
Accordingly, the practitioner must
determine that a prescription for a
controlled substance is for a legitimate
medical purpose. This determination is
the sole responsibility of the
practitioner and may not be delegated.
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Elements of a Valid Prescription Must
be Specified by the Practitioner and
Cannot be Delegated
Controlled substance prescriptions are
orders for medication to be dispensed to
an ultimate user and are required to
contain specific information including:
Patient name, address, drug name and
strength, quantity prescribed, directions
for use, and the name, address and DEA
number of the issuing practitioner. 21
CFR 1306.05(a). All prescriptions for
controlled substances must be dated as
of, and signed on, the day when issued.
Paper prescriptions must be manually
signed by the issuing practitioner in the
same manner that the practitioner
would sign a check or other legal
document (21 CFR 1306.05(d));
electronic prescriptions for controlled
substances must be signed in
accordance with DEA regulations (21
CFR 1306.05(e), 21 CFR 1311.140).
The regulations provide that ‘‘[a]
prescription may be prepared by the
secretary or agent for the signature of a
practitioner, but the prescribing
practitioner is responsible in case the
prescription does not conform in all
essential respects to the law and
regulations.’’ 21 CFR 1306.05(f).
Accordingly, an authorized agent may
prepare a controlled substance
prescription only based on the
instructions of the prescribing
practitioner as to the required elements
of a valid prescription and then provide
the prescription to the practitioner to
review. The authorized agent does not
have the authority to make medical
determinations. The practitioner must
personally sign the prescription,
whether manually or electronically. The
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Communication by Facsimile or Oral
Communication of a Valid Prescription
for a Schedule III, IV, or V Controlled
Substance May be Delegated to an
Authorized Agent
The CSA provides that a pharmacy
may dispense Schedule III and IV
controlled substances pursuant to a
‘‘written or oral prescription.’’ 21 U.S.C.
829(b). DEA regulations further specify
that a pharmacist may dispense a
Schedule III, IV, or V controlled
substance pursuant to ‘‘either a paper
prescription signed by a practitioner [or]
a facsimile of a signed paper
prescription transmitted by the
practitioner or the practitioner’s agent to
the pharmacy, * * *.’’ 21 CFR
1306.21(a). Accordingly, an authorized
agent may transmit such a practitionersigned paper prescription via facsimile
to the pharmacy on behalf of the
practitioner.
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Controlled substances in Schedules
III, IV and V may also be dispensed by
a pharmacy pursuant to ‘‘an oral
prescription made by an individual
practitioner and promptly reduced to
writing by the pharmacist containing all
information required [for a valid
prescription], except for the signature of
the practitioner.’’ 21 CFR 1306.21(a).
Under DEA regulations, an authorized
agent may orally communicate such a
prescription to a pharmacist. 21 CFR
1306.03(b). Where the pharmacist has
reason to believe that a prescription has
been communicated by an agent, the
pharmacist, in accordance with his or
her responsibility for proper dispensing
of controlled substances, may have a
duty to inquire into the legitimacy of the
prescription. The particular
circumstances will dictate the
appropriate level of inquiry by the
pharmacist. As noted above, the
practitioner remains responsible for
ensuring that the prescription conforms
to the law and regulations, and the
practitioner cannot delegate to an agent
the authority to make a medical
determination of need for a controlled
substance prescription.
Generally, a Valid Schedule II
Controlled Substance Prescription May
Not be Communicated by Facsimile
Because Schedule II controlled
substances have the highest potential for
abuse and the greatest likelihood of
dependence among the pharmaceutical
controlled substances (those in
Schedules II–V), the CSA controls on
Schedule II drugs are the most
restrictive. The CSA requires that a
Schedule II controlled substance be
dispensed by a pharmacy only pursuant
to a written prescription, except in
emergency situations, and prohibits
Schedule II prescriptions from being
refilled. 21 U.S.C. 829(a). Thus, in most
cases, a pharmacist must receive the
original, manually signed paper
prescription or an electronic
prescription prior to dispensing a
Schedule II controlled substance. 21
CFR 1306.11(a).
A Valid Schedule II Controlled
Substance Prescription For a Person in
a Hospice or Long Term Care Facility
(LTCF) May be Communicated by
Facsimile and That Communication
May be Delegated to an Authorized
Agent
DEA regulations specify two
exceptions whereby a Schedule II
controlled substance prescription sent
by facsimile may serve as the original
written prescription. A practitioner or a
practitioner’s authorized agent may
transmit a valid Schedule II controlled
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substance prescription to a pharmacy
via facsimile for: (1) Patients enrolled in
a hospice care program certified and/or
paid for by Medicare under Title XVIII
or hospice programs which are licensed
by the State (21 CFR 1306.11(g)); and (2)
residents of LTCFs (21 CFR 1306.11(f)).
The facsimile serves as the original
written prescription and must be
maintained by the pharmacy as such.
An authorized agent of the prescribing
practitioner may transmit the
practitioner-signed prescription by
facsimile on behalf of the practitioner.
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Emergency Oral Communication of a
Valid Schedule II Controlled Substance
Prescription May Not be Delegated to an
Authorized Agent
The CSA contains an exception that
allows a practitioner to issue oral
prescriptions for Schedule II controlled
substances in an emergency. 21 U.S.C.
829(a). An emergency for this purpose is
defined by the Food and Drug
Administration in 21 CFR 290.10. DEA
regulations limit such an emergency
oral prescription to the quantity
necessary to treat the patient during the
emergency period and require that it be
followed up within 7 days by a
practitioner-signed, written prescription
to the dispensing pharmacy. 21 CFR
1306.11(d). Moreover, oral emergency
prescriptions must immediately be
reduced to writing by the pharmacist
and must contain all the information
ordinarily required in a prescription,
except for the signature of the
prescribing individual practitioner. If
the prescribing individual practitioner
is not known to the pharmacist, the
pharmacist must make a reasonable
effort to determine that the oral
authorization came from a registered
individual practitioner, which may
include a call back to the prescribing
individual practitioner and/or other
good faith efforts to ensure the
practitioner’s identity. 21 CFR
1306.11(d). Because the more specific
requirement that the emergency
Schedule II oral authorization must be
from a registered individual practitioner
(21 CFR 1306.11(d)) supersedes the
general rule that an employee or agent
of the individual practitioner may
communicate prescriptions to a
pharmacist (21 CFR 1306.03(b)), the
prescribing individual practitioner must
personally communicate the emergency
oral prescription to the pharmacist. An
agent may not call in an oral
prescription for a Schedule II controlled
substance on behalf of a practitioner
even in an emergency circumstance.
