Medication Chart Orders and the DEA: Long–Term Care Facility Residents Caught in the Middle

Abstract

In 2009, several field offices of the Drug Enforcement Agency (DEA) began enforcement actions against a number of pharmacies serving long-term care facilities (LTCFs) in Ohio, Michigan, Wisconsin, and Virginia, alleging that the practice of using ‘‘chart orders’’—LTCF nurses calling or faxing prescriptions for Class II–V drugs to the pharmacies—violated certain DEA regulations. Long-term care pharmacies in these states have already been targeted by the DEA for inspection, and many now face huge fines. For example, 1 independent pharmacy was cited with more than 3,000 violations and faces fines of more than $32 million. Other pharmacies have changed their policies to reflect DEA regulations, resulting in significant delays in the delivery of pain medication to nursing facility residents. The DEA’s interpretation of the law prohibits pharmacies from dispensing Class II through Class V medications to LTCFs and their residents, where the prescription/medication order was obtained from the nursing facility by facsimile and where the pharmacy has not received the prescription by the prescriber (physician) with all the required elements. The critical ‘‘missing’’ element in the case of chart orders sent to the pharmacy via fax is usually the physician’s original signature. Although a pharmacy is permitted to fill a medication order transmitted via fax, the regulation requires the fax to be transmitted either by the prescribing physician or the