New Hampshire Regulations

New Hampshire State Regulatory Update April 2019

New Hampshire Requirements to Upgrade from a Registered Pharmacy Technician to a Certified Pharmacy Technician

The New Hampshire Board of Pharmacy would like to remind pharmacy technicians and their pharmacists-in-charge (PICs) of the requirements for upgrading from a registered pharmacy technician to a certified pharmacy technician in New Hampshire.

Responsibilities of a PIC regarding Registered Pharmacy Technicians

A registered pharmacy technician who wishes to continue to practice as a registered pharmacy technician can continue to do so under current Board regulations. There is no requirement or administrative rule requiring a technician to move from a registered pharmacy technician to a certified pharmacy technician.

If you have a registered pharmacy technician who is currently studying and working toward becoming a certified pharmacy technician, the timeline to complete this process is one year from January 15, 2019, so it should be completed no later than January 15, 2020.

If you, as a PIC, wish for this person to practice as a certified pharmacy technician in New Hampshire under your supervision in your pharmacy/practice setting, then you and the technician need to complete the required steps to register then as a certified technician with the Board of Pharmacy.

As a PIC, please be certain that the correct designation is on each permit when the technician presents it to you. All permits should be presented to the PIC within 15 days of the technician receiving the permit.

A registered pharmacy technician cannot perform the duties of a certified pharmacy technician in New Hampshire without the correct designation (CPhT) after his or her name on the permit. The permit is required to be in hand before beginning to practice as a New Hampshire certified pharmacy technician.

The PIC is required to sign the application affirming that he or she will supervise the certified pharmacy technician in New Hampshire. If your PIC does not wish to have the technician practice in this capacity, then no action is needed.

Permits must always be posted or on file at the pharmacy.

Hormonal Contraceptives by Pharmacists

In 2018, RSA 318:47-1 was passed, which allows a prescriber to delegate limited prescriptive authority via a standing order so that a licensed pharmacist may dispense oral contraception. Any such prescription shall be regarded as being issued for a legitimate medical purpose in the usual course of professional practice. A standing order shall specify a mechanism for documenting the screening used by the pharmacist, placing the document in the patient's medical record, and including any plans for evaluating and treating adverse events.

Prior to prescribing and dispensing hormonal contraception under the law, a pharmacist shall complete an Accreditation Council for Pharmacy Education (ACPE)- accredited educational training program related to hormonal contraceptives. In addition to the educational requirement, a pharmacist shall comply with the most current United States Medical Eligibility Criteria for contraceptive use as adopted by the Centers for Disease Control and Prevention (CDC). A patient receiving oral hormonal contraception from a pharmacist shall be provided with a standardized information sheet written in plain language, which shall include, but is not limited to, the indication for usage, the importance of follow-up care, and health care referral information.

A statewide protocol has been developed and approved by the New Hampshire boards of medicine and nursing and by DHHS. Rules have been drafted and are expected to be reviewed by the Board at its April 2019 meeting. The goal is to have this program operational by fall 2019.

What does this mean for pharmacists practicing in the state of New Hampshire?

• Pharmacists must ensure that all technicians that are considering national certification meet all requirements outlined by the state Board of Pharmacy. Pharmacists must also be aware of the tasks that certified and non-certified technicians can perform, and all technician registration designations reflect the capacity in which the pharmacy is using their technicians.
• Pharmacists also now have hormonal contraception prescriptive authority. If a pharmacist chooses to provide this clinical service, they must meet all training and practice requirements outlined by the state BOP. Ensure that all SOPs and policies reflect these requirements.

New Hampshire State Regulatory Summary- November 2018

New NH Controlled Drug Loss Reporting Form

The completed forms can be either mailed, faxed to 271-2856, or emailed to Pharmacy Compliance BOP NH

In order to ensure consistency in the reporting of all controlled drug losses and allow the Board to properly track them, this is now the only acceptable form for submitting controlled drug losses to the Board they will no longer accept the old paper DEA 106 forms or any other chain-specific reporting forms. Please note that this change in no way affects the reporting of controlled substance losses to the Federal Drug Enforcement Administration (DEA), which has its own reporting requirements.