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Pharmacist Dispensing a Controlled
Substance Prescription Has a Duty To
Fill Only Valid Prescriptions
Regardless of the method of
transmission of a controlled substance
prescription—by hand delivery,
facsimile, phone call or electronically—
DEA regulations make it clear that the
legal responsibility for issuing a valid
prescription that ‘‘conform[s] in all
essential respects to the law and
regulations’’ rests upon the prescribing
practitioner. As noted, however, a
pharmacist has a corresponding
responsibility for the proper prescribing
and dispensing of controlled substances.
21 CFR 1306.04(a). Further, ‘‘A
corresponding liability rests upon the
pharmacist, including a pharmacist
employed by a central fill pharmacy,
who fills a prescription not prepared in
the form prescribed by DEA
regulations.’’ 21 CFR 1306.05(f). A
pharmacist must carefully review all
purported controlled substance
prescriptions to ensure that the
prescription meets all of the legal
requirements for a valid prescription.
The pharmacist has a duty to inquire
further as to any question surrounding
the satisfaction of any or all of the legal
requirements for a valid prescription
depending upon the particular
circumstances, including the
requirement that the prescription be
issued for a legitimate medical purpose
by a practitioner acting in the usual
course of professional practice. The
pharmacist must be satisfied that the
prescription is consistent with the CSA
and DEA regulations before dispensing
a controlled substance to the ultimate
user.
Summary of the Acts That an Agent
May Take in Connection With
Controlled Substance Prescriptions
1. An authorized agent of an
individual practitioner may prepare a
written prescription for the signature of
the practitioner, provided that the
practitioner, in the usual course of
professional practice, has determined
that there is a legitimate medical
purpose for the prescription and has
specified to the agent the required
elements of the prescription. 21 CFR
1306.04(a); 1306.05(a), (f).
2. Where a DEA-registered individual
practitioner has made a valid oral
prescription for a controlled substance
in Schedules III–V by conveying all the
required prescription information to the
practitioner’s authorized agent, that
agent may telephone the pharmacy and
convey that prescription information to
the pharmacist. 21 CFR 1306.03(b),
1306.21(a).
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3. In those situations in which an
individual practitioner has issued a
valid written prescription for a
controlled substance, and the
regulations permit the prescription to be
transmitted by facsimile to a pharmacy
(as set forth in 21 CFR 1306.11(a),
1306.11(f), 1306.11(g), and 1306.21(a)),
the practitioner’s agent may transmit the
practitioner-signed prescription to the
pharmacy by facsimile.
Who Is an Agent of an Individual
Practitioner for the Purpose of
Communicating a Prescription for a
Controlled Substance
The CSA defines an ‘‘agent’’ as ‘‘an
authorized person who acts on behalf of
or at the direction of a manufacturer,
distributor, or dispenser. * * *’’
21 U.S.C. 802(3). Under the CSA, the
term ‘‘dispense’’ includes ‘‘prescribing.’’
21 U.S.C. 802(10). Establishment of an
agency relationship, consistent with the
CSA, is guided by general precepts of
the common law of agency. For the
purposes of explaining the law of
agency as it relates to the CSA, it is
appropriate to refer to and consider as
generally applicable the Restatement of
Agency (Restatement) which provides:
Agency is the fiduciary relationship that
arises when one person (a ‘‘principal’’)
manifests assent to another person (an
‘‘agent’’) that the agent shall act on the
principal’s behalf and subject to the
principal’s control, and the agent manifests
assent or otherwise consents so to act.
Restatement (Third) of Agency § 1.01
(2006).
The Restatement is useful in
evaluating whether, for CSA purposes, a
valid agency relationship exists between
a prescribing practitioner and another
person for the purpose of
communicating a prescription for a
controlled substance to a pharmacy. The
Restatement requires that the principal
(in this context, the DEA-registered
individual practitioner) ‘‘manifests
assent’’ for a certain person to act on his
or her behalf. This is consistent with the
CSA and its registration-based system of
accountability. Where non-DEA
registrants communicate a prescription
for a controlled substance on behalf of
a registrant, it is important that such
persons be clearly identified and their
activities be subject to evaluation to
ensure they do not exceed the bounds
of the agency relationship and the legal
limits of an agent’s role under the CSA.
Because the individual practitioner
remains responsible for ensuring that all
prescriptions issued pursuant to his or
her DEA registration comply in all
respects with the CSA and DEA
regulations, it is important that the
practitioner decide who may act as his
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or her agent. This is also consistent with
the CSA definition that an agent is ‘‘an
authorized person who acts on behalf of
or at the direction of’’ the prescribing
individual practitioner. 21 U.S.C.
802(3).
In addition to requiring that the
principal (i.e., individual prescribing
practitioner) ‘‘manifests assent’’ to
having a particular person act as his or
her agent, and that the agent reciprocate
by manifesting assent to serve as such,
the Restatement also requires that the
agent acts ‘‘subject to the principal’s
control.’’ In an employment situation, an
individual practitioner may establish
the duties of his or her employees and
is responsible for monitoring their
activities. Absent an employeremployee relationship, a practitioner
will generally have less control over
other persons that he or she may
designate as his or her agent(s). Prior to
designating an agent, a practitioner may
wish to consider the degree of control
that the registrant may exercise over the
proposed agent, the proposed agent’s
licensure, level of training and
experience, and other such factors to
determine whether the person would be
an appropriate agent and to ensure that
the agent will not engage in activities
that exceed the scope of the agency
relationship. Absent affirmative actions
by the practitioner and the proposed
agent, a valid agency relationship
generally will not exist outside an
employer-employee relationship.
By requiring that an agency
relationship is created when (1) the
principal manifests assent that a
particular person shall act (i) on his or
her behalf and (ii) subject to his or her
control, and (2) the agent manifests
assent so to act, the Restatement
definition of ‘‘agency’’ is consistent with
the CSA’s definition of ‘‘agent’’ as ‘‘an
authorized person who acts on behalf of
or at the direction of’’ the prescribing
practitioner. 21 U.S.C. 802(3). An agent
may not legally perform duties that
must be personally performed by the
individual practitioner. The practitioner
may assign only those duties which may
be carried out by an agent.
