Download Virginia MPJE Exam: Prescribing Authority and Regulations for Practitioners and more Exams Pharmacy in PDF only on Docsity!
VIRGINIA MPJE EXAM|| 2025 - 2026||ACTUAL EXAM
WITH CORRECT DETAILED AND VERIFIED ANSWERS.
A+ GRADE
Does Virginia or the Federal government decide who has prescribeing authority in VA?
- CORRECT ANSWER ✔✔ Virginia does. State law controls who can write valid prescriptions What practitioners can write valid Rx for controlled substances in VA? - correct answer✔✔ Practitioners of medicine (MD) Practitioners of osteopathy (DO) practitioners of dentistry (dentist, DDS, or DMD) practitioners of podiatry (Podiatrist or DPM-"foot doctor) Practitioners of Veterinary medicine (DVM or Veterinarian) Virginia licensed nurse practitioners (NP or FNP) Virginia licensed physician's assistant (PA) Virginia TPA certified optometrists (O.D) which prescribers have unrestricted prescribing authority and can write for CII- CVI prescriptions to treat their patients without the need for an agreement with any other practitioneres - correct answer ✔✔ Medical doctors Osteopathic doctors dentists Podiatrists Veterinarians
Can Virginia pharmacy fill Rx written by out of state practitioners?
- CORRECT ANSWER ✔✔ Yes, if the practitioner is a medical doctor, osteopath, dentist, podiatrist, or veterinarian and the Rx mets all of the other requirements for a valid VA issued Rx. **Out of state Rx from NP, PA and optometrists are not valid unless the prescriber is licensed in Virginia in addition to the other state Are there any restrictions on the prescribing of drugs by medical doctors, osteopathic doctors, podiatrists, dentists, and veterinarians? - CORRECT ANSWER ✔✔ Yes, MD, DO, podiatrists and dentists can NOT write Rx for animals. Veterinarians can ONLY write Rx for animals. Dentists can ONLY write Rx for the treatment of mouth conditions and diseases. A Rx for oral contraceptives would not be valid Podiatrists can only write Rx for the treatment of conditions and diseases of the foot and ankle. A Rx for an asthma medication would not be valid What are the prescribing restrictions on NP and PA? - CORRECT ANSWER ✔✔ A NP's prescribing authority is dependent upon entry into a practice agreement with a patient care team physician that clearly states the prescriptive practices of the NP. A PA's prescribing authority is dependent upon entry into a written agreement with a licensed physician or podiatrist that provides for the direction and supervision of the PA's prescriptive practices. How will you know if a NP or PA"s is prescribing drug that is NOT allowed under his agreement with a team care physician, physician or podiatrist? - CORRECT ANSWER ✔✔ You may not able ot tell if the prescription is for an approved drug. But, you should examine the practice the prescriber is in to make sure that the prescription is for a drug that would normally be prescrbed in that
What conditions are TPA certified optometrists allowed to treat?
- CORRECT ANSWER ✔✔ Diseases and abnormal conditions of the human eye and its adnexa (tissues adjoining the eye) Are there any conditions that TPA-certified optometrists are specifically prohibited from treating? - CORRECT ANSWER ✔✔ Yes. Optometrists cannot treat infantile or congenial glaucoma and their treatment of closed angle glaucoma is limited to initiation of immediate emergency care. Are pharmacies allowed to supply TPA-certified optometrists with therapeutic pharmaceutical agents listed on the TPA-Formulary? - CORRECT ANSWER ✔✔ Yes Are medical interns and residents who work in a hospital allowed to write Rx? - CORRECT ANSWER ✔✔ Yes, but only within their dueties as part of the residency program. (This may include writing Rx for ER patients that will be filled at a retail pharmacy) What is prescription under Virginia law? - CORRECT ANSWER ✔✔ An order for drugs or medical supplies, given to a pharmacist by a practitioner authorized to prescribe. The Rx may be written, oral, faxed or transmitted electronically. What prescriber information must every Virginia Rx contain? - CORRECT ANSWER ✔✔ 1. Prescriber's name
- Prescriber's address
- Prescriber's phone number
- Prescriber's signature (except for an oral prescriptions)
- Precriber's DEA number (for Federal controlled substance Rx - CII-CV )
Are medical interns and residents allowed to write Rx in Virginia?
