BEWARE: Top 10 Prescription Rules Every Patient Should Know

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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.

Imagine

  • 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.

Where are these rules coming from?

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.

30 day rule for 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.”

How?

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.

Verbal prescription rule

[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.

7 day rule for verbal prescriptions

Not 10.

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.”

Prescription cannot be repeated for longer than 6 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.

Correct?

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.”

25 percent rule for prescriptions

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.

Selling of scheduled medicines

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.

When schedule 5 can be repeated

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.

Why?

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:

  • Codeine
  • Morphine
  • Methylphenidate (Ritalin & Concerta)
  • Oxycodone
  • 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.

schedule 6 not repeatable without a new prescription

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.”

schedule 6 prescription in an emergecy

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.

particulars that should be on a prescription

Conclusion

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.

 

Yodruggist BEWARE: Top 10 Prescription Rules Every Patient Should Know 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.…

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27 comments
  1. Rx is for a month. Repeatable for 6 months. Schedule4. Patient paying cash but wants 4 months supply. Is this allowed????

    1. Hi Nyasha,

      The answer is NO.

      The prescription will have to be re-written by a doctor practising in South Africa.

  2. I have been on the same meds for 21 years. It is ridiculous that I have to see my doctor to get a new script every 6months. Money making rubbish.

    1. Hi Yvonne,

      Thank you for passing by.

      I understand your frustration. But remember this is for your own benefit. When taking medication, you need to be monitored consistently so that if anything happens (such as an adverse event), it can be picked up and corrected promptly.

    2. It isn’t necessary to see your doctor. For long term medication they’ll just issue you with a new script every six months. The only exceptions would be medications that can cause some sort of damage, e.g. to the liver or heart. Then they’d want to check you out. In some cases it would simply be a blood test and you still won’t need to see your doctor unless there is a problem.

  3. So an individual taking blood pressure medication has his/her bag/briefcase stolen. He/She is away from home and feeling the effects of not taking the medicine. He/She goes to a pharmacy (or is probably taken there). He/She dies on the floor of the pharmacy because the pharmacy abides by these rules. Pharmacist boasts ‘I didn’t give in!’ Books are written about this famous pharmacist and his/her bravery.

  4. Interesting article. Thank you. I do however have a question. On numerous occasions I have found myself
    Out of town for extended periods of time, when my supply runs out. I use GalvusMet S3 and Oratane S5. My GP is in Centurion and I am also in Cape Town. I live in both cities. My GP has, on numerous occasions, faxed my script to either Clicks or Dischem. Sometimes no problem and more often than not, I am told that they cannot accept a faced prescription. I have looked everywhere and cannot find any Gazetted legislation that can confirm this. The fax is from the Doctors practice with all their contact details on. The repeat is for 6 months and shows when I have taken from Centurion and also from Cape Town so no duplicates can occur? My point is that there is no legal grounds on which they can deny dispensing my medication to me, when they have a faxed copy from a registered medical Doctor. They can also verify whether this is a registered medical practitioner brought their normal verification channels themselves. if they so desire.

    1. Hi Eddie,

      Thank you for passing by and reading the article.

      Under the GENERAL REGULATIONS MADE IN TERMS OF THE MEDICINES AND RELATED SUBSTANCES ACT, 1965(ACT NO. 101 OF 1965), regulation 28(2) states that…

      (2) In the case of a faxed, e-mailed, telephone or electronic transmission by
      other means of a prescription or order, the pharmacist must verify the
      authenticity of the prescription or order.

      And in addition, regulation 28(4) states that…

      (4) The faxed, e-mailed, telephone or other electronic transmitted prescription
      or order should be followed by the original prescription or order within 7
      working days.

      Thus pharmacists have no legal grounds to refuse to dispense your faxed/ emailed prescription unless they can verify your script is not authentic.. But at the same time, the pharmacy needs to get the original prescription within 7 working days after the electronic script (which might be a challenge for you).

      The best thing for you to do is to ask pharmacist at Dischem/ Clicks to load the repeats on your original prescription (on the computer system) and ask to centralize it. Then ask for the copy of the script and leave the original with them. That will make it easier for you to get refills anywhere in the country as long as there is Clicks/ Dischem (but remember, they are not linked).

      Hope I have answered you

  5. good morning,

    I have a question, are doctors allowed to self-prescribe medication? particularly, S5 AND S6. And where in SA act is it.

  6. I live and work in diaspora, my anti hypertension medication is not sold here. The combination was prescribed by my Dr in SA. I get 6 months at a time, however… sometimes, my visits home are before my prescription is due, and in some cases, I run out of medication. How can I get this resolved?

  7. I hate that pharmacists are judged on what a few pharmacists do wrong. If you skip a stop sign and get caught you get a fine. The fact is though, that it is illegal and dangerous to do so. That is the same logic behind pharmacy law. Any problem with that should be taken up higher than your community pharmacist.

