155A.27  Requirements for prescription.
  1.  Except when dispensed directly by a prescriber to an ultimate user, a prescription drug shall not be dispensed without a prescription that is authorized by a prescriber and based on a valid patient-prescriber relationship.
  2.  a.  Beginning January 1, 2020, every prescription issued for a prescription drug shall be transmitted electronically as an electronic prescription to a pharmacy by a prescriber or the prescriber’s authorized agent unless exempt under paragraph “b”.
  b.  Paragraph “a” shall not apply to any of the following:
  (1)  A prescription for a patient residing in a nursing home, long-term care facility, correctional facility, or jail.
  (2)  A prescription authorized by a licensed veterinarian.
  (3)  A prescription for a device.
  (4)  A prescription dispensed by a department of veterans affairs pharmacy.
  (5)  A prescription requiring information that makes electronic transmission impractical, such as complicated or lengthy directions for use or attachments.
  (6)  A prescription for a compounded preparation containing two or more components.
  (7)  A prescription issued in response to a public health emergency in a situation where a non-patient specific prescription would be permitted.
  (8)  A prescription issued for an opioid antagonist pursuant to section 135.190 or a prescription issued for epinephrine pursuant to section 135.185.
  (9)  A prescription issued during a temporary technical or electronic failure at the location of the prescriber or pharmacy, provided that a prescription issued pursuant to this subparagraph shall indicate on the prescription that the prescriber or pharmacy is experiencing a temporary technical or electronic failure.
  (10)  A prescription issued pursuant to an established and valid collaborative practice agreement, standing order, or drug research protocol. 
  (11)  A prescription issued in an emergency situation pursuant to federal law and regulation and rules of the board.
  c.  A practitioner, as defined in section 124.101, subsection 27, paragraph “a”, who violates paragraph “a” is subject to an administrative penalty of two hundred fifty dollars per violation, up to a maximum of five thousand dollars per calendar year. The assessment of an administrative penalty pursuant to this paragraph by the appropriate licensing board of the practitioner alleged to have violated paragraph “a” shall not be considered a disciplinary action or reported as discipline. A practitioner may appeal the assessment of an administrative penalty pursuant to this paragraph, which shall initiate a contested case proceeding under chapter 17A. A penalty collected pursuant to this paragraph shall be deposited into the drug information program fund established pursuant to section 124.557. The board shall be notified of any administrative penalties assessed by the appropriate professional licensing board and deposited into the drug information program fund under this paragraph.
  d.  A pharmacist who receives a written, oral, or facsimile prescription shall not be required to verify that the prescription is subject to an exception under paragraph “b” and may dispense a prescription drug pursuant to an otherwise valid written, oral, or facsimile prescription. However, a pharmacist shall exercise professional judgment in identifying and reporting suspected violations of this section to the board or the appropriate professional licensing board of the prescriber.
  3.  For prescriptions issued prior to January 1, 2020, or for prescriptions exempt from the electronic prescription requirement in subsection 2, paragraph “b”, a prescriber or the prescriber’s authorized agent may transmit a prescription for a prescription drug to a pharmacy by any of the following means:
  a.  Electronically.
  b.  By facsimile.
  c.  Orally.
  d.  By providing an original signed prescription to a patient or a patient’s authorized representative. 
  4.  A prescription shall be issued in compliance with this subsection. Regardless of the means of transmission, a prescriber shall provide verbal verification of a prescription upon request of the pharmacy. 
  a.  If written, electronic, or facsimile, each prescription shall contain all of the following:
  (1)  The date of issue.
  (2)  The name and address of the patient for whom, or the owner of the animal for which, the drug is dispensed.
  (3)  The name, strength, and quantity of the drug prescribed.
  (4)  The directions for use of the drug, medicine, or device prescribed.
  (5)  The name, address, and written or electronic signature of the prescriber issuing the prescription.
  (6)  The federal drug enforcement administration number, if required under chapter 124.
  b.  If electronic, each prescription shall comply with all of the following:
  (1)  The prescriber shall ensure that the electronic system used to transmit the electronic prescription has adequate security and safeguards designed to prevent and detect unauthorized access, modification, or manipulation of the prescription.
  (2)  Notwithstanding paragraph “a”, subparagraph (5), for prescriptions that are not controlled substances, if transmitted by an authorized agent, the electronic prescription shall not require the written or electronic signature of the prescriber issuing the prescription. 
  c.  If facsimile, in addition to the requirements of paragraph “a”, each prescription shall contain all of the following:
  (1)  The identification number of the facsimile machine which is used to transmit the prescription.
  (2)  The date and time of transmission of the prescription.
  (3)  The name, address, telephone number, and facsimile number of the pharmacy to which the prescription is being transmitted.
  d.  If oral, the prescriber issuing the prescription shall furnish the same information required for a written prescription, except for the written signature and address of the prescriber. Upon receipt of an oral prescription, the recipient shall promptly reduce the oral prescription to a written format by recording the information required in a written prescription. 
  e.  A prescription transmitted by electronic, facsimile, or oral means by a prescriber’s agent shall also include the name and title of the prescriber’s agent completing the transmission.
  5.  An electronic, facsimile, or oral prescription shall serve as the original signed prescription and the prescriber shall not provide a patient, a patient’s authorized representative, or the dispensing pharmacist with a signed written prescription. Prescription records shall be retained pursuant to rules of the board. 
  6.  This section shall not prohibit a pharmacist, in exercising the pharmacist’s professional judgment, from dispensing, at one time, additional quantities of a prescription drug, with the exception of a prescription drug that is a controlled substance as defined in section 124.101, up to the total number of dosage units authorized by the prescriber on the original prescription and any refills of the prescription, not to exceed a ninety-day supply of the prescription drug as specified on the prescription.
  7.  A prescriber, medical group, institution, or pharmacy that is unable to timely comply with the electronic prescribing requirements in subsection 2, paragraph “a”, may petition the board for an exemption from the requirements based upon economic hardship, technical limitations that the prescriber, medical group, institution, or pharmacy cannot control, or other exceptional circumstances. The board shall adopt rules establishing the form and specific information to be included in a request for an exemption and the specific criteria to be considered by the board in determining whether to approve a request for an exemption. The board may approve an exemption for a period of time determined by the board, not to exceed one year from the date of approval, and may be annually renewed subject to board approval upon request.
87 Acts, ch 215, §27; 97 Acts, ch 39, §3, 4; 2004 Acts, ch 1036, §15, 16; 2009 Acts, ch 69, §5; 2016 Acts, ch 1060, §1; 2017 Acts, ch 145, §29; 2018 Acts, ch 1138, §11; 2019 Acts, ch 59, §53
Referred to in §124.308, 126.11, 147.107, 155A.29