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GPhC: Online pharmacies must check patient ID before supplying opiates

Online pharmacies must verify the identity of a patient before supplying opiates or medicines for diabetes, epilepsy and asthma, the regulator has said.

Online pharmacies must “carry out an appropriate identity check” before supplying “certain categories of prescription-only medicines (POMs)” (see below), the General Pharmaceutical Council (GPhC) said in updated guidance for distance-selling pharmacies published today (April 16).

It gave the example of NHS Digital's identity verification and authentication standard for digital health and care services, which it said “provides a consistent approach to identity checking across online digital health and care services”, to ensure patients only receive medicines that are “safe and clinically appropriate for them”.

Unless safeguards are put in place, the GPhC stressed the following medicines should not be prescribed online: antibiotics; “medicines liable to abuse”, including pregabalin; “medicines that require ongoing monitoring”; and medicinal products, such as Botox.

“These safeguards include making sure the prescriber proactively shares all relevant information about the prescription with their GP after seeking the patient’s consent,” it said.

Online pharmacies will also have to supply more details about where the online service and its healthcare professionals are based and how they are regulated. They must also ensure prescribers operating outside of the UK are working to the UK’s prescribing guidelines, the GPhC said.

“Not following this guidance, or not taking the appropriate steps to achieve a desired outcome under our standards, could mean that you fail to meet one or more of the standards for registered pharmacies. This could result in our taking enforcement action,” the GPhC warned.

The regulator will be checking the new guidance is being adhered to in its pharmacy inspections, GPhC chief executive Duncan Rudkin said.

“We support pharmacy services being provided in innovative ways, including online, as long as the services are safe and effective for people. But providing pharmacy services online carries particular risks, which need to be successfully managed,” he added.

“People can be put at serious risk if they are able to obtain medicines that are not appropriate for them.”

CCA: ID checks are “additional burden”

Malcolm Harrison, chief executive of the Company Chemists’ Association (CCA) – which represents the UK’s largest multiples and supermarket pharmacies – said “the introduction of identity checks will likely place an additional burden on patients and pharmacy services”.

“We recognise that checks are needed for some medicines to ensure that the risks associated with online provision are managed, as well as those in traditional face-to-face pharmacy settings,” he said.

However, the CCA is “concerned that the guidance lacks the clarity to enable providers to make the necessary informed and accurate decisions about which checks would be required for different classifications of medicines”.

“It will be important for regulators to monitor the impact of the introduction of any new verification measures, to ensure that people still receive their medicines in a safe and timely way.”

Both the National Pharmacy Association and the Royal Pharmaceutical Society welcomed the introduction of identity checks.

Online pharmacy UK Meds came under fire in a BBC investigation last year, after a former opiate addict was able to order 100 dihydrocodeine 30mg tablets by submitting false medical information and without any interaction with a healthcare professional.

Which medicine groups did the GPhC single out?

The regulator listed the following four medicines categories as not being suitable to supply online unless further safeguards are implemented:

Antimicrobials (antibiotics) – “These should be supplied only in line with good practice guidance, taking into account antimicrobial stewardship guidelines relevant for the person and their location.”

Medicines liable to abuse, overuse or misuse, or when there is a risk of addiction and ongoing monitoring is important – for example, opiates, sedatives, laxatives, pregabalin and gabapentin.

Medicines that require ongoing monitoring or management – for example, medicines with a narrow therapeutic index, such as lithium and warfarin, sodium valproate, as well as medicines used to treat diabetes, asthma, epilepsy and mental health conditions.

Non-surgical cosmetic medicinal products, such as Botox, Dysport or Vistabel – “These should be prescribed in line with good practice guidelines.”

Source: Guidance for registered pharmacies providing pharmacy services at a distance, including on the internet, GPhC, April 2019

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