DEA notes that in a 2001 notice and
solicitation of information on the
potential use of automated dispensing
systems to prevent the accumulation of
surplus controlled substances at LTCFs,
DEA briefly discussed the role of nurses
in the narrow setting of LTCFs outside
of an employer-employee relationship
and where no affirmative actions
established an agency relationship
between the individual practitioner and
the LTCF nurse. 66 FR 20833, 20834
(April 25, 2001). This incidental
example and other informal discussions
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have resulted in the need for this
published articulation of what existing
law allows and what affirmative actions
may be required to establish a valid
agency relationship for purposes of an
authorized agent to communicate
controlled substance prescriptions to
pharmacies, particularly in settings
where there is no employer-employee
relationship. DEA regulations on the
role of authorized agents in
communicating controlled substance
prescriptions to pharmacies generally
have not changed.
This policy statement outlines the
proper role of agents in those situations
where an individual practitioner and an
individual agent (including but not
limited to an LTCF nurse) have taken
affirmative steps to establish a valid
agency relationship for those aspects of
the CSA that may be appropriately
executed by an authorized agent under
Federal law. As such, DEA is hereby
outlining a suggested mechanism to
establish a valid agency relationship as
well as explaining the appropriate roles
an authorized agent may play regardless
of the setting. This statement of policy
is intended to provide general guidance
on establishment of a valid agency
relationship between an individual
practitioner and an identified
individual. DEA wishes to emphasize
that, regardless of the setting, it is the
practitioner’s sole decision as to
whether or not to designate an agent to
act on his or her behalf and subject to
his or her control. To be consistent with
the purpose of the CSA to implement a
‘‘closed system’’ of distribution and for
DEA to enforce this framework, an
agency relationship between a registered
individual practitioner and an identified
agent for the purposes of
communicating controlled substance
prescriptions must be explicit and
transparent. DEA believes its existing
regulations are adequate in addressing
the role of an authorized agent but will
analyze whether additional federal
rulemaking or guidance is needed
beyond this statement to establish the
necessary explicit and transparent
nature of an authorized agency
relationship, particularly when outside
an employer-employee relationship.
Written Authorization of an Agent
Recommended—Sample Agency
Agreement
Due to the legal responsibilities of
practitioners and pharmacists under the
CSA and the potential harm to the
public from inappropriate and unlawful
prescribing and dispensing of controlled
substances, violations of the law are
subject to criminal, civil, and
administrative sanctions. DEA believes
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it is in the best interests of the
practitioner, the agent, and the
dispensing pharmacist that the
designation of those persons authorized
to act on behalf of the practitioner and
the scope of any such authorization be
reduced to writing.
DEA provides below an example of a
written agreement that would properly
confer authority to an agent to act on
behalf of an individual practitioner with
regard to controlled substance
prescriptions. Individual practitioners
may choose to designate and authorize
one or more persons at one or more
locations within or outside their
practice to act as their agent. Likewise,
an individual may act as an authorized
agent for multiple individual
practitioners depending upon the
circumstances. A practitioner may or
may not wish to delegate all of these
types of authorized communications to
a particular agent and may tailor the
agreement accordingly. The agreement
should be clear that the agent may not
further delegate the outlined
responsibilities.
Designating Agent of Practitioner For
Communicating Controlled Substance
Prescriptions to Pharmacies
llllllllllllllllll
l
(Name of registered individual
practitioner)
llllllllllllllllll
l
(Address as it appears on certificate of
registration) llllllllllll
llllllllllllllllll
l
(DEA registration number)
I, llllllll (name of registrant),
the undersigned, who is authorized to
dispense (including prescribe)
controlled substances in Schedules II,
III, IV, and V under the Controlled
Substances Act, hereby
authorizellllllll (name of
agent), to act as my agent only for the
following limited purposes:
1. To prepare, for my signature,
written prescriptions for controlled
substances in those instances where I
have expressly directed the agent to do
so and where I have specified to the
agent the required elements of the
prescription (set forth in 21 CFR
1306.05).
2. To convey to a pharmacist by
telephone oral prescriptions for
controlled substances in Schedules III,
IV, and V in those instances where I
have expressly directed the agent to do
so and where I have specified to the
agent the required elements of the
prescription (set forth in 21 CFR
1306.05).
3. To transmit by facsimile to a
pharmacy prescriptions for controlled
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substances in those instances where I
have expressly directed the agent to do
so and where I have specified to the
agent the required elements of the
prescription (set forth in 21 CFR
1306.05) and I have signed the
prescription.
This authorization is not subject to
further delegation to other persons. Both
the undersigned DEA-registered
individual practitioner and the
undersigned agent understand and agree
that the practitioner is solely
responsible for making all medical
determinations relating to prescriptions
for controlled substances communicated
by the agent pursuant to this agreement,
and for ensuring that all such
prescriptions conform in all other
essential respects to the law and
regulations.
The undersigned agent understands he
or she does not have authority to make
any medical determinations. The
undersigned DEA-registered prescribing
practitioner further understands that the
prescribing practitioner must personally
communicate all Schedule II emergency
oral prescriptions to the pharmacist.
Both the undersigned practitioner and
agent understand that the agent may not
call in an emergency oral prescription
for a Schedule II controlled substance
on behalf of the practitioner.
This agency agreement shall be
terminated immediately if and when
any of the following occur:
1. The undersigned practitioner no
longer possesses the active DEA
registration specified in this agreement.
2. The undersigned agent is no longer
employed in the manner described in
this agreement.
3. The practitioner or the agent
revokes this agency agreement by
completing the revocation section at the
end of this document or by executing a
written document that is substantially
similar to the revocation section at the
end of this document.
llllllllllllllllll
l
(Signature of practitioner)
I, llllllll (name of agent),
hereby affirm that I am the person
named herein as agent and that the
signature affixed hereto is my signature.