- CORRECT ANSWER ✔✔ Yes Since interns and some residents do NOT have a DEA number, what do they use in place of their own DEA number? - correct answer✔✔ They use the hospital where they are practicing's DEA number plus a suffix assigned to the intern/resident by the institution Do intern and resident's Rx need to comply with all of the regular requirements for valid Virginia Rx? - correct answer✔✔ Yes Are the interns/residents allowed to use their identification number to write for CII-CVI controlled substance? - correct answer✔✔ Yes When can a medical intern or resident working for a hospital prescribe controlled substnaces under the hospital's DEA number? - correct answer✔✔ When it is in furtherance of the person's duties at the hospital. The intern or resident cannot use the number if he/she is working somewhere else like an urgent care center that is not affiliated with the hospital. What if the patient was seen by the intern/resident at the hospitals emergency room? - correct answer✔✔ The intern/resident can use the hospital identification number assigned to him to write a Rx for the patient What other information has to go on the Rx when patient was seen at ER by intern/resident? - correct answer✔✔ - The intern/resident's signature and the legibly printed name, address and telephone number of the resident/intern
- The address and phone number are usually pree-printed on the hospital's Rx blank but the intern/resident's information is often not included and must be added by hand.
calculate the authorized quantity using directions for use and duration. CII-CV Rx must contain a quantity How long are prescriptions for CII-CV drugs valid? - correct answer✔✔ 6months from the date of issance How long is a prescription for a CVI drug valid? - correct answer✔✔ It is valid for one year after the date of issue, which means that you can continue to refill the prescription for up to one year after the date of issuance. However, if the prescriber specifically authorizes the dispensing or refilling of the prescription for two years. This would apply if the prescriber wrote on the prescription: "May refill prn for 2 years." If such instructions are not present, the prescription is only valid for one year. Can a prescription be written in pencil? - correct answer✔✔ No. Rx must be written in ink, individually typed, or printed only. How many medications can be on a single prescription form? - correct answer✔✔ The general rule is only one medication per prescription What are the exceptions to the general rule? - correct answer✔✔ - Rx written as chart orders for patients in hospitals
- Rx wirtten as chart orders for patients in long term care facilities
- patients receiving home infusion servcies
- hospice patients
- patients whose Rxs will be filled at pharmacies operated by one of these departments: Corrections, Juvenile Justice, Health, Behavioral Health and Developmenteal Services
- Patients residing in detention centers, jails, or work release centers operated by the Dpt. of Corrections note: all of the exceptions include the use of chart orders or governmental
provision of services What about Rx written as chart orders for hospital or long term care patient who is then discharged? - correct answer✔✔ These can be filled at an outpatient pharmacy if:
- the pahrmacist has all the information necessary for a valid outpatient prescription
- the pharmacist has written or verbal directions indicating that the chart orders are intended to serve as prescription orders
- the orders include some directions related to the quantity to be dispensed or duration of the order. can you accept a post-dated CII prescription? - correct answer✔✔ No. It must be signed and dated on the date it was written Can you accept a post dated CIII-CVI prescription? - correct answer✔✔ No, it must be signed and dated on the date it was written When can prescriber use a completely pre-printed prescription form? - correct answer✔✔ Only for CVI prescriptions and they will still need to sign the prescription Can a pharmacist accept oral or telephone prescriptions for CIII-CVI drugs in Virginia? - correct answer✔✔ Yes Who is allowed to call in an oral prescription? - correct answer✔✔ The prescriber or his authorized agent Who may act as the prescriber's "authorized agent"? - correct answer✔✔ - An employee under the prescriber's immediate and personal supervision
- An individual holding a valid license allowing administration or dispensing of drugs who has been specifically directed by the prescriber (e.g. nurse or a
emergency dispensing Are there any special requirements for the originial signed CII prescription? - correct answer✔✔ Yes. It must be dated and signed on the date of the emergency oral Rx and must include the words: "authorization for emergenecy dispensing" on the face of the Rx. It must meet all of the usual requirements for a CII prescription. What is the Rph required to do with the hard copy emergenecy prescription when he receives it? - correct answer✔✔ Attach it to the emergency oral Rx and file it. How long does the prescriber have to get the pharmacy the written CII prescription? - correct answer✔✔ The prescriber has 7 days to provide the pharmacy with the written CII Rx. What must the Rph do if the Rx is Not received within 7 days? - correct answer✔✔ Contact the prescriber to find out if it was mailed within the 7 day time frame. The Rph should call earlier to make sure that the prescriber does NOT miss the deadline. Does the Rph have to do anything if the Rx is NOT received or mailed within the 7 day limit? - correct answer✔✔ Yes. The Rph has to notify the DEA that the Rx was never received. What happens if the Rph doesn't notify the DEA? - correct answer✔✔ The Rph's authority under law to dispense an emergency CII Rx is revoked and the Rph can be found guilty of illegally distributing a CII drug! Are oral orders for CII drugs allowed in a hospital? - correct answer✔✔ Yes. A hospital RPh or nurse can take an oral order for a CII drug. It has to be immediately reduced to writing and signed by the prescriber within 72hrs.
