Understanding Florida’s Emergency Prescription Refill Law

Overview of Emergency Prescription Refill in Florida

Emergency prescription refills fill a critical role in our ever-changing world. In Florida, these laws allow for the dispensing of a limited size emergency supply of a prescription medication under certain defined circumstances. Whether it be a hurricane, tornado, flood, or even a school shooting, emergencies often have a way of causing interruption in supply chains. For this reason, prescription medications are often not available during an emergency, leaving patients to seek alternative courses of action. Over the past 20 years, governors of Florida have taken advantage of emergency prescription refill laws in a number of emergency situations. During Hurricane Andrew in 1992 , Governor Chiles allowed state Medicaid beneficiaries to receive an emergency supply of prescription medication in Dade County to account for pharmacy closings and evacuations. In 1998, Governor Chylies again utilized the emergency prescription refill provisions to enact a prescription medication refill program in Miami-Dade County to cover people working on the cleanup of the aftermath of Hurricane Mitch. Shortly thereafter, the Florida Legislature expanded the law, allowing for a statewide emergency refill program that would be triggered by a declared state of emergency.

Important Aspects of Florida’s Emergency Prescription Refill Statute

Florida’s emergency prescription refill law is codified in section 465.0276 of the Florida Statutes. The statute essentially provides a process for dispensing "an emergency supply of up to a 72-hour supply of a medication" to a patient without a prescription under certain circumstances.
Under the lawyerly and recondite language of the statute, an "emergency refill" means "the dispensing of a prescription drug or medication for a period of up to 72 hours in the event of an emergency situation." An "emergency situation," in turn, is defined as "a circumstance under which a prescription medication needed by a patient is not available at the pharmacy where the patient is currently filling the prescription and the prescribing practitioner cannot be contacted or the prescriber has failed to authorize a refill, and the interruption of therapy may reasonably result in the negative consequences enumerated in the statute."
If a pharmacist determines that such an emergency exists, he or she may dispense a quantity of medication up to a 72-hour supply, provided the following conditions are met:
In determining the "safety, health, and welfare" of the patient, the pharmacist may consider progressive steps beginning with dispensing only the medication necessary to sustain life and continuing to refill the prescription until the patient can securely obtain the prescribed medication. In other words, if there is a chance that the patient could get access to the drug in a day or two, then the pharmacist should probably limit the emergency authorization to a 24-hour supply. If there is no way the patient can get access to the drug in less than 72 hours, then the pharmacist can dispense the drug for the full 72 hours in an emergency.
One important limitation on the Act’s application is that it does not apply to controlled substances. That is, Florida’s pharmacy staff is not authorized to dispense a refill of a controlled substance without a doctor’s authorization.
There are other significant limitations to the emergency prescription law, but those should provide a good basis for understanding the use of the law in the event of an emergency situation.

Who Can Authorize Emergency Refill

A retailer pharmacist may authorize the dispensing of an emergency prescription refill for a noncontrolled and non-extended release controlled prescription drug pursuant to Florida’s pharmacy practice act. However, this authorization is limited where the drug is essential to the maintenance of life, treatment of a chronic condition or where discontinuation of the drug would cause a patient in the healthcare provider’s or the healthcare provider’s covering practitioner’s opinion to suffer an adverse health consequence or where the healthcare provider writes on the prescription "authorization for emergency refill." The emergency refill may only be for a quantity of up to a 72-hour supply or the days’ supply determined by the healthcare practitioner’s prescriber for the patient’s health benefit, whichever is less. The pharmacist must include the amount of the emergency prescription refill as part of the authorized refill amount to a prescription; for instance, the emergency refill could be dispensed as part of the total number of refills authorized by the prescriber’s authorization.
The emergency refill may not be authorized by a pharmacist for a controlled substance classified as a schedule II, unless it is an extended release version of a schedule II drug as described above. If a pharmacist chooses to authorize an emergency refill, the pharmacist must notify the patient’s healthcare provider within 72 hours of the dispensing of the emergency refill and must keep a written or electronic copy of the authorization of the emergency refill with the pharmacy record on file for at least 4 years.

