Dispensing ePrescriptions for the OTP: A guide for community pharmacists  

What are ePrescriptions?

An electronic prescription (ePrescription) is a digital version of a paper prescription that contains a Conformance ID. Conformant* ePrescriptions prescribed by medical and nurse practitioners can be accessed by community pharmacists using a conformant dispensing system either through a QR code token scanned at the pharmacy or from the patient’s Active Script List (ASL). ePrescriptions improve patient safety by reducing the risk of transcription errors.
More information about the regulatory and system requirements for dispensing medicines from ePrescriptions can be found on the Commonwealth Department of Health and NSW Health websites.

* Only prescriptions created, transmitted or dispensed from a system that is listed on the Electronic Prescribing Conformance Register with a Conformance ID is legally valid for dispensing.

Dispensing ePrescriptions for the Opioid Treatment Program

When dispensing oral methadone or buprenorphine for treatment under the NSW Opioid Treatment Program (OTP), pharmacists must ensure the ePrescription is legally valid.
Exemptions to the Poisons and Therapeutic Goods Regulation 2008 for ePrescriptions means some requirements for paper Schedule 8 medication prescriptions do not apply:

• prescribers are not required to handwrite directions on an ePrescription, nor sign in their handwriting
• pharmacists do not need to create and store a paper duplicate of an ePrescription.

Pharmacists must refer to the actual ePrescription on screen when dosing a patient or dispensing take-home doses. The on-screen display is the current and valid prescription. Printed output of the on-screen display of an ePrescription is not a valid prescription.
You will only know if a new ePrescription has been issued once you enter the token or view the patient’s Active Script List.

Requirements for ePrescriptions for OTP

An OTP ePrescription token must be sent directly to the dosing point pharmacy by the prescriber.
Pharmacists must confirm the ePrescription includes:

• patient identity information – Name, Address, Date of Birth
• the name, strength and quantity of the medicine and adequate dosing instructions including total daily dose and any variations to the dose applicable to the circumstance
• a date range for dosing, other than for prescribing for six months treatment
• clear instructions for the dispensing of any unsupervised (take home) doses – this should be provided by a number of unsupervised dosing days and the days of the week (e.g. 3 (three) takeaway doses per week – Monday, Wednesday, Saturday)
• directions for dilution of methadone with an approved diluent, if applicable.

​Most of this information will be pre-populated through the conformant prescribing software.

Reminders about OTP dosing procedures

• Confirm the identity of the patient before providing supervised administration or dispensing unsupervised doses of methadone or buprenorphine, referring to identification information (including a clear and current photograph) kept at the pharmacy.
• Depot buprenorphine injection (Buvidal® and Sublocade®) must not be dispensed directly to patients. The pharmacist must arrange for delivery of the medicine to the health practitioner assigned to administer the depot injection or administer the medicine under the direction of a medical practitioner, if competent in administration.
• Pharmacies intending to dispense OTP medications need to register with the Ministry of Health Pharmaceutical Regulatory Unit and are entitled to claim a incentive payment through the Pharmacy Incentive Scheme.
• Refer to the NSW Opioid Treatment Program Community Pharmacy Dosing Protocol for supervised dosing procedures and preparation of takeaway doses.

How do pharmacies access OTP ePrescriptions?

Pharmacies may need to make changes to workflow to receive OTP ePrescriptions. Pharmacies can access ePrescriptions through the token system or from the patient’s Active Script List.

Receiving tokens for OTP ePrescriptions at the pharmacy

Prescribers are advised to contact the pharmacy to confirm the ability to receive ePrescription tokens. Ensure the prescriber has the correct email address of the pharmacy for sending the token.
Prescribers will send tokens for ePrescriptions directly to the pharmacy, as is the standard practice with handwritten and computer-generated paper OTP prescriptions. This is to prevent the token from being misplaced, lost, or stolen. Once the token is scanned and used by a pharmacist to dispense the medicine it cannot be reused. The prescription delivery service will lock an ePrescription as soon as it is accessed, so no other pharmacy can dispense it.
If a patient claims the prescriber has emailed the token to the pharmacy, but no token has been received at the pharmacy, do not continue to dose the patient based on a previous ePrescription as it may be superseded. Follow up with the prescriber to confirm where the token has been sent and request that the ePrescription is cancelled and re-issued if there has been a mistake.
Do not accept tokens that have been issued to a patient – remind prescribers that tokens should be sent directly to the dosing point pharmacy. Any repeats authorised MUST be retained at the pharmacy – tokens are not to be provided to the patient.

What happens if conformant ePrescriptions are not available in my setting?

Prescribers and pharmacists at NSW Health clinics and hospitals and private OTP clinics that do not have access to conformant electronic prescribing and dispensing systems should refer to local procedures for supply and dispensing.

Additional information

For more information please refer to the Commonwealth Department of Health and NSW Health websites.