Can a prescriber write multiple CII Rx for the same drug for a single patient on the same day and place instructions on the prescriptions as to when they may be filled? - correct answer✔✔ Yes. Each prescription must still be issued for a legitimate medical purpose by a prescriber acting in the usual course of his professional practice. What are the requirements for the issuance of multiple CII Rx at the same time? - correct answer✔✔ Each prescription, other than the first one to be filled, must indicate the earliest date that it can be filled. The max days supply for multiple issued Rx is 90days. The prescriptions must meet all other requirements for valid CII Rx. Are veterinarians allowed to write CII prescriptions for animals? - correct answer✔✔ Yes. The same rules apply as for human CII prescriptions. Are RPh allowed to make any changes to a written CII prescription? - correct answer✔✔ Yes. A Rph may make the following changes to a hard copy CII Rx:
- Add or correct the pbubutyric acid atient's name after verifying it
- Add to patient's address after verifying it
- Add the prescriber's DEA number
- After direct consultation and agreement of the prescriber, the Rph can add or change dosage form, drug strength, directions for use, drug quantity, and issue date What two changes are prohibited for CII Rx? - correct answer✔✔ The RPh is NEVER allowed to change the drug prescribed, other than generic substitution, or add the prescriber's signature to the prescription. Are there any special requirements for a Rx that is written for gamma- hydroxybutyric acid (rohypnol)? - correct answer✔✔ yes. The medical need for the drug must be written on the Rx.
Do regular written Rx need to have a fax number on them? - correct answer✔✔ No Who decides where the prescription will be faxed? - correct answer✔✔ The patient gets to choose the pharmacy where the Rx will be faxed. Where can a faxed Rx originate? - correct answer✔✔ - The prescriber's practice location
- A faxed order received by a long term care facility may be forwarded to a pharmacy for filling
- A faxed order received by a hospice (including home hospice) may be forwarded to a pharmacy for filling
- A wrritten Rx can be faxed by an authorized agent of a long term care facility if the pharmacy has written procedures. The hard copy must be delivered to the pharmacy within 7 days and attached to the faxed copy. When can a Rx for a CII drug be faxed? - correct answer✔✔ For information purposes only. This does NOT count as the original written Rx but allows the pharmacy to prepare the Rx prior to receiptof the actual hard copy prescription. The originial hard copy prescription must be received before the Rx can be dispensed to the patient. This would be done when a patient is being discharged from the hospital and should not be waiting at the pharmacy for any extended period of time. Are there any times when a CII Rx can be faxed and actually filled? - correct answer✔✔ Yes. Faxed CII Rx are valid for:
- Long term care facility patients
- Home infusion patients, and
- Medicare certified hospice patients; including home hospice patients. [The prescriber must note on the Rx that the patient is in hospice] Does Virginia allow the electronic transmission of Rx from prescriber to
pharmacies? - correct answer✔✔ Yes What is an electronic Rx? - correct answer✔✔ A Rx that is generated using an electronic application and transmitted to a pharmacy as an electronic data file. what schedules of drugs can be transmitted as electronic prescriptions? - correct answer✔✔ schedules II, III, IV, V and VI How does a prescriber apply for authorization to issue elctronic prescriptions for CII-CV drugs? - correct answer✔✔ A prescriber applies to a federally approved credential service provider (CSP) or certification authority (CA) to obtain a two- factor authentication credential or a digital certificate. Does an electronic prescription have to be manually signed? - correct answer✔✔ No. It will contain an electronic or digital signature that identifies the prescriber as the source of the precription and indicate his approval of the information contained in the presecription. What Federal requirements do electronic presceriptions have to meet? - correct answer✔✔ - Security and authentication features
- Required recordkeeping by the prescriber and the pharmacy
Who decides which pharmacy will receive an electronic Rx? - correct answer✔✔ The patient. An electronic Rx must be transmitted to the patient's pharmacy of choice What information does an electronically transmitted Rx need to include? - correct answer✔✔ - All of the information required for a written Rx.
- The full name of the prescriber's agent if the prescriber is not transmitting the electronic Rx.
