23.04.2015 Views

Dispensing Legend Drugs

Dispensing Legend Drugs

Dispensing Legend Drugs

SHOW MORE
SHOW LESS

Create successful ePaper yourself

Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.

Laws and Rules Governing<br />

<strong>Dispensing</strong> i Prescription<br />

<strong>Drugs</strong> During the Practice<br />

of Veterinary Medicine<br />

Edwin A. Bayó<br />

Grossman, Furlow, and Bayó, LLC<br />

1408 N. Piedmont Way<br />

Tallahassee, FL. 32308<br />

(850) 385-1314<br />

e.bayo@gfblawfirm.com<br />

Florida Association of Equine Practitioners


Section 1<br />

Veterinary Prescription <strong>Drugs</strong>


Veterinary Prescription <strong>Drugs</strong><br />

Veterinary prescription drugs are labeled for use<br />

only by or on the order of a licensed<br />

veterinarian.<br />

Veterinary prescription drugs are used or<br />

prescribed only within the context of a valid<br />

veterinarian/client/patient relationship (VCPR).<br />

A veterinarian can be disciplined for “using the<br />

privilege of ordering, prescribing, or making<br />

available medicinal drugs” outside of a VCPR.<br />

§474.214(1)(y), F.S.


Veterinary Prescription <strong>Drugs</strong><br />

<br />

<br />

Veterinary yprescription<br />

p<br />

drugs must be properly<br />

labeled before being<br />

dispensed. dspe sed<br />

Appropriate dispensing<br />

and treatment records<br />

must be maintained, and<br />

veterinary prescription<br />

drugs should be<br />

dispensed d only in<br />

quantities required for<br />

the treatment of the<br />

animal(s) for which the<br />

drugs are dispensed.


Veterinarian/Client/Patient<br />

Relationship<br />

A VCPR exists when all of the following<br />

conditions have been meet:<br />

1. The veterinarian has sufficient knowledge of the<br />

animal(s) to initiate at least a general or<br />

preliminary diagnosis of the medical condition of<br />

the animal(s), which h means that t the veterinarian<br />

i<br />

is personally acquainted with the keeping and<br />

caring of the animal(s) and has seen the<br />

animal(s) or has made medically appropriate<br />

and timely visits to the premises where the<br />

animal(s) are kept.


Veterinarian/Client/Patient<br />

Relationship (continued)…<br />

2 The veterinarian is available or provides for<br />

2. The veterinarian is available or provides for<br />

follow up care and treatment in case of an<br />

adverse reaction or failure of the regimen of<br />

therapy.<br />

3. Maintains records which document patient<br />

visits, diagnosis, treatment, and other relevant<br />

information.


Section 2<br />

Federal Laws


U.S. Drug Enforcement<br />

Agency


DEA Registration<br />

In order for Florida licensed veterinarians to be<br />

able to prescribe, administer or dispense<br />

controlled substances, they must be registered<br />

with the U.S. Drug Enforcement Agency (DEA).<br />

DEA Form-224<br />

Available online and can be submitted electronically:<br />

www.deadiversion.usdoj.gov/drugreg/process.htm<br />

Send by U.S. Mail:<br />

DEA Registration ti Unit<br />

Registration Section/ODR<br />

P.O. Box 2639<br />

Springfield, VA 22152-2639


Source: An Informational Outline of the Controlled Substances Act (2006 ed.)


DEA Registration<br />

Veterinarians who practice at multiple locations<br />

must be registered with the DEA at each location.<br />

The only exception is the practitioner who uses or<br />

dispenses controlled substances as an agency of<br />

a veterinarian who is registered at each location.<br />

You must furnish your DEA registration number to<br />

obtain Schedule III, IV, and V controlled<br />

substances from suppliers. Veterinarians must<br />

use DEA Triplicate Order Form-222 to obtain<br />

Schedule II substances.


DEA Registration: Mobile<br />

Clinics<br />

Veterinarians who<br />

operate mobile clinics<br />

would be registered at<br />

the location where the<br />

controlled substances<br />

are stored.<br />

Records should be<br />

maintained as if the<br />

mobile unit were part<br />

of the registrant’s<br />

permanent location.


DEA Registration Modification<br />

Practitioners who wish to modify their Drug<br />

Enforcement Administration Registration for a<br />

name change or change of address should let<br />

their local DEA office know ahead of time, so<br />

appropriate registration changes can be made.<br />

Information concerning the DEA registration<br />

process can also be obtained by contacting<br />

the Registration Call Center at (800) 882-<br />

9539.


DEA Registration Renewal<br />

The DEA Form 224a is currently available online.<br />

Renewal applications are mailed automatically to<br />

the registered location 60 days prior to the<br />

expiration date.<br />

Any changes of address must be reported in<br />

writing to the DEA at the time the change occurs<br />

so that the renewal application will be sent to the<br />

correct address.<br />

Renewal applications will not be forwarded by the<br />

Post Office. If you are moving to a new state, t the<br />

DEA asks that you submit a copy of the new state<br />

license and a copy of the state controlled<br />

substance bt registration. it ti


DEA Registration Renewal<br />

Certificates must renewed every three (3)<br />

years.<br />

Cost of the registration fee, background check,<br />

etc. are the responsibility of the requesting<br />

veterinarian.


Source: An Informational Outline of the Controlled Substances Act (2006 ed.)


DEA Inspections<br />

<br />

<br />

The DEA does not routinely<br />

investigate t veterinary clinics, i but if<br />

an inspection does take place,<br />

organization and accurate records<br />

are essential. The DEA’s descent<br />

on a clinic will not allow the<br />

owner(s) time to search for files-<br />

one must be able to immediately<br />

access critical information.<br />

Situations that may provoke an<br />

investigation include those<br />

involving unusual prescribing<br />

practices, reports of controlled<br />

substance abuse, diversion, or<br />

other illegal activity.


