A. The following responsibilities require the use of professional judgment and therefore shall be performed only by a pharmacist or pharmacist intern:

1. (1) receipt of all new verbal prescription orders and reduction to writing;
2. (2) initial identification, evaluation and interpretation of the prescription order and any necessary clinical clarification prior to dispensing;
3. (3) professional consultation with a patient or his agent regarding a prescription;
4. (4) evaluation of available clinical data in patient medication record system;
5. (5) oral communication with the patient or patient's agent of information, as defined in this section under patient counseling, in order to improve therapy by ensuring proper use of drugs and devices;
6. (6) professional consultation with the prescriber, the prescriber's agent, or any other health care professional or authorized agent regarding a patient and any medical information pertaining to the prescription;
7. (7) drug regimen review, as defined in Section 61-11-2L NMSA 1978;
8. (8) professional consultation, without dispensing, will require that the patient be provided with the identification of the pharmacist or pharmacy intern providing the service.

B. Only a pharmacist shall perform the following duties:

1. (1) final check on all aspects of the completed prescription including sterile products and cytotoxic preparations, and assumption of the responsibility for the filled prescription, including, but not limited to, appropriateness of dose, accuracy of drug, strength, labeling, verification of ingredients and proper container;
2. (2) evaluation of pharmaceuticals for formulary selection within the facility;
3. (3) supervision of all supportive personnel activities including preparation, mixing, assembling, packaging, labeling and storage of medications;
4. (4) ensure that supportive personnel have been properly trained for the duties they may perform;
5. (5) any verbal communication with a patient or patient's representative regarding a change in drug therapy or performing therapeutic interchanges (i.e. drugs with similar effects in specific therapeutic categories); this does not apply to substitution of generic equivalents;
6. (6) any other duty required of a pharmacist by any federal or state law.

C. Patient records.

1. (1) A reasonable effort must be made to obtain, record and maintain at least the following information:

   1. (a) name, address, telephone number, date of birth (or age) and gender of the patient;
   2. (b) individual medical history, if significant, including disease state or states, known allergies and drug reactions and a comprehensive list of medications and relevant devices; and
   3. (c) pharmacist’s comments relevant to the individuals drug therapy.
2. (2) Such information contained in the patient record should be considered by the pharmacist or pharmacist intern in the exercise of their professional judgment concerning both the offer to counsel and the content of counseling.

D. Prospective drug regimen review.

1. (1) Prior to dispensing any prescription, a pharmacist shall review the patient profile for the purpose of identifying:

   1. (a) clinical abuse/misuse;
   2. (b) therapeutic duplication;
   3. (c) drug-disease contraindications;
   4. (d) drug-drug interactions;
   5. (e) incorrect drug dosage;
   6. (f) incorrect duration of drug treatment;
   7. (g) drug-allergy interactions;
   8. (h) appropriate medication indication.
2. (2) Upon recognizing any of the above, a pharmacist, using professional judgment, shall take appropriate steps to avoid or resolve the potential problem. These steps may include requesting and reviewing a controlled substance prescription monitoring report or another states’ reports if applicable and available, and consulting with the prescriber and counseling the patient. The pharmacist shall document steps taken to resolve the potential problem.

E. Prescription monitoring program (PMP) report for opioid prescriptions. When presented with an opioid prescription for a patient, obtaining and reviewing a PMP report for that patient can be an important tool that assists the pharmacist in identifying issues or problems that put his or her patient at risk of prescription drug abuse, overdose, or diversion. A pharmacist shall use professional judgment based on prevailing standards of practice in determining whether to obtain and review a PMP report before dispensing an opioid prescription to that patient, and shall document his or her action regarding such reports.

1. (1) A pharmacist shall request and review a PMP report covering at least a one year time period and another states’ report, where applicable and available if;