- Date of transmission What does a pharmacist have to do when she receives a paper or oral Rx that was originally electronically transmitted to the pharmacy? - correct answer✔✔ The Rph has to check the pharmacy's record to make sure that the electronic version was NOT received and dispensed. If the pharmacy received both prescriptions, the Rph will have to mark one of the Rx as void. What does a Rph have to do when she receives a paper or oral Rx that was originally electronically transmitted to another pharmacy? - correct answer✔✔ The Rph has to check with the other pharmacy to determine if the Rx was received and dispensed by the other pharmacy. If the other pharmacy received but did not already dispense the medication, that pharmacy must mark the electronic Rx as void or cancelled. If the other pharmacy already dispensed the Rx, the Rph must mark the paper copy as void and not dispense it. What is the difference between an intangible and a tangible prescription requirement? - correct answer✔✔ You can see a tangible Rx requirement and cannot see an intangible Rx requirement. An example of a "tangible" requirement is the signature of the practitioner, which you can see is either on or not on the Rx. You cannot see whether a Rx was issued for medicinal or therapeutic purpose. Instead, you have to use your judgement to determine whether the Rx was issued for a valid medicinal purpose. Are there "intangible" Rx requirements in Virginia? - correct answer✔✔ Yes. A Rx
is not valid unless it was:
- Issued for a medicinal or therapeutic purpose
- To a patient with whom the practitioner has a bona fide practitioner-patient relationship. What does the practitioner have to do to create a bona fide practitioner-patient relationship? - correct answer✔✔ - Obtain a medical or drug history
- Provide information to the patient about the benefits and risks of the drug being prescribed.
- Perform an appropriate examination of the patient, either physically or by using equipment to electronically transmit images and medical records.
- Except for medical emergencies, the examination of the patient should be performed by the practitioner, within the group in which he or she practices, or by a consulting practitioner
- Initiate additional interventions and follow-up care, if necessary especially if a prescribed drug may have serious side effects What is bona fide practitioner patient relationship deemed to exist by law or not needed for the issuance of a valid Rx? - correct answer✔✔ The practitioner does not have to personally examine the partner of one of his patients with whom he has a bona fide practitioner patient relationship in order to issue the partner a prescription for a CVI antibiotic to treat a communicable disease (e.g. syphilis) in accordance with CDC guidance to prevent imminent risk of death, illness or serious disability Practice tip: there are other situations where protocols, such as for the administration of vaccines in hospitals, substitute for the bona fide relationship. What are the potential consequences for a pharmacist who knowingly fills an invalid prescription? - correct answer✔✔ The RPh may be criminally prosecuted for drug distribution!
control pills and a surgeon can prescribe eye drops. What must a Rph do if he declines to fill a Rx for any reason other than the unavailability of the drug? - correct answer✔✔ Write the following on the back of the prescription:
- The word "Declined"
- The name, address, and telephone number of the pharmacy
- The date the Rx was declined
- The Rph's signature What is a Rph required to do if he determines that a Rx is a forgery? - correct answer✔✔ - Refrains from returning the Rx to the patient
- Maintain the Rx for a minimum of 30days prior to destroying it
- Provide the Rx to a law enforcement official who is investigating the forgery How long is a CII Rx valid in Virginia and how many times can it be refilled? - correct answer✔✔ 6 months and cannot be refilled. How long are CIII-CV Rx valid in Virginia and how many times can they be refilled? - correct answer✔✔ valid for 6months and may be refilled a maximum of 5 times How long are CVI prescriptions valid in Virginia and how many times can they be refilled? - correct answer✔✔ CVI Rx with no additional notations are valid for 1 year. As previously covered, the prescriber can specifically extend the time that a CVI Rx may be filled up to 2 years. There are no specific limits on the number of refills that a prescriber can include on a CVI Rx and a Rph can continue to refill the CVI Rx until it expires.
What can a Rph do if the patient needs a refill for a CVI drug and the prescriber is not available? - correct answer✔✔ Virginia allows a CVI medication Rx to be refilled by a Rph without authorization from the prescriber if:
- The Rph has a made reasonable effort to contact the prescriber and
- the patient's health would be in imminent danger without the drug Any other Requirements?
- Inform the pt that the refill is being made without the prescriber's authorization
- Inform the prescriber of the refill
- Document on the back of the Rx the date and quantity of the refill, the prescriber's unavailability, and the reason for the refill Are pharmacists allowed to refill CIII-CVI Rxs any time the patient requests a refill? 18 VAC110- 20 - 320 - correct answer✔✔ NO. authorized refills may only be dispensed in reasonable conformity with the prescriber's directions for use. If there are no directions for use, the authorized refills may only be dispensed in reasonable conformity with the recommended dosages for the particular medication. This requires the RPh to exercise sound professional judgement. A RPh can refill a Rx early provided he docu,ents a valid reason for the early refill. This documentation should be either on the actual Rx or in the electronic recordkeeping system of the pharmacy. Does Virginia allow you to partially fill a CIII, CIV or CV Rx? - correct answer✔✔ Yes, You can partially fill CIII-CV Rx provided that:
- The toal quantity dispensed does not exceed the total quantity prescribe
- All partial dispensings take place during the six months that the prescription is valid
- The partial dispensings are done in reasonable conformity with the directions for use of the mediation or within the RPh's sound professional judgement
- Each partial dispensing is recorded in the same manner as refill (covered later)