DEA Identification of<br />

Controlled Substances<br />

Controlled substances are labeled with a<br />

large “C” and contain a roman numeral in<br />

the center to identify the schedule of the<br />

substance.<br />

The drugs and drug products that come<br />

under the jurisdiction of the Controlled<br />

Substance Act are divided into 5 schedules.<br />

These schedules are:


Controlled Substances Act:<br />

Drug Scheduling<br />

Schedule Description: Examples:<br />

I.<br />

The drug or other substance has a high<br />

potential for abuse. The drug or other<br />

substance has no currently accepted<br />

medical use in treatment in the United<br />

States.<br />

GHB, Heroin, Cannabis,<br />

Ecstasy, LSD.<br />

II.<br />

The drug or other substance has a high<br />

potential for abuse. The drug or other<br />

substance has a currently accepted<br />

medical use in treatment in the United<br />

States or a currently accepted medical<br />

use with severe restrictions. Abuse of<br />

the drug or other substances may lead<br />

to severe psychological l or physical<br />

dependence<br />

Cocaine, Codeine,<br />

Opium, Oxycodone,<br />

Morphine, Dexedrine.


Controlled Substances Act:<br />

Drug Scheduling (continued)<br />

Schedule Description: Examples:<br />

III.<br />

The drug or other substance has a<br />

potential for abuse less than the drugs<br />

or other substances in Schedules I and<br />

II. The drug or other substance has a<br />

currently accepted medical use in<br />

treatment in the United States. Abuse<br />

of the drug or other substance may<br />

lead to moderate or low physical<br />

dependence or high psychological<br />

dependence.<br />

Anabolic steroids;<br />

Intermediate-acting<br />

barbiturates, such as<br />

talbutal or butalbital;<br />

Buprenorphine;<br />

Ketamine; Xyrem;<br />

Hydrocodone / codeine,<br />

when compounded with<br />

an NSAID


Controlled Substances Act:<br />

Drug Scheduling (continued)<br />

Schedule Description: Examples:<br />

IV.<br />

The drug or other substance has a low<br />

potential for abuse relative to the drugs<br />

or other substances in Schedule III.<br />

The drug or other substance has a<br />

currently accepted medical use in<br />

treatment in the United States.<br />

Abuse of the drug or other substance<br />

may lead to limited physical<br />

dependence or psychological<br />

dependence relative to the drugs or<br />

other substances in Schedule III.<br />

Xanax, Stadol, Librium,<br />

Klonopin, Ativan, Restoril,<br />

Ambien, Serax


Controlled Substances Act:<br />

Drug Scheduling (continued)<br />

Schedule Description: Examples:<br />

V.<br />

The drug or other substance has a low<br />

potential for abuse relative to the drugs<br />

or other substances in Schedule IV.<br />

The drug or other substance has a<br />

currently accepted medical use in<br />

treatment in the United States.<br />

Abuse of the drug or other substance<br />

may lead to limited physical<br />

dependence or psychological<br />

dependence relative to the drugs or<br />

other substances in Schedule IV<br />

Cough suppressants<br />

containing small amounts<br />

of codeine (e.g.,<br />

promethazine+codeine);<br />

Preparations containing<br />

small amounts of opium<br />

or diphenoxylate (used to<br />

treat diarrhea);<br />

Pyrovalerone.


Ordering Controlled<br />

Substances<br />

Due to their potential for addiction, Schedule II<br />

drugs get more attention during their<br />

manufacturing, distribution, and dispensing.<br />

To order Schedule II substances, a federal<br />

triplicate order form must be used. These<br />

forms can be obtained by requesting them on<br />

the initial application form (DEA-224) by<br />

checking block “3.”<br />

They may also be obtained from the DEA<br />

Registration Unit in Washington, D.C. or online<br />

at https://www.deadiversion.usdoj.gov.<br />

di i d


Ordering Controlled<br />

Substances<br />

When using the DEA Triplicate Order Form-<br />

222 to obtain Schedule II substances, be sure<br />

to:<br />

Fill out the correctly or it will be sent back to the<br />

supplier.<br />

Fill in the “number of packages” and the “date<br />

received” sections.


Source: An Informational Outline of the Controlled Substances Act (2006 ed.)


Ordering Controlled<br />

Substances<br />

All other controlled substances are ordered in the<br />

same manner as any other medication. The<br />

supplier will ask for a copy of your current DEA<br />

registration form.<br />

There are no special requirements for Schedule<br />

III, IV, and V purchases.<br />

Obtaining controlled substances from a local<br />

pharmacy for “in-house” or “re-sale” use is<br />

prohibited.<br />

Prescriptions for controlled substances to be filled<br />

by a local pharmacy should be written only for<br />

specific patients.


DEA Records and<br />

Prescriptions<br />

Veterinarians must keep records for all<br />

controlled substances used or dispensed.<br />

These must be kept for 3 years by Florida law.<br />

Records for Schedule III, IV, and V controlled<br />

substances can be maintained as part of<br />

patient t records, by must be readily retrievable.<br />

Schedule II records must be kept separately.<br />

You must maintain i records or invoices i of<br />

controlled substances received for a 2 year<br />

period after the last quantity of each controlled<br />

substance on the invoice has been depleted.


DEA Records and<br />

Prescriptions<br />

You might be required to keep a copy of each<br />

prescription issued. Although the DEA does<br />

not require registrants to keep records of<br />

prescriptions issued, approximately 40% of<br />

states require multiple copies of controlled<br />

substance prescriptions.<br />

Prescriptions for Schedule II drugs must be in<br />

writing and cannot be refilled. Prescriptions<br />

for Schedule III or IV may be issued orally or in<br />

writing and can be refilled only up to five times<br />

in 6 months.


DEA Records and<br />

Prescriptions<br />

In emergencies, a<br />

pharmacist may fill<br />

oral prescriptions for<br />

Schedule II drugs<br />

but must notify the<br />

DEA if a written<br />

prescription order is<br />

not received within<br />

72 hours.


DEA: Biennial Inventory<br />

In addition to an initial inventory, yyou must make a<br />

biennial inventory of all controlled substances on<br />

hand. The inventory must be made every 2 years<br />

from initial registration and opening inventory.<br />

The following information should be included:<br />

1. Name, address, and registration number of each<br />

registrant.<br />

2. Name, unit size, and total quantity of each controlled<br />

substance.<br />

3. Date and time of inventory.<br />

4. Signature of person(s) making the inventory<br />

5. Separate records for Schedule II drugs.<br />

6. And new controlled drugs introduced must be put on<br />

inventory list with quantity and date.