I further affirm that I am a lll____
(title), licensed in the State of lll,
(where applicable) and (if applicable)
am employed by/under contract with
llllllll (name of employer or
contracting entity). I agree to abide by
all the terms of this agreement and to
comply with all applicable laws and
regulations relating to controlled
substances.
llllllllllllllllll
l
(Signature of agent)
VerDate Mar<15>2010
15:06 Oct 05, 2010
Jkt 223001
llllllllllllllllll
l
(State license number of agent where
applicable)
llllllllllllllllll
l
(Name of employer/contracting entity
where applicable)
llllllllllllllllll
l
(Address of employer/contracting entity
where applicable)
Witnesses:
1.llllllllll
2.llllllllll
Signed and dated on the llll day
of llllll (month) llllll,
(year), at llllllll.
Revocation
The foregoing agency agreement is
hereby revoked by the undersigned. The
agent is no longer authorized to
communicate Schedule II, III, IV and V
controlled substance prescriptions to a
pharmacy on my behalf. A copy of this
revocation has been given to the agent
this same day.
llllllllllllllllll
l
(Signature of registered practitioner
revoking power)
Witnesses:
1. llllllllll
2. llllllllll
Signed and dated on the llllday of
llllll(month)llll, (year), at
llllllll.
DEA recommends that the original
signed agency agreement be kept by the
practitioner during the term of the
agency relationship and for a reasonable
period after termination or revocation.
DEA requires that inventory and other
records be kept for at least two years (21
U.S.C. 827(b), 21 U.S.C. 828(c), 21 CFR
1304.04). This is simply a suggested
time period for retention of agency
agreements and is not required by DEA.
A signed copy should also be provided
to the practitioner’s designated agent,
the agent’s employer (if other than the
practitioner), and any pharmacies that
regularly receive communications from
the agent pursuant to the agreement.
Providing a copy to pharmacies likely to
receive prescriptions from the agent on
the practitioner’s behalf may assist those
pharmacies with their corresponding
responsibility regarding the dispensing
of controlled substances. It is important
to reiterate that a pharmacist always has
a corresponding responsibility to ensure
that a controlled substance prescription
conforms with the law and regulations,
including the requirement that the
prescription be issued for a legitimate
medical purpose by a practitioner acting
in the usual course of professional
practice, and a corresponding liability if
a prescription is not prepared or
PO 00000
Frm 00029
Fmt 4700
Sfmt 4700
61617
dispensed in a manner consistent with
the CSA or DEA regulations. Even
where the pharmacist has a copy of an
agency agreement, the pharmacist may
also have a duty to inquire further
depending upon the particular
circumstances. Because the agency
agreement may be revoked at any time
by the practitioner or by the agent, the
party terminating the agreement should
notify the other party immediately upon
termination. The practitioner should
notify those pharmacies that were
originally made aware of the agency
agreement of the termination of that
agreement. In most circumstances where
an agent changes employment, the
agreement should be revoked.
Dated: October 1, 2010.
Joseph T. Rannazzisi,
Deputy Assistant Administrator, Office of
Diversion Control.
[FR Doc. 2010–25136 Filed 10–5–10; 8:45 am]
BILLING CODE 4410–09–P
DEPARTMENT OF DEFENSE
Office of the Secretary
32 CFR Part 323
[Docket ID DOD–2010–OS–0139]
Privacy Act of 1974; Implementation
Defense Logistics Agency; DoD.
Final rule; request for
comments.
AGENCY:
ACTION:
The Defense Logistics Agency
is revising two exemption rules. The
exemption rule for S100.10 entitled
‘‘Whistleblower Complaint and
Investigative Files’’ is being deleted in
its entirety and the exemption rule
system identifier for the ‘‘Incident
Investigation/Police Inquiry Files’’
system of records is being revised.
DATES: The rule will be effective on
December 6, 2010, unless comments are
received that would result in a contrary
determination.
Comments will be accepted on or
before December 6, 2010.
ADDRESSES: You may submit comments,
identified by docket number and title,
by any of the following methods:
• Federal eRulemaking Portal: https://
www.regulations.gov. Follow the
instructions for submitting comments.
• Mail: Federal Docket Management
System Office, 1160 Defense Pentagon,
Room 3C843, Washington, DC 20301–
1160.
Instructions: All submissions received
must include the agency name, docket
number and title for this Federal
Register document. The general policy
SUMMARY:
E:\FR\FM\06OCR1.SGM
06OCR1
Agencies
[Federal Register Volume 75, Number 193 (Wednesday, October 6, 2010)]
[Rules and Regulations]
[Pages 61613-61617]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-25136]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF JUSTICE
Drug Enforcement Administration
21 CFR Part 1306
[Docket No. DEA-339S]
Role of Authorized Agents in Communicating Controlled Substance
Prescriptions to Pharmacies
AGENCY: Drug Enforcement Administration, Department of Justice.
ACTION: Statement of policy.
-----------------------------------------------------------------------
SUMMARY: The Drug Enforcement Administration (DEA) is issuing this
statement of policy to provide guidance under existing law regarding
the proper role of a duly authorized agent of a DEA-registered
individual practitioner in connection with the communication of a
controlled substance prescription to a pharmacy.
FOR FURTHER INFORMATION CONTACT: Mark W. Caverly, Chief, Liaison and
Policy Section, Office of Diversion Control, Drug Enforcement
Administration, 8701 Morrissette Drive, Springfield, VA 22152;
telephone (202) 307-7297.
SUPPLEMENTARY INFORMATION:
Legal Authority
DEA implements and enforces Titles II and III of the Comprehensive
Drug Abuse Prevention and Control Act of 1970, often referred to as the
Controlled Substances Act (CSA) and the Controlled Substances Import
and Export Act (CSIEA) (21 U.S.C. 801-971), as amended. DEA publishes
the implementing regulations for these statutes in title 21 of the Code
of Federal Regulations (CFR), parts 1300 through 1321. These
regulations are designed to ensure that there is a sufficient supply of
controlled substances for legitimate medical, scientific, research, and
industrial purposes and to deter the diversion of controlled substances
to illegal purposes. Controlled substances are drugs that have a
potential for abuse and dependence; these include substances classified
as opioids, stimulants, depressants, hallucinogens, anabolic steroids,
and drugs that are immediate precursors of these classes of substances.
The CSA mandates that DEA establish a closed system of control for
manufacturing, distributing, and dispensing controlled substances. Any
person who manufactures, distributes, dispenses, imports, exports, or
conducts research or chemical analysis with controlled substances must
register with DEA (unless exempt) and comply with the applicable
requirements for the activity.