Required PSE electronic tracking

In compliance with SB 376, this bill requires all pharmacies in New Hampshire that sell over the counter pseudoephedrine (PSE)/ephedrine (EPH) products to participate in NPLEx, which provides real time PSE electronic tracking in accordance with the Combat Methamphetamine Epidemic Act (CMEA). NPLEx is provided FREE of charge. Register your pharmacy by these steps:

• Go to Apriss Website
• If your pharmacy is not found, you can manually register
• You will receive a confirmation email with instructions for account set up
• Optional Scanner: Pharmacies interested in further enhancing their workflow have the option of purchasing scanners that will scan 2D Driver's License, product UPC, and capture signature. The State of Wisconsin does NOT require scanners.
• Point-of-Sale Integration:

• By integrating with the POS software, transactions can be submitted directly to NPLEx from your existing POS system instead of using the NPLEx retail web portal.
• Please contact your POS vendor to see if this is an option for your pharmacy.

• Don't Sell OTC PSE? If your store does NOT sell over the counter PSE products, please send an email to NHNPLEx@appriss.com stating your pharmacy name, DEA #, your name, and that you do not sell PSE over the counter.
• All pharmacies must be fully compliant with the law by January 1, 2019.

What do these new regulations mean for pharmacists practicing within the state of New Hampshire?

• All pharmacies must ensure that they discard all old controlled substance loss forms and include the new form into their standard operating procedure. All individuals responsible for reporting these losses must be properly trained on the new procedure/form. This is also a great opportunity to review the requirements for reporting CS losses.
• All locations that sell PSE products must ensure compliance with the new reporting through NPLEx before January 1, 2019. Ensure that all standard operation procedures and training include this new process.

New Hampshire State Regulatory Summary- 2018

The following laws, summarized below, were enacted by the New Hampshire legislature during the 2018 session:

HB 1791 Disclosure of information pertaining to lower cost medications regarding biologics Effective January 1, 2019

• A pharmacist may substitute a biological product only if it has been licensed by the federal Food and Drug Administration as an interchangeable biological product.
• When a pharmacist dispenses an interchangeable biological product the pharmacist or his or her designee shall inform the patient.
• A pharmacist shall not substitute an interchangeable biological product if the prescriber indicates that substitution is not authorized by specifying "medically necessary" on a paper prescription, or uses electronic indications, or gives instructions when transmitted orally.
• Within 3 business days following dispensing, the dispensing pharmacist or the pharmacist's designee shall make an entry of the specific product provided to the patient, including the name of the product and the manufacturer.
• Entry into an electronic records system as described in this paragraph is presumed to provide notice to the prescriber. Otherwise, the pharmacist shall communicate the biological product dispensed to the prescriber using facsimile, telephone, electronic transmission, or other prevailing means.

HB 1822 Pharmacist Dispensing of Oral Contraception Pursuant to Standing Order - Effective August 7, 2018

• Licensed pharmacists following standing orders may dispense hormonal contraceptives to persons in this state without a prior prescription.
• Prior to dispensing hormonal contraceptives under this section, a pharmacist shall complete an Accreditation Council for Pharmacy Education (ACPE) accredited educational training program related to hormonal contraceptives.
• The pharmacist shall provide each recipient of hormonal contraceptives pursuant to this section with a standardized information sheet written in plain language, which shall include, but is not limited to;

• the indication for the use of the hormonal contraceptive,
• the importance of follow-up care,
• health care referral information.

What do these new regulations mean for pharmacists practicing within the state of New Hampshire?

• Pharmacists may, using the board of pharmacy FDA list of interchangeable biological products and their professional judgement, may provide an alternate product to a patient upon their request to provide cost effective alternatives that assists the patient in adherence and therapy outcomes.
• The prescriber must allow for interchangeable products through the prescription. No DAW or non-substitution indicators must be present. The pharmacist must notify the prescribing physician of the change within three days of dispensing. This can be done electronically or by other means.
• Pharmacists can also provide oral contraceptives to patients via a standing order after they have completed approved training outlined by the board of pharmacy; ensure that training is completed by all pharmacists and proof of training can be provided, and also be sure that standard operations procedures are in place to ensure that all required information is provided to the patient at time of dispensing and counseling.

For full regulatory language, refer to the New Hampshire Board of Pharmacy.