DEA: Transfers of<br />

Controlled Substances<br />

You may transfer or receive a limited amount of<br />

controlled substances to or from another<br />

practitioner if you are both DEA registrants. Both<br />

registrants must maintain records of the<br />

transaction.<br />

Records of Schedule II controlled substance<br />

transfers must be kept on DEA Order Form-222.<br />

Records of Schedule III, IV, and V controlled<br />

substances bt may be in the form of finvoices.<br />

i<br />

The total amount transferred by a registrant must<br />

not be more that 5% of the total number of dosage<br />

units used, dispensed, or prescribed during the<br />

same calendar year.


DEA: Safety Requirements<br />

You must keep<br />

controlled<br />

substances in a<br />

securely locked,<br />

substantially<br />

constructed cabinet<br />

or safe.


DEA: Safety Requirements<br />

If a moveable lock-box is used, it must be<br />

securely affixed to a wall, floor, or cabinet.<br />

Similarly, lightweight filling cabinets or fire<br />

safes are inappropriate since they can be<br />

easily picked up and removed.<br />

Mobile units should be stocked with only<br />

enough of each controlled drug necessary for<br />

basic operation.<br />

Excess supplies should remain in a fixed<br />

secure location.


DEA: Safety Requirements<br />

There are no additional security requirements<br />

for vehicles other than a substantial container<br />

must be used if the vehicle is unsupervised<br />

(i.e.. parking lot or store).<br />

Keeping drugs in a bag is not adequate. If the<br />

vehicle is not equipped with locking bins or<br />

compartments, then a small lockable box<br />

should be affixed to the vehicle.<br />

It is not necessary to remove the drugs from<br />

the vehicle for storage if a strong, non-<br />

moveable safe box is available.


DEA: Safety Recommendations<br />

It is recommended that the controlled<br />

substance stocks be kept to a minimum.<br />

Should it be necessary to have a substantial<br />

quantity of controlled substances stored in the<br />

clinic, the DEA encourages having security,<br />

which exceeds the minimum requirements,<br />

such as a large safe and alarm system.<br />

Access to the controlled substance storage<br />

area should be restricted to the absolute<br />

minimum number of employees.


DEA: Accountability of<br />

Controlled Substances<br />

Whenever a practice administers a controlled<br />

substance to a patient, it must be recorded<br />

both on the patient’s medical record AND a<br />

“readily retrievable” log or controlled<br />

substance record.<br />

See §893.07, F.S.- Records


DEA: Theft And Loss Reporting<br />

You must report thefts or other losses of<br />

controlled substances or records promptly to<br />

the DEA.<br />

Completing DEA Form-106 is required in such<br />

cases.


DEA Form-106 Report of Theft or<br />

Loss of Controlled Substances<br />

Source: An Informational Outline of the Controlled Substances Act (2006 ed.)


U.S. Food and Drug<br />

Administration


Food, Drug, & Cosmetic Act<br />

Under the FD&C section of Title 21 of the<br />

United States Code, the FDA’s Center for<br />

Veterinary Medicine has been given the<br />

authority to govern the manufacture,<br />

distribution, and use of veterinary drugs that<br />

are distributed between states.<br />

The Federal Code also gives the FDA the<br />

authority to write regulations on how it will<br />

enforce the FD&C Act. Those regulations are<br />

contained in the Code of Federal Regulations<br />

Title 21.


The Food and Drug<br />

Modernization Act of 1997<br />

Signed into law in November of 1997 and fully<br />

enacted in April of 1999, the Act (among many<br />

other things) called for:<br />

A reduction in the time for the approval of new<br />

pharmaceutical drugs.<br />

Relaxed medical device regulations.<br />

Restricted the advertising of compounded<br />

drugs, i.e. mixtures made up by pharmacists.<br />

This provision was overturned by the US<br />

Supreme Court in 2002 on grounds of freedom<br />

of speech.


Obtaining Approval: New<br />

Animal Drug Applications<br />

Section 512 of the FD&C Act outlines the rules<br />

that govern the safety and efficacy of new<br />

animal drugs.<br />

The Code of Federal Regulations (CFR)<br />

details the requirements of submissions<br />

demonstrating the safety and efficacy of a drug<br />

before approval can be granted.<br />

The new animal drug approval (NADA)<br />

process is extremely complicated and has so<br />

far proved a very effective safeguard.


Extra-Label Drug Use (ELDU)<br />

"Extra-label use" is defined as:<br />

"Actual use or intended use of a drug in an<br />

animal in a manner that is not in accordance<br />

with the approved labeling. This includes, but<br />

is not limited to, use in species not listed in the<br />

labeling, use for indications (disease and other<br />

conditions) not listed in the labeling, use at<br />

dosage levels, frequencies, or routes of<br />

administration other than those stated in the<br />

labeling, li and deviation from labeled l withdrawal<br />

time based on these different uses."


Extra-Label Drug Use<br />

Under the provisions of the Animal Medicinal<br />

Drug Use Clarification Act of 1994, the FDA<br />

recognizes the professional judgment of<br />

veterinarians, i and allows the extra-label l use of<br />

drugs by veterinarians under certain conditions<br />

(21 CFR 530).<br />

Any drug used in an extra-label manner is by<br />

definition a prescription p drug since the<br />

involvement of a veterinarian is required.<br />

Extra-label use of drugs may only take place<br />

within the scope of a valid veterinarian-client-<br />

i t<br />

patient relationship (VCPR)


Extra-Label Drug Use<br />

In the absence of a<br />

valid VCPR, if an<br />

approved new animal<br />

drug is used for a use<br />

for which it is not<br />

labeled, such use has<br />

caused dthe drug to be<br />

deemed unsafe and<br />

therefore adulterated<br />

under the Act (21<br />

U.S.C. 351(a)(5)).


Extra-Label Drug Use<br />

The FDA has taken legal action against<br />

veterinarians who were responsible for<br />

creating violative drug tissue residues in the<br />

human food supply, especially when these<br />

were the result of drugs used contrary to label<br />

instructions.<br />

Nevertheless, extra-label drugs used in<br />

treating food-producing animals may be<br />

considered by a veterinarian when the health<br />

of animals is immediately threatened and<br />

suffering or death would result from failure to<br />

treat the affected animals.