Requesting an Emergency Prescription Refill

An important point to keep in mind when requesting an emergency prescription refill is to inform the pharmacist of the prescriber’s contact information as well. If the pharmacy cannot get a hold of the prescriber, the emergency refill will not occur.
A telephone request for an emergency prescription refill will be valid if the following conditions are met:
• An emergency prescription refill was previously written by the prescriber;
• The prescriber cannot be contacted;
• The pharmacist is confident that the patient is in need of the medication and will experience a significant delay in therapy by not getting the medication immediately; and
• The pharmacist has confirmation that the prescriber has authorized the emergency prescription refill. In other words, the pharmacist should contact the prescriber to confirm any and all of the above before filling the emergency prescription.
The pharmacist/proxy or practitioner would be wise to document the following:
• The date and time the prescription refill request was received;
• A summary of the conversation with the prescriber regarding the emergency prescription refill (i.e., why the prescriber was unable to be reached);
• The drug name, strength, day supply, quantity, and whether the prescriber authorized the emergency prescription refill;
• Whether the emergency refill prescription was for a controlled substance;
• The date and time the emergency refill prescription was filled.
Keep in mind that the emergency prescription refill law allows pharmacists to refills for up to a 72 hour supply. However, if the prescriber had previously prescribed a larger day supply prescription, such as a 90 day supply, then the emergency prescription refill may be for the full amount.

Commonly Refilled Medications

For the Emergency Prescription Refill provisions to apply to an emergency refill, the medication must have been previously authorized by the prescribing physician. Obviously, this is an important consideration. These types of medications are typically chronic medications, such as anticoagulants, antiplatelet agents, supplemental hormones, and immunosuppressive therapy. These medications may also require frequent refills for short courses of therapy, such as:
When a patient has experienced a drug loss, or a situation leading to a medical emergency, where he or she would be in considerable pain or discomfort , the patient would likely want to transition to an appropriate therapy, if available, under an emergency treatment plan.
Short of getting the patient into the office of his or her physician, the Emergency Prescription Refill provisions of the Florida Drug and Cosmetic Act allow the patient to fill a 72-hour emergency prescription. Depending on the type of medication, this might then allow the patient to transition to an over-the-counter alternative, if one exists, or allow adequate time to speak with his or her physician’s office regarding a proper course of therapy.

Legal Consequences and Patient Rights

The emergency prescription refill law in Florida has a number of legal implications for pharmacists and patients. For pharmacists, the law requires them to honor request for emergency refills. Failing to do so could lead to disciplinary action from the Florida Department of Health, which oversees the licensing of pharmacists in the state.
For patients, the law is meant to both protect them and encourage cooperation with the pharmacist. Patients must contact their prescribing doctor to resolve any issue which may have prevented the refill, but do not have to cease filling the prescription until this happens. In the case of a family emergency where the doctor cannot be reached, the law applies as if the patient is in a disaster area.
The law also protects the pharmacist. If a pharmacist fills a prescription under the emergency refill law and the prescription is within the dollar and day limitations, that pharmacist may not be penalized for the decision. It is illegal for any other person and/or entity to penalize a pharmacist for following the law.