Background
Under longstanding Federal law, controlled substances are strictly
regulated to ensure a sufficient supply for legitimate medical,
scientific, research, and industrial purposes and to deter diversion of
controlled substances to illegal purposes. The substances are regulated
because of their potential for abuse and likelihood to cause dependence
when abused and because of their serious and potentially unsafe nature
if not used under proper circumstances. To minimize the likelihood that
pharmaceutical controlled substances would be diverted into illicit
channels, Congress established under the CSA a closed system of drug
distribution for legitimate handlers of controlled substances. The
foundation of this system is the concept of registration. The only
persons who may lawfully manufacture, distribute and dispense
controlled substances under the CSA are those who have obtained a DEA
registration authorizing them to do so. 21 U.S.C. 822. Thus, the
prescribing of controlled substances may be carried out only by those
practitioners who have obtained a DEA registration authorizing such
activity.
To be eligible for a DEA registration as a practitioner under the
CSA, one must be a physician, dentist, veterinarian, hospital, or other
person licensed, registered, or otherwise permitted by the United
States or the State in which he or she practices to dispense controlled
substances in the course of professional practice. 21 U.S.C. 802(21),
823(f). Thus, State licensure to prescribe controlled substances is
generally a prerequisite to obtaining a DEA registration to do so. The
term ``individual practitioner'' excludes institutions such as
hospitals, which are themselves DEA registrants and are permitted to
administer and dispense, but not prescribe, controlled substances under
their registration. 21 CFR 1300.01(b)(17).
By longstanding statutory requirement, a valid prescription issued
by a DEA-registered practitioner is required for dispensing a
controlled substance. To be effective (i.e., valid), a prescription for
a controlled substance must be issued for a legitimate medical purpose
by a practitioner acting in the usual course of professional practice.
United States v. Moore, 423 U.S. 122 (1975); 21 CFR 1306.04(a). Thus,
the practitioner must determine that a prescription for a controlled
substance is for a legitimate medical purpose. While the core
responsibilities pertaining to prescribing controlled substances may
not be delegated to anyone else, an individual practitioner may
authorize an agent to perform a limited role in communicating such
prescriptions to a pharmacy in order to make the prescription process
more efficient. Nonetheless, it is important to understand that any
agency relationship must also preserve the requirement that medical
determinations to prescribe controlled substances be made by a
practitioner only, not by an agent. Accordingly, this statement of
policy outlines DEA's existing statutory and regulatory requirements as
to the proper role of duly authorized agents of individual
practitioners. DEA anticipates the utilization of electronic
prescribing by practitioners for
[[Page 61614]]
controlled substance prescriptions will reduce the role of agents over
time.
Medical Determination of Need for a Controlled Substance Prescription
Cannot Be Delegated
DEA regulations state: ``A prescription for a controlled substance
to be effective must be issued for a legitimate medical purpose by an
individual practitioner acting in the usual course of his professional
practice. The responsibility for the proper prescribing and dispensing
of controlled substances is upon the prescribing practitioner, but a
corresponding responsibility rests with the pharmacist who fills the
prescription.'' 21 CFR 1306.04(a). Accordingly, the practitioner must
determine that a prescription for a controlled substance is for a
legitimate medical purpose. This determination is the sole
responsibility of the practitioner and may not be delegated.
Elements of a Valid Prescription Must be Specified by the Practitioner
and Cannot be Delegated
Controlled substance prescriptions are orders for medication to be
dispensed to an ultimate user and are required to contain specific
information including: Patient name, address, drug name and strength,
quantity prescribed, directions for use, and the name, address and DEA
number of the issuing practitioner. 21 CFR 1306.05(a). All
prescriptions for controlled substances must be dated as of, and signed
on, the day when issued. Paper prescriptions must be manually signed by
the issuing practitioner in the same manner that the practitioner would
sign a check or other legal document (21 CFR 1306.05(d)); electronic
prescriptions for controlled substances must be signed in accordance
with DEA regulations (21 CFR 1306.05(e), 21 CFR 1311.140).
The regulations provide that ``[a] prescription may be prepared by
the secretary or agent for the signature of a practitioner, but the
prescribing practitioner is responsible in case the prescription does
not conform in all essential respects to the law and regulations.'' 21
CFR 1306.05(f). Accordingly, an authorized agent may prepare a
controlled substance prescription only based on the instructions of the
prescribing practitioner as to the required elements of a valid
prescription and then provide the prescription to the practitioner to
review. The authorized agent does not have the authority to make
medical determinations. The practitioner must personally sign the
prescription, whether manually or electronically. The prescribing
practitioner cannot delegate his or her signature authority.
Role of Agent Under the CSA
As discussed above, the CSA does not permit a prescribing
practitioner to delegate to an agent or any other person the
practitioner's authority to issue a prescription for a controlled
substance. A practitioner acting in the usual course of his or her
professional practice must determine that there is a legitimate medical
purpose for a controlled substance prescription; an agent may not make
this determination. Even though the CSA established a closed system in
which all persons in the distribution chain are required to be
registered and are held accountable for every controlled substance
transaction, Congress recognized a role for agents under the Act. The
CSA exempts agents of registrants, including practitioners, from the
requirement of registration. 21 U.S.C. 822(c)(1). The statute defines
an ``agent'' as ``an authorized person who acts on behalf of or at the
direction of a manufacturer, distributor, or dispenser. * * *.'' 21
U.S.C. 802(3). Likewise, DEA regulations implementing the CSA
specifically permit a practitioner to use an authorized agent to
perform certain ministerial acts in connection with communicating
prescription information to a pharmacy. The common means to communicate
a prescription to a pharmacy include hand delivery, facsimile, phone
call, or an electronic transmission. As explained below, the proper
role of an agent depends upon the schedule of the controlled substance
prescribed, the circumstances of the ultimate user, and the method of
communication.
Communication by Facsimile or Oral Communication of a Valid
Prescription for a Schedule III, IV, or V Controlled Substance May be
Delegated to an Authorized Agent
The CSA provides that a pharmacy may dispense Schedule III and IV
controlled substances pursuant to a ``written or oral prescription.''