Labeling of drugs prescribed<br />

for extra-label use<br />

At a minimum, the following label information is recommended:<br />

1. The name and address of the prescribing veterinarian.<br />

2. The established name of the drug (active ingredient), or if<br />

formulated from more than one ingredient, the established<br />

name of each ingredient.<br />

3. Any directions for use specified by the practitioner (including<br />

class/species or identification of the animals; dosage,<br />

frequency, and route of administration; and, duration of<br />

therapy).<br />

4. Any cautionary statements specified by the veterinarian.<br />

5. The veterinarian's specified withdrawal/discard time(s) for<br />

meat, milk, eggs, or any food which h might be derived d from<br />

the treated animals.


<strong>Drugs</strong> Prohibited for Extra-<br />

Label Use in Food Animals:<br />

Chloramphenicol; Sulfonamide drugs in<br />

Clenbuterol;<br />

lactating dairy cattle<br />

(except approved use<br />

Diethylstilbestrol<br />

of sulfadimethoxine,<br />

(DES);<br />

sulfabromomethazine,<br />

Dimetridazole;<br />

and<br />

<br />

Ipronidazole;<br />

sulfaethoxypyridazine);<br />

i Other nitroimidazoles; Fluoroquinolones;<br />

<br />

Furazolidone;<br />

<br />

Phenylbutazone in<br />

Nitrofurazone;<br />

female dairy cattle 20<br />

months of age or older.<br />

<br />

Glycopeptides;


Compounding Under<br />

AMDUCA<br />

Animal Medicinal Drug Use Clarification Act<br />

The extra-label drug use regulation also<br />

provides for the legal compounding of animal<br />

drugs from approved animal drugs and<br />

approved human drugs. The compounding<br />

must be in compliance with the provisions of<br />

this regulation. The regulation provides<br />

additional requirements for extra-label<br />

compounding (21 CFR 530.13).<br />

The extra-label drug use regulation does not<br />

allow for legal l animal drug compounding from<br />

active pharmaceutical ingredients (bulk drugs).


Human-Label Drug Products<br />

Veterinarians, as licensed health professionals,<br />

must have the right to purchase or prescribe<br />

human-labeled prescription drugs and to use them<br />

according to their best medical judgment in<br />

compliance with relevant laws and regulations.<br />

The FDA has confirmed that manufacturers may<br />

legally sell human-labeled prescriptions drugs to<br />

veterinarians upon their order.<br />

Veterinarians have full responsibility when using<br />

human-labeled prescription products in the<br />

treatment of animals, and must recognize that<br />

manufacturers cannot promote the sale of those<br />

products to veterinarians.


Adulterated <strong>Drugs</strong><br />

Under Section 301 of the FD&C Act, the<br />

introduction or delivery into interstate commerce<br />

of any food, drug, device, or cosmetic that is<br />

adulterated is prohibited.<br />

Section 501 of Title 21 defines what constitutes an<br />

adulterated drug.<br />

Simply stated, drugs that contain unsanitary<br />

components, lack adequate control in<br />

manufacture, differ in strength th from that<br />

t<br />

recognized in the official compendium, or that are<br />

mixed with another substance to reduce their<br />

quality or strength are considered to have been<br />

adulterated.


Compounding<br />

The Federal Food, Drug, and Cosmetic Act (the<br />

Act) does not distinguish compounding from<br />

manufacturing or other processing of drugs for<br />

use in animals.<br />

FDA acknowledges the use of compounding<br />

within certain areas of veterinary practice.<br />

The current state of veterinary medicine requires<br />

products to treat many conditions in a number of<br />

different species, some of which are known to<br />

have unique physiological characteristics.<br />

Furthermore, FDA regulations specifically permit<br />

the compounding of products from approved<br />

animal or human drugs under the conditions set<br />

forth in 21 CFR 530.13.


Compounding<br />

However, the FDA is<br />

greatly concerned<br />

about veterinarians and<br />

pharmacies that are<br />

engaged in<br />

manufacturing and<br />

distributing unapproved<br />

new animal drugs in a<br />

manner that is clearly<br />

outside the bounds of<br />

traditional pharmacy<br />

practice and that<br />

violates the Act


Compounding<br />

With regard to compounding from bulk drug<br />

substances, two Federal Appeals Court<br />

decisions, United States v. Algon Chemical<br />

Inc., 879 F.2d 1154 (3d Cir. 1989) and United<br />

States v. 9/1 Kg. Containers, 854 F.2d 173 (7th<br />

Cir. 1988), affirmed the FDA position that the<br />

Act does not permit veterinarians to compound<br />

unapproved finished drug products from bulk<br />

drug substances, unless the finished i drug is<br />

not a new animal drug.<br />

The principle established by the court applies<br />

The principle established by the court applies<br />

equally to compounding by pharmacists.


Compounding<br />

Neither the Act nor its implementing regulations<br />

exempt veterinarians or pharmacists from the<br />

approval requirements in the new animal drug<br />

provisions of the Act, 21 U.S.C. Section 360b.<br />

In the absence of an approved new animal drug<br />

application, the compounding of a new animal<br />

drug from any unapproved drug or from bulk drug<br />

substances results in an adulterated new animal<br />

drug in violation of section 21 U.S.C. Section<br />

351(a)(5).<br />

The compounding of a new animal drug from an<br />

approved human or animal drug also results in an<br />

adulterated new animal drug in violation of 21<br />

U.S.C. Section 351(a)(5), unless the conditions<br />

set forth in 21 CFR 530.13(b) are met.


Compounding<br />

<br />

<br />

Generally, FDA will defer to state authorities regarding g the day-<br />

to-day regulation of compounding by veterinarians and<br />

pharmacists of animal and human drugs that are intended for<br />

use in animals. FDA anticipates that, in such cases, cooperative<br />

efforts between the states and the Agency will result in<br />

coordinated investigations, referrals, and follow-up actions by<br />

the states.<br />

However, when the scope and nature of activities of<br />

veterinarians and pharmacists raise the kinds of concerns<br />

normally associated with a drug manufacturer and result in<br />

significant violations of the new animal drug, adulteration, or<br />

misbranding provisions of the Act, FDA has determined that it<br />

will seriously consider enforcement action.


Compounding<br />

<br />

<br />

The FDA chooses to enforce its “regulatory discretion” and<br />

“ordinarily” will not take regulatory action when:<br />

1. A legitimate need is identified.<br />

2. There is a need for an appropriate dosage regimen for the<br />

particular species, size, age, or medical condition, and<br />

3. There is no marketed approved animal drug which, when<br />

used in conformity with the regulations as set forth<br />

AMDUCA, may treat the condition diagnosed in the<br />

available dosage form, or there is some other rare<br />

extenuating circumstance.<br />

The FDA places its highest priority on compounding products for<br />

use in food animals.


