1. (a) Pharmacist shall exercise sound professional judgment with respect to the accuracy and authenticity of any prescription drug order dispensed. If the pharmacist questions the accuracy or authenticity of a prescription drug order, the pharmacist shall verify the order with the practitioner prior to dispensing.

2. (b) A pharmacist shall make every reasonable effort to ensure that any prescription drug order, regardless of the means of transmission, has been issued for a legitimate medical purpose by a practitioner in the course of medical practice. A pharmacist shall not dispense a prescription drug if the pharmacist knows or should have known that the order for such drug was issued without a valid pre-existing patient-practitioner relationship as defined by the Texas Medical Board in 22 Texas Administrative Code (TAC) §174.4 (relating to Use of the Internet in Medical Practice) and §190.8 (relating to Violation Guidelines).

   1. (1) A prescription drug order may not be dispensed or delivered by means of the Internet unless pursuant to a valid prescription that was issued for a legitimate medical purpose in the course of medical practice by a practitioner, or practitioner covering for another practitioner, who has conducted at least one in-person medical evaluation of the patient.
   2. (2) A prescription drug order may not be dispensed or delivered if the pharmacist has reason to suspect that the prescription drug order may have been authorized in the absence of a valid patient-practitioner relationship, or otherwise in violation of the practitioner's standard of practice.

3. (c) If a pharmacist has reasons to suspect that a prescription was authorized solely based on the results of a questionnaire and/or in the absence of a documented patient evaluation including a physical examination, the pharmacist shall ascertain if that practitioner's standard of practice allows that practitioner to authorize a prescription under such circumstances. Reasons to suspect that a prescription may have been authorized in the absence of a valid patient-practitioner relationship, or in violation of the practitioner's standard of practice, include:

   1. (1) the number of prescriptions authorized on a daily basis by the practitioner;
   2. (2) the manner in which the prescriptions are authorized by the practitioner or received by the pharmacy;
   3. (3) the geographical distance between the practitioner and the patient;
   4. (4) knowledge by the pharmacist that the prescription was issued solely based on answers to a questionnaire; or
   5. (5) knowledge by the pharmacist that the pharmacy he/she works for directly or indirectly participates in or is otherwise associated with an Internet site that markets prescription drugs to the public without requiring the patient to provide a valid prescription order from the patient's practitioner.
4. (d) A pharmacist shall ensure that prescription drug orders for the treatment of chronic pain have been issued in accordance with the guidelines set forth by the Texas Medical Board in 22 TAC §174.4 (relating to Use of the Internet in Medical Practice), prior to dispensing or delivering such prescriptions.

Source Note:The provisions of this §291.29 adopted to be effective May 30, 2010, 35 TexReg 4164.