  8. Thank you for a useful article Bandela. Hope you are still there. I have one question. I received a script from my doctor with two items on it. The first one was repeated 6 times. The second item was for Lenovate cream of which I still had a small amount in a tube at home. On the same day I received the prescription I handed it in at Dischem and took a months supply of the first item saying I did not need any Lenovate yet. Yesterday I went in for my last repeat of the first item which I was given (5th repeat) but was told I could not get the Lenovate (which I had now run out of) as it had expired and that I should have taken it up front. My question is have you “filled” the prescription the day you hand it to the pharmacist or do you have to buy the item within 30 days for it to be considered “filled”??? If this is so then I would have expected Dischem to have told me this!!! I am one unhappy Dischem customer!!!

  9. My repeat script for generic Anviro ran out so I rang my doctor to renew. Previously I went to collect the script because if it was faxed to me I received a charge. If I collected it (no inconvenience to me) I was not charged or if the script was given at the end of a consultation. This time I have been sent an invoice for R.190. Just for a script I am collecting. Can a doctor charge anything he or she likes ?

  10. I have a script written on 29 April. It is now 17th July. The script is from a dentist for antibiotics. Is the script still valid?

  11. Can a dr/specialist refuse script renewal if you have not been to them in 2 years or such? Especially when they have not advised you as a patient that this will be required when it is ongoing medication you have to take on a monthly basis?

  12. Hi thanks for this article. My question is the following: I have a schedule 5 prescription for 6 months, how many days before the first repeat end, may I go get the new one? Lets say for example I have 6 tablets left, but will leave on holiday for 2 weeks, and need to stock up before I go. When will be the soonest to collect the new month’s meds?

  13. Hi ………This article is so enlightening, could you help?
    I have severe Osteoporosis age 72 and 7 surgeries over past 3 years due to fractured hips and spine last surgery January 2019. I now attend a local government hospital for all my medications. One of them is Tramadol for severe pain which the dr writes out every 5 months repeats of all meds. The Tramadol is 1 / three times a day with panado. ……..pharmacist always supplies each month. This past month I was told I could only get 20 a month?? How does that work for been told to take 3 per day ? The Pharmacist was very flustered and busy with other things and the waiting room was full…..I had just come from Dr with the script, The Dr understands and knows the pain I have. Twenty is never enough. Pharmacist told me to go to hospital where surgeries were done { Im on a walker} a pensioner and need to use Uber to get around……very inconvenient. She says she wants a script from the Ortho clinic. Fortunately I had an upcoming appointment at Ortho but when I mentioned my problem and asked for script the Dr said no that is for the Dr at the hospital I now attend to write up. I recapped with him I take 3 per day a month and he sad yes. Now I have a medicine collection shortly at the hospital where I get all my meds and I’m terrified as I have no script from the surgical hospital and the pharmacist all of a sudden refuses the hospital Drs. script for 100 Tramadol for the month. I’m terrified of her and terrified as the 20 is not even enough for 1 a day and I have severe pain not only from the severe Osteoporosis but my latest hip surgery done late January is still healling nd paining and as usuall all my bones are screaming with pain. I was told my bones are like egg shells and I go for bone infusions. What should I do? Please could you advise me? Thank you,

  14. Thank you so much for an awesome article. I am an addict who has been in recovery from heroin abuse for nearly three years now. I am on a schedule 6 maintenance program of suboxone. In the case of centralised pharmacies such as clicks or dis-chem why can my schedule 6 script not even be moved from one particular dis-chem store to another dis-Chem pharmcy? I do not buy the entire months supply at once but rather in weekly increments. Now I am in a position or problem where I am in Cape Town but my script lays in Johannesburg what do I do? I have always been aware that a schedule 6 medication script needs to be in the position of the pharmacy that has dispensed that schedule 6 medication. But surely if the medication dispensed at a clicks or dischem was only supplied in weekly increments and I have 3 weeks worth of medication remaining on that script, why can’t that script be sent from one disc into another dischem? Thank you for taking the time to read my message.

  15. Actually the mother needing a new prescription for her son would not need to pay to see the doctor again. She can simply ask the doctor to write a new one. The doctor would be doing that anyway for a script that cannot be repeated. Once treatment is established and working there is really no need to see the doctor every month.

  16. Hey i have a bit of situation my mom comited suicide and we had to move very urgently out if a city and im in a small town my docter gave me a repeat script for 3 months in oct. But my script got damage only on the sides its still readable is my script not legal any more?

    1. Hi Patrick,
      Thank you for passing by.

      Take the script to your nearest pharmacy and ask a pharmacist to evaluate the script for you – It might still be valid

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