Compounding in Florida<br />

<br />

Rule 64B16-27.700, F.A.C.- Definition of Compounding:<br />

“Compounding” is the professional act by a pharmacist or<br />

other practitioner authorized by law, employing the science<br />

or art of any branch of the profession of pharmacy,<br />

incorporating ingredients to create a finished product for<br />

dispensing to a patient or for administration by a<br />

practitioner or the practitioner’s agent; and shall specifically<br />

include the professional act of preparing a unique finished<br />

product containing any ingredient or device defined by<br />

Sections 465.003(7) and (8), F.S.<br />

(1) Compounding includes:


Compounding in Florida<br />

(a) The preparation of drugs or devices in anticipation of<br />

prescriptions based on routine, regularly observed prescribing<br />

patterns.<br />

(b) The preparation pursuant to a prescription of drugs or<br />

devices which are not commercially available.<br />

(c) The preparation of commercially available products from bulk<br />

when the prescribing practitioner has prescribed the<br />

compounded product on a per prescription basis and the patient<br />

has been made aware that the compounded product will be<br />

prepared by the pharmacist. The reconstitution of commercially<br />

available products pursuant to the manufacturer’s guidelines is<br />

permissible without notice to the practitioner.<br />

(2) The preparation of drugs or devices for sale or transfer to<br />

pharmacies, practitioners, ii or entities ii for purposes of fdispensing<br />

i<br />

or distribution is not compounding.


Section 3<br />

State t Laws


Chapter 465, F.S.<br />

Chapter 465, F.S.<br />

Florida Pharmacy Act


§ 465.003, F.S.- Definitions:<br />

(8) "Medicinal drugs" or "drugs" means those<br />

substances or preparations commonly known as<br />

"prescription" or "legend" drugs which are<br />

required by federal or state law to be dispensed<br />

only on a prescription, but shall not include<br />

patents or proprietary preparations as hereafter<br />

defined.<br />

d<br />

(9) "Patent or proprietary preparation" means a<br />

medicine in its unbroken, original package which<br />

is sold to the public by, or under the authority of,<br />

the manufacturer or primary distributor thereof<br />

and which h is not misbranded d under the provisions<br />

i<br />

of the Florida Drug and Cosmetic Act.


§465.0255, F.S.- Expiration date of<br />

medicinal drugs; display; related use<br />

and storage instructions:<br />

ti<br />

(1) The manufacturer, repackager, or other distributor of<br />

any medicinal i drug shall display the expiration i date of<br />

each drug in a readable fashion on the container and on<br />

its packaging. The term "readable" means conspicuous<br />

and bold.<br />

(2) Each pharmacist for a community pharmacy<br />

dispensing medicinal drugs and each practitioner<br />

dispensing i medicinal i drugs on an outpatient ti t basis shall<br />

display on the outside of the container of each medicinal<br />

drug dispensed, or in other written form delivered to the<br />

purchaser:<br />

(a) The expiration date when provided by the manufacturer,<br />

repackager, or other distributor of the drug; or<br />

(b) An earlier beyond-use date for expiration, which may be up<br />

to 1 year after the date of dispensing.


§465.0255, F.S.- Expiration date of<br />

medicinal drugs; display; related use<br />

and storage instructions ti (continued):<br />

The dispensing pharmacist or practitioner must provide<br />

information i concerning the expiration i date to the purchaser<br />

upon request and must provide appropriate instructions<br />

regarding the proper use and storage of the drug.<br />

(3) This section does not impose liability on the dispensing<br />

pharmacist or practitioner for damages related to, or<br />

caused by, a medicinal drug that loses its effectiveness<br />

prior to the expiration date displayed d by the dispensing i<br />

pharmacist or practitioner.<br />

(4) The provisions of this section are intended to notify the<br />

patient t receiving i a medicinal i drug of the information<br />

required by this section, and the dispensing pharmacist<br />

or practitioner shall not be liable for the patient's failure<br />

to heed such notice or to follow the instructions for<br />

storage.


Other Pertinent Chap. 465<br />

Sections:<br />

§465.026, F.S.: Filling of certain prescriptions<br />

§465.0276, F.S.: <strong>Dispensing</strong> practitioner<br />

§465.035, F.S.: <strong>Dispensing</strong> of medicinal drugs<br />

pursuant tto facsimile il of prescription


Chapter 499, F.S.: <strong>Drugs</strong>, Devices,<br />

Chapter 499, F.S.: <strong>Drugs</strong>, Devices,<br />

Cosmetics, and Household Products


Chapter 499, F.S.: <strong>Drugs</strong>, Devices,<br />

Cosmetics, and Household Products.<br />

§499.003(52): "Veterinary yprescription p drug"<br />

means a prescription drug intended solely for<br />

veterinary use. The label of the drug must bear<br />

the statement, "Caution: Federal law restricts this<br />

drug to sale by or on the order of a licensed<br />

veterinarian."<br />

§ 499.006 Adulterated drug or device. --Adrug<br />

or device is adulterated:<br />

(11) If it is a prescription drug subject to, defined by,<br />

or described by s. 503(b) of the Federal Food, Drug,<br />

and Cosmetic Act which has been returned by a<br />

veterinarian to a limited prescription drug veterinary<br />

wholesale distributor.


Chapter 499, F.S.: <strong>Drugs</strong>, Devices,<br />

Cosmetics, and Household Products.<br />

499.005 Prohibited acts.--It is unlawful for a<br />

person to perform or cause the performance of<br />

any of the following acts in this state:<br />

(14) The purchase or receipt of a prescription<br />

drug from a person that is not authorized under<br />

this chapter to distribute prescription drugs to that<br />

purchaser or recipient.<br />

(15) The sale or transfer of a prescription drug to<br />

a person that is not authorized under the law of<br />

the jurisdiction in which the person receives the<br />

drug to purchase or possess prescription drugs<br />

from the person selling or transferring the<br />

prescription drug.