21 U.S.C. 829(b). DEA regulations further specify that a pharmacist may
dispense a Schedule III, IV, or V controlled substance pursuant to
``either a paper prescription signed by a practitioner [or] a facsimile
of a signed paper prescription transmitted by the practitioner or the
practitioner's agent to the pharmacy, * * *.'' 21 CFR 1306.21(a).
Accordingly, an authorized agent may transmit such a practitioner-
signed paper prescription via facsimile to the pharmacy on behalf of
the practitioner.
Controlled substances in Schedules III, IV and V may also be
dispensed by a pharmacy pursuant to ``an oral prescription made by an
individual practitioner and promptly reduced to writing by the
pharmacist containing all information required [for a valid
prescription], except for the signature of the practitioner.'' 21 CFR
1306.21(a). Under DEA regulations, an authorized agent may orally
communicate such a prescription to a pharmacist. 21 CFR 1306.03(b).
Where the pharmacist has reason to believe that a prescription has been
communicated by an agent, the pharmacist, in accordance with his or her
responsibility for proper dispensing of controlled substances, may have
a duty to inquire into the legitimacy of the prescription. The
particular circumstances will dictate the appropriate level of inquiry
by the pharmacist. As noted above, the practitioner remains responsible
for ensuring that the prescription conforms to the law and regulations,
and the practitioner cannot delegate to an agent the authority to make
a medical determination of need for a controlled substance
prescription.
Generally, a Valid Schedule II Controlled Substance Prescription May
Not be Communicated by Facsimile
Because Schedule II controlled substances have the highest
potential for abuse and the greatest likelihood of dependence among the
pharmaceutical controlled substances (those in Schedules II-V), the CSA
controls on Schedule II drugs are the most restrictive. The CSA
requires that a Schedule II controlled substance be dispensed by a
pharmacy only pursuant to a written prescription, except in emergency
situations, and prohibits Schedule II prescriptions from being
refilled. 21 U.S.C. 829(a). Thus, in most cases, a pharmacist must
receive the original, manually signed paper prescription or an
electronic prescription prior to dispensing a Schedule II controlled
substance. 21 CFR 1306.11(a).
A Valid Schedule II Controlled Substance Prescription For a Person in a
Hospice or Long Term Care Facility (LTCF) May be Communicated by
Facsimile and That Communication May be Delegated to an Authorized
Agent
DEA regulations specify two exceptions whereby a Schedule II
controlled substance prescription sent by facsimile may serve as the
original written prescription. A practitioner or a practitioner's
authorized agent may transmit a valid Schedule II controlled
[[Page 61615]]
substance prescription to a pharmacy via facsimile for: (1) Patients
enrolled in a hospice care program certified and/or paid for by
Medicare under Title XVIII or hospice programs which are licensed by
the State (21 CFR 1306.11(g)); and (2) residents of LTCFs (21 CFR
1306.11(f)). The facsimile serves as the original written prescription
and must be maintained by the pharmacy as such. An authorized agent of
the prescribing practitioner may transmit the practitioner-signed
prescription by facsimile on behalf of the practitioner.
Emergency Oral Communication of a Valid Schedule II Controlled
Substance Prescription May Not be Delegated to an Authorized Agent
The CSA contains an exception that allows a practitioner to issue
oral prescriptions for Schedule II controlled substances in an
emergency. 21 U.S.C. 829(a). An emergency for this purpose is defined
by the Food and Drug Administration in 21 CFR 290.10. DEA regulations
limit such an emergency oral prescription to the quantity necessary to
treat the patient during the emergency period and require that it be
followed up within 7 days by a practitioner-signed, written
prescription to the dispensing pharmacy. 21 CFR 1306.11(d). Moreover,
oral emergency prescriptions must immediately be reduced to writing by
the pharmacist and must contain all the information ordinarily required
in a prescription, except for the signature of the prescribing
individual practitioner. If the prescribing individual practitioner is
not known to the pharmacist, the pharmacist must make a reasonable
effort to determine that the oral authorization came from a registered
individual practitioner, which may include a call back to the
prescribing individual practitioner and/or other good faith efforts to
ensure the practitioner's identity. 21 CFR 1306.11(d). Because the more
specific requirement that the emergency Schedule II oral authorization
must be from a registered individual practitioner (21 CFR 1306.11(d))
supersedes the general rule that an employee or agent of the individual
practitioner may communicate prescriptions to a pharmacist (21 CFR
1306.03(b)), the prescribing individual practitioner must personally
communicate the emergency oral prescription to the pharmacist. An agent
may not call in an oral prescription for a Schedule II controlled
substance on behalf of a practitioner even in an emergency
circumstance.
Pharmacist Dispensing a Controlled Substance Prescription Has a Duty To
Fill Only Valid Prescriptions
Regardless of the method of transmission of a controlled substance
prescription--by hand delivery, facsimile, phone call or
electronically--DEA regulations make it clear that the legal
responsibility for issuing a valid prescription that ``conform[s] in
all essential respects to the law and regulations'' rests upon the
prescribing practitioner. As noted, however, a pharmacist has a
corresponding responsibility for the proper prescribing and dispensing
of controlled substances. 21 CFR 1306.04(a). Further, ``A corresponding
liability rests upon the pharmacist, including a pharmacist employed by
a central fill pharmacy, who fills a prescription not prepared in the
form prescribed by DEA regulations.'' 21 CFR 1306.05(f). A pharmacist
must carefully review all purported controlled substance prescriptions
to ensure that the prescription meets all of the legal requirements for
a valid prescription. The pharmacist has a duty to inquire further as
to any question surrounding the satisfaction of any or all of the legal
requirements for a valid prescription depending upon the particular
circumstances, including the requirement that the prescription be
issued for a legitimate medical purpose by a practitioner acting in the
usual course of professional practice. The pharmacist must be satisfied
that the prescription is consistent with the CSA and DEA regulations
before dispensing a controlled substance to the ultimate user.
Summary of the Acts That an Agent May Take in Connection With
Controlled Substance Prescriptions
1. An authorized agent of an individual practitioner may prepare a
written prescription for the signature of the practitioner, provided
that the practitioner, in the usual course of professional practice,
has determined that there is a legitimate medical purpose for the
prescription and has specified to the agent the required elements of
the prescription. 21 CFR 1306.04(a); 1306.05(a), (f).