   1. (a) a pharmacist becomes aware of a person currently exhibiting potential abuse or misuse of opioids (i.e. over-utilization, early refills, multiple prescribers, appears sedated or intoxicated upon presenting a prescription for an opioid or an unfamiliar patient requesting an opioid by specific name, street name, color, or identifying marks, or paying cash when the patient has prescription insurance);
   2. (b) a pharmacist receives an opioid prescription issued by a prescriber with whom the pharmacist is unfamiliar (i.e. prescriber is located out-of-state or prescriber is outside the usual pharmacy geographic prescriber care area);
   3. (c) a pharmacist receives an opioid prescription for an unfamiliar patient who resides outside the usual pharmacy geographic patient population area;
   4. (d) a pharmacist receives an initial prescription for any long-acting opioid formulations, including oral and transdermal dosage forms (e.g fentanyl or methadone);
   5. (e) a pharmacist becomes aware of a patient receiving an opioid concurrently with a benzodiazepine or carisoprodol;
2. (2) The pharmacist shall document the review of these PMP reports.
3. (3) Upon recognizing any of the above conditions described in Paragraph (1 ) of Subsection E of 16.19.4.16 NMAC, a pharmacist, using professional judgment, shall take appropriate steps to avoid or resolve the potential problem. These steps may include consulting with the prescriber and counseling the patient. The pharmacist shall document steps taken to resolve the potential problem.
4. (4) After obtaining an initial PMP report on a patient, a pharmacist shall use professional judgment based on prevailing standards of practice, in deciding the frequency of requesting and reviewing further prescription monitoring reports and other states’ reports for that patient. Except that PMP reports shall be reviewed a minimum of once every three months during the continuous use of opioids for each established patient. The pharmacist shall document the review of these reports.
5. (5) In the event a report is not immediately available, the pharmacist shall use professional judgment in determining whether it is appropriate and in the patient’s best interest to dispense the prescription prior to receiving a report.
6. (6) A prescription for an opioid written for a patient in a long term care facility (LTCF) or for a patient with a medical diagnosis documenting a terminal illness is exempt from Subsection E of 16.19.4.16 NMAC. If there is any question whether a patient may be classified as having a terminal illness, the pharmacist shall contact the practitioner. The pharmacist shall document whether the patient is “terminally ill” or an “LTCF patient”.

F. Counseling.

1. (1) Upon receipt of a new prescription drug order and following a review of the patient's record, a pharmacist or pharmacist intern shall personally offer to counsel on matters which will enhance or optimize drug therapy with each patient or the patient's agent. Upon receipt of a refill prescription drug order a pharmacy technician may query the patient or patient's agent regarding counseling by the pharmacist or pharmacist intern concerning drug therapy. Such counseling shall be in person, whenever practicable, or by telephone, and shall include appropriate elements of patient counseling which may include, in their professional judgment, one or more of the following:

   1. (a) the name and description of the drug;
   2. (b) the dosage form, dosage, route of administration, and duration of drug therapy;
   3. (c) intended use of the drug and expected action;
   4. (d) special directions and precautions for preparation, administration and use by the patient;
   5. (e) common severe side or adverse effects or interactions and therapeutic contraindications that may be encountered, including their avoidance and the action required if they occur;
   6. (f) techniques for self-monitoring drug therapy;
   7. (g) proper storage;
   8. (h) prescription’s refill information;
   9. (i) action to be taken in the event of a missed dose;
   10. (j) the need to check with the pharmacist or practitioner before taking other medication; and
   11. (k) pharmacist comments relevant to the individual's drug therapy, including any other information peculiar to the specific patient or drug.
2. (2) [REPEALED]
3. (3) Alternative forms of patient information may be used to supplement patient counseling when appropriate. Examples include, but not limited to, written information leaflets, pictogram labels and video programs.
4. (4) Patient counseling, as described above and defined in this regulation shall not be required for in-patients of a hospital or institution where other licensed health care professionals are authorized to administer the drug(s).
5. (5) A pharmacist shall in no way attempt to circumvent or willfully discourage a patient or patient's agent from receiving counseling. However, a pharmacist shall not be required to counsel a patient or patient's agent when the patient or patient's agent refuses such consultation.
6. (6) When the patient or agent is not present when the prescription is dispensed including, but not limited to, a prescription that was shipped by the mail, the pharmacist shall ensure that the patient receives written notice of available counseling. Such notice shall include days and hours of availability, and: (a) of his or her right to request counseling; and (b) a toll-free telephone number in which the patient or patient's agent may obtain oral counseling from a pharmacist who has ready access to the patient's record. For pharmacies delivering more than fifty percent of their prescriptions by mail or other common carrier, the hours of availability shall be a minimum of 60 hours per week and not less than six days per week. The facility must have sufficient toll-free phone lines and personnel to provide counseling within 15 minutes.
7. (7) In every pharmacy there shall be prominently posted in a place conspicuous to and readable by prescription drug consumers a notice concerning available counseling.

H. Regulatory assessment. Profiles, either electronic or hard copy, shall be available for inspection, and shall provide the capability of storing the described historical information. The profiles must demonstrate that an effort is being made to fulfill the requirements by the completion of the detail required. A patient record shall be maintained for a period of not less than three years from the date of the last entry in the profile record.

[8/27/1990; 16.19.4.16 NMAC - Rn, 16 NMAC 19.4.16, 3/30/2002; 16.19.4.16 NMAC - Rn, 16.19.4.17 NMAC, 12/15/2002; A, 2/1/2004; A, 11/30/2004; A, 1/15/2005; A, 1/31/2007; A, 8/31/2012; A, 10/25/2012; A, 10/19/2019; A, 9/13/2022]