Chapter 499, F.S.: <strong>Drugs</strong>, Devices,<br />

Cosmetics, and Household Products.<br />

499.01 Permits:<br />

(j) A veterinary prescription drug retail<br />

establishment;<br />

(k) A veterinary prescription drug wholesale<br />

distributor;<br />

(l) A limited prescription drug veterinary<br />

wholesale distributor


Chapter 828, F.S.: Animals: Cruelty,<br />

Chapter 828, F.S.: Animals: Cruelty,<br />

Sales, Animal Enterprise Protection


Chapter 828, Florida Statutes<br />

Animals: Cruelty, Sales, Animal Enterprise<br />

Protection.<br />

§828.05: Killing an injured or diseased domestic<br />

animal.<br />

§828.055: Sodium pentobarbital; permits for<br />

use in euthanasia of domestic animals.


Chapter 828, Florida Statutes<br />

§828.058: Euthanasia of dogs and cats.<br />

§828.065: Euthanasia of animals offered for<br />

sale by pet shops.<br />

§828.29: Dogs and cats transported or offered<br />

for sale; health requirements; consumer<br />

guarantee.– Official certificates of veterinary<br />

inspection.


Chapter 893, F.S.<br />

Florida Comprehensive Drug Abuse<br />

Prevention and Control Act.


§893.02 Definitions<br />

<br />

"Practitioner" means a physician licensed<br />

pursuant to chapter 458, a dentist licensed<br />

pursuant to chapter 466, a veterinarian<br />

licensed pursuant to chapter 474, an<br />

osteopathic physician licensed pursuant to<br />

chapter 459, a naturopath licensed pursuant to<br />

chapter 462, or a podiatric physician licensed<br />

pursuant to chapter 461, provided such<br />

practitioner holds a valid federal controlled<br />

substance registry number.


§893.02 Definitions<br />

<br />

"Prescription" means and includes an order for drugs or<br />

medicinal i supplies written, signed, or transmitted by word of<br />

mouth, telephone, telegram, or other means of communication by<br />

a duly licensed practitioner licensed by the laws of the state to<br />

prescribe such drugs or medicinal supplies, issued in good faith<br />

and in the course of professional practice, intended to be filled,<br />

compounded, or dispensed by another person licensed by the<br />

laws of the state to do so, and meeting the requirements of s.<br />

893.04. The term also includes an order for drugs or medicinal<br />

supplies so transmitted or written by a physician, dentist,<br />

veterinarian, or other practitioner licensed to practice in a state<br />

other than Florida, but only if the pharmacist called upon to fill<br />

such an order determines, in the exercise of his or her<br />

professional judgment, that the order was issued pursuant to a<br />

valid patient-physician relationship, that it is authentic, and that the<br />

drugs or medicinal supplies so ordered ed are considered ed necessary<br />

for the continuation of treatment of a chronic or recurrent illness.


§893.02 Definitions<br />

Continued…<br />

However, if the physician writing the prescription is not<br />

known to the pharmacist, the pharmacist shall obtain<br />

proof to a reasonable certainty of the validity of said<br />

prescription. A prescription order for a controlled<br />

substance shall not be issued on the same<br />

prescription blank with another prescription order for a<br />

controlled substance which is named or described in a<br />

different schedule, nor shall any prescription order for<br />

a controlled substance be issued on the same<br />

prescription blank as a prescription order for a<br />

medicinal drug, as defined in 1 s. 465.031(5), which<br />

does not fall within the definition of a controlled<br />

substance as defined in this act.


§893.07: Records<br />

(3) The record of all controlled substances sold,<br />

administered, dispensed, or otherwise disposed of<br />

shall show:<br />

(a) The date of selling, administering, or<br />

dispensing.<br />

(b) The correct name and address of the person<br />

to whom or for whose use, or the owner and<br />

species of animal for which, sold,<br />

administered, or dispensed.<br />

(c) The kind and quantity of controlled substances<br />

sold, administered, or dispensed.


§893.07: Records<br />

(2) The record of controlled substances received<br />

shall in every case show:<br />

(a) The date of receipt.<br />

(b) The name and address of the person from<br />

whom received.<br />

(c) The kind and quantity of controlled substances<br />

received.


§893.07: Records<br />

(4) Every inventory or record required by this chapter, including<br />

prescription records, shall be maintained:<br />

i (a) Separately from all other records of the registrant, or<br />

(b) Alternatively, in the case of Schedule III, IV, or V controlled<br />

substances, in such form that t information required by this<br />

chapter is readily retrievable from the ordinary business<br />

records of the registrant.<br />

In either case, records shall be kept and made available for a period<br />

of at least 2 years for inspection and copying by law enforcement<br />

officers whose duty it is to enforce the laws of this state relating to<br />

controlled substances.<br />

(5) Each person shall maintain a record which shall contain a<br />

detailed d list of controlled substances lost, destroyed, d or stolen, if<br />

any; the kind and quantity of such controlled substances; and the<br />

date of the discovering of such loss, destruction, or theft.


Other Chapter 893 Provisions<br />

§893.04: Pharmacist and practitioner.<br />

§893.05: Practitioners and persons<br />

administering controlled substances in their<br />

absence.<br />

§893 055: Prescription drug monitoring<br />

§893.055: Prescription drug monitoring<br />

program.


Other Chapter 893 Provisions<br />

§893.0551: Public records exemption for the<br />

prescription drug monitoring program.<br />

§893.06: Distribution of controlled substances;<br />

order forms; labeling and packaging<br />

requirements.<br />

§893.065: Counterfeit-resistant prescription<br />

blanks for controlled substances listed in<br />

Schedule II, Schedule III, or Schedule IV.


Rule 64F-12.006, F.A.C.: <strong>Drugs</strong> and<br />

Rule 64F 12.006, F.A.C.: <strong>Drugs</strong> and<br />

Devices; Labeling Requirements.


Rule 64F-12.006, F.A.C.<br />

<br />

(1) The department<br />

adopts and incorporates<br />

by reference the labeling<br />

requirements e e for<br />

prescription drugs and<br />

over-the-counter drugs<br />

as set forth in the<br />

federal act at 21 U.S.C.<br />

ss. 301 et seq. and in<br />

Title 21 Code of Federal<br />

Regulations Parts 1-<br />

1299 (as of 10/1/03).


