I will never forget the day I almost had a brawl with a patient.
Being a non-busy day, I was the only pharmacist by the dispensary with a few assistants.
Mrs J came in with a prescription and here’s what went on:
“Hi, I need this medication for my son. Here is his prescription,” said Mrs J.
After I had a quick look at the script, and I responded,
“Mrs J, this prescription is expired. And I’m sorry; I won’t be able to help you.”
“What do you mean my script is expired?” she asked with a reprimanding tone.
“The medicine prescribed here is a schedule 6 drug. You have to fill a schedule 6 prescription within 30 days. If you don’t, it expires.”
“That’s bullshit,” she responded. Her face turned red. I had an aura there was a war coming.
And even before I could say anything, she started berating me:
“You people are useless. I spent R900 to get this script from the psychiatrist. And now, you tell me I can’t get my son’s medicine. F*ck-off. You don’t know what you are talking about.”
She kept going, attracting all the eyes in the pharmacy.
I had to remain professional, keep my cool, and do what the law requires.
And I must confess: She left me boiling.
But I would’ve been angry too if I was in the same situation.
- The money she has lost,
- The hustle and amount of time she has to spare for the next doctor’s appointment,
- And not forgetting she’s about to spend another couple of rands to get a new script.
But then, I had no choice, or I would take a punishing from the pharmacy council for contravening the law. And guess what?
You can also be in the same situation.
So, to help you avoid being in Mrs J’s situation, I wrote this article. It’s about the top 10 prescription rules you need to know (before you step in a South African pharmacy).
But before you jump in, let me first clarify something about these rules.
The Law That Controls Everything Related to Registered Medicines
Glad you’ve asked that question.
These are provisions stipulated in the MRSA – The Medicines and Related Substances Act, 101 of 1965.
MRSA is a law that controls everything related to registered drugs in South Africa. From registration, storage, and prescribing to dispensing of scheduled drugs by pharmacists.
Medicines and Related Substances Act got introduced:
- For the registration of medicines and related substances intended for human and for animal use;
- To provide for the establishment of a Medicines Control Council;
- To control medicines, scheduled substances and medical devices;
- To make further provision for the prohibition on the sale of medicines subject to registration and those not registered;
- To provide for the generic substitution of medicines.
And a lot more. I’ve mentioned above a few points that relate to this article. But the list is endless.
So, next time you hear a pharmacist saying “its required by the law” – know they are referring to the MRSA (Medicines and Related Substances Act).
Now that you’ve got a clear picture about the MRSA, let’s get started.
Rule #1: Fill your Prescriptions within 30 days
What does this mean?
Your doctor expects you to use the medication he prescribed immediately. Unless he specifies otherwise.
But sometimes, you might decide to collect the medication later.
In that case, you only have 30 days to fill your prescription. The 30 days starts from the day the doctor writes the prescription.
That’s the date on the script. If you don’t, your script expires and become unusable.
Rule #2: No telephonic prescription from doctors unknown to the pharmacist.
Did you know?
You can get a prescription drug from any pharmacy, without a “physical script.”
By requesting your doctor to give verbal instruction to a pharmacist through a phone.
But there’s a catch:
The pharmacist taking the prescription must be familiar with your physician.
If not, he can refuse to take the script.
[clickToTweet tweet=”Because let’s be real; there are a lot of crooks out there. People who have ‘PhDs’ in being fake doctors.” quote=”Because let’s be real; there are a lot of crooks out there. People who have ‘PhDs’ in being fake doctors.”]
I come across many individuals who come to the pharmacy, saying:
“Hi, I’ve got my doctor on the phone, and he wants to prescribe something for me.”
And in those circumstances, I often respond with a polite tone, “Ok, no problem. But I will first need to check if I have your doctor in my computer database.”
In essence, be aware that a pharmacist can refuse to take a telephonic script if he doesn’t know your doctor.
Rule #3: Treatment from a verbal prescription cannot exceed 7 days.
This part is a continuation of rule 2.
For a verbal prescription, a pharmacist can only dispense a treatment that will cover you for seven days max.
If your doctor prescribed a 30-day treatment via a phone, you need to get the original script to get the balance.
Rule #4: Prescription repeats are only up to 6 months.
This one is self-explanatory. Your doctor can write on your script:
“Repeat for 1 year.”
As a pharmacist, I will only dispense your prescription for 6 months.
“But why? It’s chronic medication,” you argue.
Section 22A (6f) of Medicines and Related Substances Act states that for schedule 2-4 prescription, it “may be repeated if the person who issued the script has indicated thereon the number of times it may be dispensed, but not for longer than six months.”
Rule #5: Pharmacist can sell a greater or lesser quantity than the amount prescribed.
Imagine for a second.
You go to your nearest pharmacy to fill your prescription.
It’s for pain medication. The prescription is readable. You notice that he prescribed:
“24 tablets of pynstop – you’ll be taking 2 tablets three times a day for 4 days.”
2 x 3 x 4 = 24.
Yes, but as a pharmacist, I only dispense a sealed box of 18 tablets. And I tell you to take two tablets up to 3 times a day when necessary.
You get home, and you wonder, “Why did I get a box of 18, instead of 24?”