2. Where a DEA-registered individual practitioner has made a valid
oral prescription for a controlled substance in Schedules III-V by
conveying all the required prescription information to the
practitioner's authorized agent, that agent may telephone the pharmacy
and convey that prescription information to the pharmacist. 21 CFR
1306.03(b), 1306.21(a).
3. In those situations in which an individual practitioner has
issued a valid written prescription for a controlled substance, and the
regulations permit the prescription to be transmitted by facsimile to a
pharmacy (as set forth in 21 CFR 1306.11(a), 1306.11(f), 1306.11(g),
and 1306.21(a)), the practitioner's agent may transmit the
practitioner-signed prescription to the pharmacy by facsimile.
Who Is an Agent of an Individual Practitioner for the Purpose of
Communicating a Prescription for a Controlled Substance
The CSA defines an ``agent'' as ``an authorized person who acts on
behalf of or at the direction of a manufacturer, distributor, or
dispenser. * * *'' 21 U.S.C. 802(3). Under the CSA, the term
``dispense'' includes ``prescribing.'' 21 U.S.C. 802(10). Establishment
of an agency relationship, consistent with the CSA, is guided by
general precepts of the common law of agency. For the purposes of
explaining the law of agency as it relates to the CSA, it is
appropriate to refer to and consider as generally applicable the
Restatement of Agency (Restatement) which provides:
Agency is the fiduciary relationship that arises when one person
(a ``principal'') manifests assent to another person (an ``agent'')
that the agent shall act on the principal's behalf and subject to
the principal's control, and the agent manifests assent or otherwise
consents so to act.
Restatement (Third) of Agency Sec. 1.01 (2006).
The Restatement is useful in evaluating whether, for CSA purposes,
a valid agency relationship exists between a prescribing practitioner
and another person for the purpose of communicating a prescription for
a controlled substance to a pharmacy. The Restatement requires that the
principal (in this context, the DEA-registered individual practitioner)
``manifests assent'' for a certain person to act on his or her behalf.
This is consistent with the CSA and its registration-based system of
accountability. Where non-DEA registrants communicate a prescription
for a controlled substance on behalf of a registrant, it is important
that such persons be clearly identified and their activities be subject
to evaluation to ensure they do not exceed the bounds of the agency
relationship and the legal limits of an agent's role under the CSA.
Because the individual practitioner remains responsible for ensuring
that all prescriptions issued pursuant to his or her DEA registration
comply in all respects with the CSA and DEA regulations, it is
important that the practitioner decide who may act as his
[[Page 61616]]
or her agent. This is also consistent with the CSA definition that an
agent is ``an authorized person who acts on behalf of or at the
direction of'' the prescribing individual practitioner. 21 U.S.C.
802(3).
In addition to requiring that the principal (i.e., individual
prescribing practitioner) ``manifests assent'' to having a particular
person act as his or her agent, and that the agent reciprocate by
manifesting assent to serve as such, the Restatement also requires that
the agent acts ``subject to the principal's control.'' In an employment
situation, an individual practitioner may establish the duties of his
or her employees and is responsible for monitoring their activities.
Absent an employer-employee relationship, a practitioner will generally
have less control over other persons that he or she may designate as
his or her agent(s). Prior to designating an agent, a practitioner may
wish to consider the degree of control that the registrant may exercise
over the proposed agent, the proposed agent's licensure, level of
training and experience, and other such factors to determine whether
the person would be an appropriate agent and to ensure that the agent
will not engage in activities that exceed the scope of the agency
relationship. Absent affirmative actions by the practitioner and the
proposed agent, a valid agency relationship generally will not exist
outside an employer-employee relationship.
By requiring that an agency relationship is created when (1) the
principal manifests assent that a particular person shall act (i) on
his or her behalf and (ii) subject to his or her control, and (2) the
agent manifests assent so to act, the Restatement definition of
``agency'' is consistent with the CSA's definition of ``agent'' as ``an
authorized person who acts on behalf of or at the direction of'' the
prescribing practitioner. 21 U.S.C. 802(3). An agent may not legally
perform duties that must be personally performed by the individual
practitioner. The practitioner may assign only those duties which may
be carried out by an agent.
DEA notes that in a 2001 notice and solicitation of information on
the potential use of automated dispensing systems to prevent the
accumulation of surplus controlled substances at LTCFs, DEA briefly
discussed the role of nurses in the narrow setting of LTCFs outside of
an employer-employee relationship and where no affirmative actions
established an agency relationship between the individual practitioner
and the LTCF nurse. 66 FR 20833, 20834 (April 25, 2001). This
incidental example and other informal discussions have resulted in the
need for this published articulation of what existing law allows and
what affirmative actions may be required to establish a valid agency
relationship for purposes of an authorized agent to communicate
controlled substance prescriptions to pharmacies, particularly in
settings where there is no employer-employee relationship. DEA
regulations on the role of authorized agents in communicating
controlled substance prescriptions to pharmacies generally have not
changed.
This policy statement outlines the proper role of agents in those
situations where an individual practitioner and an individual agent
(including but not limited to an LTCF nurse) have taken affirmative
steps to establish a valid agency relationship for those aspects of the
CSA that may be appropriately executed by an authorized agent under
Federal law. As such, DEA is hereby outlining a suggested mechanism to
establish a valid agency relationship as well as explaining the
appropriate roles an authorized agent may play regardless of the
setting. This statement of policy is intended to provide general
guidance on establishment of a valid agency relationship between an
individual practitioner and an identified individual. DEA wishes to
emphasize that, regardless of the setting, it is the practitioner's
sole decision as to whether or not to designate an agent to act on his
or her behalf and subject to his or her control. To be consistent with
the purpose of the CSA to implement a ``closed system'' of distribution
and for DEA to enforce this framework, an agency relationship between a
registered individual practitioner and an identified agent for the
purposes of communicating controlled substance prescriptions must be
explicit and transparent. DEA believes its existing regulations are
adequate in addressing the role of an authorized agent but will analyze
whether additional federal rulemaking or guidance is needed beyond this
statement to establish the necessary explicit and transparent nature of
an authorized agency relationship, particularly when outside an
employer-employee relationship.