Rule 64F-12.006, F.A.C.<br />

(a) The label on the immediate container of each<br />

unit dose repackaged drug product or multiple unit<br />

prepackaged drug product must contain the<br />

following:<br />

1. Brand or generic name, or both;<br />

2. Strength of drug;<br />

3. Dosage form;<br />

4. Manufacturer’s name and lot number or a<br />

control number if a log is maintained which cross<br />

references the control number with the<br />

manufacturer’s name and lot number; and<br />

5. Expiration date.


Rule 64F-12.006, F.A.C.<br />

(b) An authorized practitioner dispensing complimentary<br />

prescription i drugs to his own patients may dispense<br />

them in the manufacturer’s package which shall also<br />

include the practitioner’s name, the patient’s name<br />

and the date dispensed. If complimentary prescription<br />

drugs are not dispensed in the manufacturer’s labeled<br />

package, they shall be dispensed in a container which<br />

bears a label containing the following:<br />

1. Practitioner’s name and address;<br />

2. Patient’s name;<br />

3. Date dispensed;<br />

4. Name and strength of drug;<br />

5. Directions for use; and<br />

6. Expiration date.


Rule 64F-12.006, F.A.C.<br />

(c) A Veterinary <strong>Legend</strong> Drug Retail establishment shall<br />

attach a label l to the original, i sealed manufacturer’s<br />

container in a manner which leaves the manufacturer’s<br />

labeling intact and legible, upon the sale of a veterinary<br />

legend drug to a consumer. The label shall bear the<br />

following:<br />

1. Name, address and veterinary legend drug retail<br />

establishment number;<br />

2. Prescribing veterinarian’s name;<br />

3. Name of the animal or kennel name if so authorized;<br />

4. Date prescription filled or refilled;<br />

5. Prescription number or other prescription identification<br />

adequate to readily identify the prescription; p and<br />

6. Directions for use.


Rule 64F-12.006, F.A.C.<br />

(2) The department adopts and incorporates by<br />

reference the labeling requirements for medical<br />

devices as set forth in the federal act at 21 U.S.C.<br />

ss. 301 et seq. and in Title 21 Code of Federal<br />

Regulations Parts 800-895 (as of 10/1/03).<br />

Note: Title 21 Code of Federal Regulations Parts<br />

800-895 contain the specific regulations governing<br />

medical devices. The requirements include<br />

labeling, premarket approval, registration and<br />

listing, medical device reporting, in vitro diagnostic<br />

labeling, investigational devices exemptions, and<br />

device classifications.


Wrap Up<br />

Questions?


END OF PRESENTATION<br />

Edwin A. Bayó<br />

Grossman, Furlow, and Bayó, LLC<br />

1408 N. Piedmont Way<br />

Tallahassee, FL. 32308<br />

(850) 385-1314<br />

e.bayo@gfblawfirm.com


The Laws and Rules<br />

Governing the Practice of<br />

Veterinary Medicine and<br />

Disciplinary Actions<br />

Edwin A. Bayó<br />

Grossman, Furlow, and Bayó, LLC<br />

2022-2 2 Raymond Diehl Rd<br />

Tallahassee, FL 32308<br />

(850) 385-1314<br />

e.bayo@gfblawfirm.com


The Sources<br />

Chapter 474, Florida Statutes: Veterinary Medical<br />

Practice Act<br />

Grants the Board of Veterinary Medicine the authority<br />

to promulgate rules, including standards of practice,<br />

and provides the grounds for disciplinary action<br />

against a licensed veterinarian.<br />

i<br />

Rule 61G18, FL Administrative Code:<br />

Contains all the rules promulgated by the Board of<br />

Veterinary Medicine, including grounds for disciplinary<br />

proceedings and disciplinary guidelines.


The Sources<br />

Chapter 455, Florida Statutes:<br />

Establishes the authority and procedures to conduct<br />

an investigation and disciplinary action. Provides<br />

general grounds for disciplinary action against all<br />

DBPR licensees<br />

Chapter 828, Florida Statutes:<br />

Animals: Cruelty, Sales, Animal Enterprise Protection<br />

§828.29 Dogs and cats transported or offered for<br />

sale; health requirements; consumer guarantee.–<br />

Official certificates of veterinary inspection.


The Sources<br />

Chapter 499, F.S.: <strong>Drugs</strong>, Devices,<br />

Cosmetics, and Household Products.<br />

Chapter 465, F.S.: Florida Pharmacy Act.<br />

Chapter 893, F.S.: Florida Comprehensive<br />

Drug Abuse Prevention and Control lAct.<br />

Rule 64F-12.006, F.A.C.: <strong>Drugs</strong> and Devices;<br />

Labeling Requirements.


Common Causes for<br />

Disciplinary Action<br />

Found in Chp. 475, F.S., Chp. 455, F.S., and Rule<br />

61G18-30.001, F.A.C.<br />

Include:<br />

Inadequate Record Keeping<br />

Knowingly employing unlicensed persons in the<br />

practice of veterinary medicine.<br />

i<br />

Knowingly operating a veterinary establishment<br />

or premises without a valid premise permit.<br />

Having a license to practice veterinary medicine<br />

revoked, suspended, or otherwise acted against,<br />

including the denial of licensure, by the licensing<br />

authority of another state, territory, or country.


Common Causes for<br />

Disciplinary Action<br />

<br />

<br />

<br />

Being convicted or found guilty, regardless<br />

of an adjudication, of a crime in any<br />

jurisdiction which directly relates to the<br />

practice of veterinary medicine or the ability<br />

to practice veterinary medicine.<br />

Practicing with a revoked, suspended, or<br />

inactive license.<br />

Being unable to practice veterinary medicine<br />

with reasonable skill and safety to patients<br />

t<br />

by reason of illness, drunkenness, use of<br />

drugs, narcotics, chemicals, or any other<br />

material or substance or as a result of any<br />

mental or physical condition.


Common Causes for<br />

Disciplinary Action<br />

Knowingly gymaintaining a professional connection or<br />

association with any person who is in violation of the<br />

provisions of Chapter 474, F.S., or the rules of the<br />

Board.<br />

Paying or receiving kickbacks, rebates, bonuses, or<br />

other remuneration for receiving a patient or client or<br />

for referring a patient t or client to another provider of<br />

veterinary services or goods. In construing this<br />

section, the Board shall deem that a referral to an<br />

entity with which the veterinarian has a contractual<br />

relationship, for the sale of non-veterinary, non-<br />

medical pet food or pet supplies, does not constitute a<br />

kickback, so long as the client is aware of the<br />

relationship.