Case Examples and Real-World Situations

To illustrate the application and impact of the emergency prescription refill law, let’s examine a few real-life scenarios.
The Family with Children
One example is the family with three children who lived in a home in Jacksonville Beach on the east coast of northern Florida. When the storm hit, the area was without power for two weeks and had limited access to gasoline as residents were forced to wait in two-hour lines to fill up their cars. The threat of looting also kept some residents off the streets at night and many stayed close to home. Fortunately, the storm passed without severe damage to the family or their home, but this situation is similar to others like it that occurred during the storm. Regardless of the availability of the pharmacy’s front door, employees and patients alike were confined to the surrounding blocks and unable to drive. The pharmacy manager was confronted with the reality that this family and certainly others would have difficulty accessing the pharmacy. Because of the relatively smooth operations experienced with the first two storms, this pharmacy had been able to contact and serve most of its patients with little or no disruption. However, this situation, several days into the storm and recovery, called for a different response. The manager clearly recognized the possibility of having to fill another 50 prescriptions but wanted to guard against stockpiling by calling only those patients he felt would probably "need them." He called the board of Pharmacy’s drug info center and subsequently faxed information about this family with three children, both of whom had ADD/ADHD and one of whom had celiac disease and asthma. By using the fax, the manager was able to reduce the possibility of not (or only "subjectively") matching patients to products. The board of pharmacy’s drug info center provided quick and clear answers to the types and amounts of medications needed for the family members. The manager faxed an immediately-available supply of the indicated products to the local emergency care center in Jacksonville. Emergency care center staff were able to review the faxed information, verify the needs of the family and contact the pharmacy. Medications were dispatched to the family, who reported that not only were they grateful for the immediate assistance that prevented their children from having to go through withdrawal, but they were also relieved to learn that two asthma inhalers with new prescriptions had been provided which would have taken their pharmacy days to replenish. Because this process did not require a separate "decision" from each family member, the process was streamlined and more quickly accomplished. It is well worth noting that all parties were pleased with the overall response and results of relying on a collaborative approach to medication delivery in an emergency.
The Elderly Patient
A second scenario is a bit less dramatic. A retired pharmacist living on the coast south of Daytona experienced relatively minor hurricane damage. This patient, who took multiple medications and had a blood pressure problem, was able to get an extra day or two of medications when the local grocery store pharmacist began filling prescriptions for local residents and allowing them to bill Medicare or their local pharmacy plan for the medications. The pharmacist’s wife was fortunate to get her medications at the hospital where she works. Due to her husband’s medications and a shortage of electricity, the pharmacist was not able to keep medications in refrigerator. Then a week into the power outage, the pharmacist’s blood pressure increased to the point that he had symptoms of chest pain. The patient was accustomed to coping with the pain on non-hurricane days and had assured his spouse that he was able to manage it. However, by Friday, the pain became unbearable when the storm had moved on and the first clean-up operations were being organized. Finally, the pharmacist’s wife persuaded him to go to the local nurse practitioner’s office nearby and get a refill of his amlodipine. The pharmacist said he could have gotten the refill from the hospital, but it was operating with generators and was closed to all but emergencies. The nurse practitioner’s office had experienced some water damage and had limited staff due to the lack of electricity. The nurse practitioner provided the refill after determining that the pharmacist’s wife had a legitimate concern and the pharmacist was under significant stress. This case is a bit of cautionary note, but instead of concluding that the pharmacist had taken the wrong action and should have sought help from a pharmacy, in fact, there was nowhere to go to get help. It appears that there was insufficient management at the hospital to either accept this woman’s husband as an acute patient suffering from a medication emergency or to know that their pharmacy was open. Because of the unusual circumstances and the fact that the governor’s emergency order was applicable, a prompt decision was made to allow the pharmacist to have his medication at the office of the nurse practitioner. No additional information was provided about the staff and function of the pharmacist’s previous pharmacy, but the lesson here is that communication across respondents is just as essential to the appropriate functioning of the emergency prescription refill readiness requirements as the rules and enforcement processes are for those who have regulatory bodies.

Future Amendments and Developments

With the policy change of allowing pharmacists to dispense emergency supplies to patients, a review of this statute creates opportunities for even further expansions in the future. There are certainly patients whose health conditions require more than three (3) day supplies of medication, particularly in instances in which they can’t communicate with their doctor or refills aren’t possible due to lack of pharmacy coverage or availability issues. As a matter of practicality, and as alluded to by the Board of Pharmacy director, this law may be expanded in future sessions to include eight (8) day and even thirty (30) day supplies of medication under emergency circumstances. If you think about it, it’s hard to imagine a world where this is not the case. Without revisiting the Affordable Care Act ("ACA"), there were patients that had insurance coverage through the ACA, who were still unable to get a refill for their hypertension or cholesterol medication, for example, at the local CVS. It requires a bit of a suspension of disbelief when considering a patient with a chronic medical condition must have refills to their medication covered by an insurance company , or at very least pay out of their pocket for medication, yet they are already covered by insurance, which is really a bill of rights on at least 80% of doctors’ office cards and practice websites. A change of this nature – to expand the emergency prescription refill provision to eight (8) days for heart medications such as Lipitor, or other chronic medications that are needed by patients to remain healthy, would help doctors and patients alike. As a claimed conservative right now, Governor Rick Scott has made good on Obamacare. Note that the Governor did veto SB 1030 by Senator Paul Renner (R-24), which would have expanded the emergency refill provision up to a 72 hour supply (HB 479). Even Rep. Ray Pilon (R-72), who drafted the bill didn’t seem to mind the veto, since he stated at the time that "I don’t think this is something we need to do, if they’re out of town for a weekend, I think they can figure out how to save their own lives." Realistically, though, the emergency refill provision is going to be amended to cover eight (8) day supplies of medication and possibly thirty (30) day supplies of regularly prescribed medication.