Providing medication based on online prescriptions: If in doubt, do not dispense!

How does Dutch legislation align with the use of online platforms like Dokteronline? 

Den Exter explains that the Medicines Act allows online prescriptions to be written and dispensed under certain conditions. "One condition is that the prescriber must be familiar with the patient, and the pharmacist must conduct a risk assessment before the medication is handed over." In the case of Dokteronline, where foreign doctors prescribe medications, the doctors do not know the patients. "The approach taken by Dokteronline is not acceptable from a health perspective for the patient," Den Exter says. Additionally, Den Exter points to another requirement for online prescriptions: the medication history. He refers to Article 2 of the Healthcare Quality, Complaints and Disputes Act. This article requires the healthcare provider, in this case, the pharmacist, to provide good pharmaceutical care. Den Exter states: "Good pharmaceutical care includes, among other things, safe care and a risk assessment based on the medication history. If this is absent, there is no proper care, and the platform does not meet the legal requirement." 

What Responsibilities Do Pharmacists Have? 

The Medicines Act provides various regulations for pharmacists' dispensing of medications. Additionally, pharmacists must adhere to the Royal Dutch Society for the Advancement of Pharmacy (KNMP) professional standards. Den Exter states: "One of these standards is the risk assessment before dispensing a prescription medication. This risk assessment is based on the patient's medication record or in consultation with the prescribing doctor. There is an obligation to verify the prescription, and only then can the medication be dispensed to the patient. This can be done at the counter or through an online channel. Foreign prescriptions may be accepted but are also subject to a verification obligation. If the prescription seems unreliable, the pharmacist must refuse to dispense the medication." 

Den Exter mentions that in the past, a pharmacist was reprimanded for dispensing medication to a patient they did not know without verifying the prescription. In this case, a patient with psychiatric issues received a prescription for Tramadol, a strong painkiller, via Dokteronline. The patient took 50 tablets at once, requiring hospitalization and resulting in serious health complications. This incident led to an investigation by the Health Care Inspectorate (IGZ). The Minister of Health, Welfare, and Sport ultimately prohibited the pharmacy from dispensing online-prescribed medication without adequate checks. Den Exter notes: "The disciplinary judge also considered the pharmacist's actions negligent at the time. When in doubt, do not dispense!" 

What steps can be taken? 

Den Exter explains that the Health and Youth Care Inspectorate (IGJ) is the relevant authority in this case. The IGJ can take steps such as conducting inspections and investigations and, if necessary, imposing measures like administrative fines or even closing the pharmacy. Additionally, the IGJ may initiate disciplinary proceedings against individual pharmacists for breaching professional standards and the Medicines Act. It is crucial that pharmacists are aware of their responsibilities and the consequences of not complying with the law. 

To combat the dispensing of medication based on questionable prescriptions, Den Exter believes a good first step is to discuss the professional standards within the industry and explain them to its members. He suggests providing information about the risks of dispensing medication to unknown patients without proper verification could be a good starting point. By clearly communicating these standards, the profession can better position itself against inappropriate practices and contribute to ensuring safe pharmaceutical care.