Here is the thing: I may sell you a greater or lesser quantity of the schedule 1 to 4 medicine prescribed.
As long as the “the quantity so sold shall not exceed or be less than, 25 percent of the amount specified in the prescription or order in question.”
Rule #6: Schedule 3 to 6 cannot be dispensed without a prescription, but
In South Africa, medicines are scheduled from 1 to 6.
You can buy schedule 1 and 2 without a prescription.
For schedule 3 to 6, you need a prescription. But under certain circumstance, you can get schedule 3 and 4 without a script. But I won’t cover those details in this article.
[clickToTweet tweet=”Sometimes I do get patients that say they get up to schedule 5 medication without a script. Be aware, It’s illegal.” quote=”Sometimes I do get patients that say they get up to schedule 5 medication without a script. Be aware, It’s illegal.”]
The Medicines and Related Substances Act states that any schedule 3 to 6 medicine can only be sold:
“Upon a written prescription issued by an authorised prescriber or on the verbal instruction of an authorised prescriber who is known to such a pharmacist.
Rule #7: Schedule 5 prescription are only repeated under these 2 conditions.
I must confess.
A lot of pharmacists are not implementing these two schedule 5 conditions. Including me.
But what are these conditions?
For repeats of a schedule 5 script to be valid, your prescription should have:
- Number of times it should be repeated,
- And the interval.
As an example, your schedule 5 script should be written as “repeat for 6 months every 30 days.”
Rule #8: Schedule 6 prescriptions are NOT repeatable.
Schedule 6 medicines are the most controlled drugs in the pharmacy sector.
And the most protected.
Because schedule 6 drugs have a moderate to high potential for abuse or for producing dependence. This necessitates close medical management, supervision and strict control over supply.
Schedule 6 medicines include the likes of:
- Methylphenidate (Ritalin & Concerta)
- Norpseudoephedrine (Relislim)
to name a few.
For schedule 2 to 5 medicines, your doctor can repeat your prescription for up to six months.
But things are different with schedule 6 medicines.
As shown above, Medicines and Related Substances Act section 22A (6)(i) states that:
“In the case of a schedule 6 substance, it shall not be repeated without a new prescription being issued.”
That does not need further clarification.
Rule #9: NO “Emergency Supply” for schedule 5 & 6 drugs unless….
Imagine, it’s the festive season. You’ve a prescription for Zolpidem (a schedule 5 drug) in one of the big pharmacy chain stores.
Let’s call the chain B Pharmacies – That “B” stands for “Bandela” – Bandela Pharmacies. Wouldn’t that be awesome 🙂
So, you’re driving from Johannesburg and visiting East London for a holiday. Along the way, you realise you’re left with 1 tablet for tonight. Meaning you need to get more supply that will last you for the holiday period, or you’ll be an insomniac.
So, you pass by a B Pharmacy – the East London branch – to fill your prescription.
Upon arriving, you get to see a pharmacist, and you ask for a refill. He logs into your profile to access your script.
“Your previous prescription was your last repeat. Your repeated are now finished,” he says.
Because you are in need of your tablets, you ask for a few days’ supply “until your doctor comes back from holiday.”
To which the pharmacist responds, “Sorry Mr/ Mrs J, I won’t be able to dispense you an emergency supply. Zolpidem is a schedule 5 drug. The law doesn’t allow me to issue emergency supply for schedule 5.”
Ok, what’s going on here?
In an emergency situation, I can sell you schedule 3 and 4 substance for a 30-day treatment even if your repeats are complete.
But for schedule 5 and 6, things are different.
You can get an emergency supply only if I get a verbal instruction from your doctor or dentist. And in such case, the quantity you’ll get will not be:
“Greater than that required for continuous use for a period of 48 hours.”
So, next time you ask for an emergency supply for your schedule 5 or 6 medicine, remember this part.
Rule #10: Your prescription must have a date & signed by your doctor.
It sometimes happens that I get a prescription with no doctor’s signature or date of issue.
That prescription will not be valid.
Why? Because it violates the requirements of Regulation 28 of the MRSA.
So what does this regulation say about the prescription?
It states that:
“Every prescription or order for a medicine must be written in legible print, typewritten or computer generated and signed in person by a medical practitioner, dentist, veterinarian or authorised prescriber or in the case of an order, an authorised person.”
There’s also a laundry list of things that should at least be in the script:
- the name, qualification, practice number, and address of the prescriber,
- the name and address of the patient,
- the date of issue of the prescription,
- the approved name or the proprietary name of the medicine,
- the dosage form,
- the strength of the dosage form and the quantity of the medicine to be supplied,
- the age and sex of the patient,
- the number of times the prescription may be repeated.
MRSA is a law that controls everything related to registered medicines in South Africa. From registration, storage, and prescribing to dispensing of scheduled drugs by pharmacists.
As with any other law in the country, you should acquaint yourself with it. You need to understand your rights as a prescription owner.
Now that you’ve read about the top 10 prescription rules, I’d like to hear from you.
What do you think about?
Or you have a question about a step in the process.
Either way, leave a comment below.
And please share this article with your family, friends, and colleagues.