Common Causes for<br />

Disciplinary Action<br />

Engaging in fraud in the collection of fees from<br />

consumers or any person, agency, or<br />

organization paying fees to practitioners.<br />

Fraud, deceit, negligence, incompetency, or<br />

misconduct in the practice of veterinary<br />

medicine.<br />

Being convicted of a charge of cruelty to<br />

animals.<br />

Performing or prescribing unnecessary or<br />

unauthorized treatment.


Common Causes for<br />

Disciplinary Action<br />

Being guilty of incompetence or negligence by failing<br />

to practice veterinary medicine with that level of care,<br />

skill, and treatment which is recognized by a<br />

reasonably prudent veterinarian i as being acceptable<br />

under similar conditions and circumstances.<br />

Failing to keep the equipment and premises of the<br />

business establishment in a clean and sanitary<br />

condition or having a premise permit suspended or<br />

revoked pursuant to Section 474.215, F.S.<br />

Refusing to permit the Department to inspect the<br />

business premises of the licensee during regular<br />

business hours.


Common Causes for<br />

Disciplinary Action<br />

Using the privilege of ordering, prescribing, or making<br />

available medicinal drugs or drugs defined in Chapter<br />

465, F.S., or controlled substances as defined in Chapter<br />

893, F.S., for use other than for the specific treatment of<br />

animal patients for which there is a documented<br />

veterinarian/client/patient relationship.<br />

Violating any of the requirements of Chapter 499, F.S.,<br />

the Florida Drug and Cosmetic Act; 21 U.S.C. ss. 301-<br />

392, the Federal Food, Drug, and Cosmetic Act; 21<br />

U.S.C. ss. 821 seq., the Comprehensive Drug Abuse<br />

Prevention and Control Act of 1970, more commonly<br />

known as the Federal Drug Abuse Act; or Chapter 893,<br />

F.S.<br />

The list goes on…


Disciplinary Process<br />

§455.225, F.S., Disciplinary proceedings:<br />

A complaint is legally sufficient if it contains ultimate<br />

facts that show that a violation of this chapter, of any of<br />

the practice acts relating to the professions regulated<br />

by the department, or of any rule adopted by the<br />

department or a regulatory board in the department<br />

has occurred.<br />

The department may investigate an anonymous<br />

complaint if the complaint is in writing and is legally<br />

sufficient, if the alleged violation of law or rules is<br />

substantial, and if the department has reason to<br />

believe, after preliminary inquiry, that the violations<br />

alleged in the complaint are true.<br />

Division of Regulation: enforcement authority for<br />

the professional boards and programs.


Important:<br />

When an investigation i i of any subject is<br />

undertaken, the department shall promptly furnish<br />

to the subject or the subject's attorney a copy of<br />

the complaint or document that resulted in the<br />

initiation of the investigation.<br />

The subject may submit a written response to<br />

the information contained in such complaint or<br />

document within 20 days after service to the<br />

subject of the complaint or document. The<br />

subject's written response shall be considered<br />

by the probable cause panel.


Important:<br />

Upon completion of the investigation i i and pursuant<br />

to a written request by the subject, the department<br />

shall provide the subject an opportunity to inspect<br />

the investigative file or, at the subject's expense,<br />

forward to the subject a copy of the investigative file.<br />

The subject may file a written response to the<br />

information contained in the investigative file.<br />

Such response must be filed within 20 days,<br />

p y ,<br />

unless an extension of time has been granted by<br />

the department.


Important:<br />

When its investigation is complete and legally sufficient, the<br />

department shall prepare and submit to the probable cause<br />

panel of the appropriate regulatory board the investigative<br />

report of the department. The report shall contain the<br />

investigative findings and the recommendations of the<br />

department concerning the existence of probable cause.<br />

The determination as to whether probable cause exists shall<br />

be made by majority vote of a probable cause panel of the<br />

board, or by the department, as appropriate.<br />

All proceedings of the panel and all documents and<br />

information obtained during an investigation are confidential<br />

only until an investigation ceases to be active. An<br />

investigation ceases to be active when the case is dismissed<br />

without a finding of probable cause or 10 days after probable<br />

cause is found.


Important:<br />

<br />

In lieu of a finding of probable cause, the probable<br />

cause panel, or the department when there is no<br />

board, may issue a letter of guidance to the<br />

subject.<br />

If the probable bl cause panel finds that t probable<br />

bl<br />

cause exists, it shall direct the department to file a<br />

formal complaint against the licensee.


Final Agency Action<br />

§ 455.225(6), F.S.: : The appropriate board, with those<br />

members of the panel, if any, who reviewed the<br />

investigation pursuant to subsection (4) being<br />

excused, or the department when there is no board,<br />

shall determine and issue the final order in each<br />

disciplinary case. Such order shall constitute final<br />

agency action. Any consent order or agreed<br />

settlement t shall be subject to the approval of the<br />

department.


What can the Board do to<br />

you for a violation?<br />

Range of Penalties:<br />

Denial of an application for licensure.<br />

Revocation or suspension of a license.<br />

Imposition of an administrative fine not to exceed<br />

$5,000 for each count or separate offense.<br />

Issuance of a reprimand.<br />

Placement of the licensee on probation for a period<br />

of time and subject to such conditions as the board<br />

may specify.<br />

Restriction of the authorized scope of practice by the<br />

licensee.<br />

Also: Aggravating and Mitigating Circumstances


Emergency suspension, restriction,<br />

or limitation of a license:<br />

If the agency finds that immediate serious danger to<br />

the public health, safety, or welfare requires<br />

emergency suspension, restriction, or limitation of a<br />

license, the agency may take such action by any<br />

procedure that is fair under the circumstances<br />

Example of such a situation: Being arrested for a<br />

crime pertaining to substance abuse of diversion.


What is the best way to avoid<br />

legal and disciplinary problems?<br />

Become familiar<br />

with the laws and<br />

rules.<br />

Renew your license<br />

and keep up with<br />

your continuing<br />

education.<br />

Respond (timely) to<br />

any notice from the<br />

Board.


END OF PRESENTATION<br />

Edwin A. Bayó<br />

Grossman, Furlow, and Bayó, LLC<br />

2022-2 Raymond Diehl Rd<br />

Tallahassee, FL 32308<br />

(850) 385-1314<br />

e.bayo@gfblawfirm.com

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!