Written Authorization of an Agent Recommended--Sample Agency Agreement
Due to the legal responsibilities of practitioners and pharmacists
under the CSA and the potential harm to the public from inappropriate
and unlawful prescribing and dispensing of controlled substances,
violations of the law are subject to criminal, civil, and
administrative sanctions. DEA believes it is in the best interests of
the practitioner, the agent, and the dispensing pharmacist that the
designation of those persons authorized to act on behalf of the
practitioner and the scope of any such authorization be reduced to
writing.
DEA provides below an example of a written agreement that would
properly confer authority to an agent to act on behalf of an individual
practitioner with regard to controlled substance prescriptions.
Individual practitioners may choose to designate and authorize one or
more persons at one or more locations within or outside their practice
to act as their agent. Likewise, an individual may act as an authorized
agent for multiple individual practitioners depending upon the
circumstances. A practitioner may or may not wish to delegate all of
these types of authorized communications to a particular agent and may
tailor the agreement accordingly. The agreement should be clear that
the agent may not further delegate the outlined responsibilities.
Designating Agent of Practitioner For Communicating Controlled
Substance Prescriptions to Pharmacies
-----------------------------------------------------------------------
(Name of registered individual practitioner)
-----------------------------------------------------------------------
(Address as it appears on certificate of registration)-----------------
-----------------------------------------------------------------------
(DEA registration number)
I, ---------------- (name of registrant), the undersigned, who is
authorized to dispense (including prescribe) controlled substances in
Schedules II, III, IV, and V under the Controlled Substances Act,
hereby authorize---------------- (name of agent), to act as my agent
only for the following limited purposes:
1. To prepare, for my signature, written prescriptions for
controlled substances in those instances where I have expressly
directed the agent to do so and where I have specified to the agent the
required elements of the prescription (set forth in 21 CFR 1306.05).
2. To convey to a pharmacist by telephone oral prescriptions for
controlled substances in Schedules III, IV, and V in those instances
where I have expressly directed the agent to do so and where I have
specified to the agent the required elements of the prescription (set
forth in 21 CFR 1306.05).
3. To transmit by facsimile to a pharmacy prescriptions for
controlled
[[Page 61617]]
substances in those instances where I have expressly directed the agent
to do so and where I have specified to the agent the required elements
of the prescription (set forth in 21 CFR 1306.05) and I have signed the
prescription.
This authorization is not subject to further delegation to other
persons. Both the undersigned DEA-registered individual practitioner
and the undersigned agent understand and agree that the practitioner is
solely responsible for making all medical determinations relating to
prescriptions for controlled substances communicated by the agent
pursuant to this agreement, and for ensuring that all such
prescriptions conform in all other essential respects to the law and
regulations.
The undersigned agent understands he or she does not have authority to
make any medical determinations. The undersigned DEA-registered
prescribing practitioner further understands that the prescribing
practitioner must personally communicate all Schedule II emergency oral
prescriptions to the pharmacist. Both the undersigned practitioner and
agent understand that the agent may not call in an emergency oral
prescription for a Schedule II controlled substance on behalf of the
practitioner.
This agency agreement shall be terminated immediately if and when any
of the following occur:
1. The undersigned practitioner no longer possesses the active DEA
registration specified in this agreement.
2. The undersigned agent is no longer employed in the manner
described in this agreement.
3. The practitioner or the agent revokes this agency agreement by
completing the revocation section at the end of this document or by
executing a written document that is substantially similar to the
revocation section at the end of this document.
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(Signature of practitioner)
I, ---------------- (name of agent), hereby affirm that I am the person
named herein as agent and that the signature affixed hereto is my
signature. I further affirm that I am a -------------- (title),
licensed in the State of ------, (where applicable) and (if applicable)
am employed by/under contract with ---------------- (name of employer
or contracting entity). I agree to abide by all the terms of this
agreement and to comply with all applicable laws and regulations
relating to controlled substances.
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(Signature of agent)
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(State license number of agent where applicable)
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(Name of employer/contracting entity where applicable)
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(Address of employer/contracting entity where applicable)
Witnesses:
1.--------------------
2.--------------------
Signed and dated on the -------- day of ------------ (month) ----------
--, (year), at ----------------.
Revocation
The foregoing agency agreement is hereby revoked by the undersigned.
The agent is no longer authorized to communicate Schedule II, III, IV
and V controlled substance prescriptions to a pharmacy on my behalf. A
copy of this revocation has been given to the agent this same day.
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(Signature of registered practitioner revoking power)
Witnesses:
1. --------------------
2. --------------------
Signed and dated on the --------day of ------------(month)--------,
(year), at ----------------.
DEA recommends that the original signed agency agreement be kept by
the practitioner during the term of the agency relationship and for a
reasonable period after termination or revocation. DEA requires that
inventory and other records be kept for at least two years (21 U.S.C.
827(b), 21 U.S.C. 828(c), 21 CFR 1304.04). This is simply a suggested
time period for retention of agency agreements and is not required by
DEA. A signed copy should also be provided to the practitioner's
designated agent, the agent's employer (if other than the
practitioner), and any pharmacies that regularly receive communications
from the agent pursuant to the agreement. Providing a copy to
pharmacies likely to receive prescriptions from the agent on the
practitioner's behalf may assist those pharmacies with their
corresponding responsibility regarding the dispensing of controlled
substances. It is important to reiterate that a pharmacist always has a
corresponding responsibility to ensure that a controlled substance
prescription conforms with the law and regulations, including the
requirement that the prescription be issued for a legitimate medical
purpose by a practitioner acting in the usual course of professional
practice, and a corresponding liability if a prescription is not
prepared or dispensed in a manner consistent with the CSA or DEA
regulations. Even where the pharmacist has a copy of an agency
agreement, the pharmacist may also have a duty to inquire further
depending upon the particular circumstances. Because the agency
agreement may be revoked at any time by the practitioner or by the
agent, the party terminating the agreement should notify the other
party immediately upon termination. The practitioner should notify
those pharmacies that were originally made aware of the agency
agreement of the termination of that agreement. In most circumstances
where an agent changes employment, the agreement should be revoked.
Dated: October 1, 2010.
Joseph T. Rannazzisi,
Deputy Assistant Administrator, Office of Diversion Control.
[FR Doc. 2010-25136 Filed 10-5-10; 8:45 am]
BILLING CODE 4410-09-P