4.2.2 Those who are responsible for submitting data for multiple pharmacies or locations may submit a single report for all of its their pharmacies. The report shall identify the specific pharmacy or location from which each reportable prescription was dispensed. 4.3 Distribution of Advisory Notices 4.3.1 Each pharmacy shall provide to every customer to whom a controlled substance is dispensed an advisory notice informing the customer that all prescriptions for controlled substances are entered into a statewide VPMS database in order to protect patients and the public. The advisory notices are available on the Department’s website. 4.3.1.1 Pharmacies shall provide these notices by: • Prominently displaying the advisory notice in a manner readily accessible to its customers; or • Duplicating the complete text of the advisory notice in another format, such as by printing it on customer receipts, patient instructions; or on a written insert for delivery to the patient. 4.3.2 The pharmacy shall post brief advisories in at least six (6) languages offering a referral telephone number for people with limited English proficiency. 4.4 Required Data Submission for Prescribers that Dispense Prescribers who dispense controlled substances to their patients must submit a Report of Controlled Substances Dispensed to the VPMS following the same frequency and format as described in Sections 4.1 and 4.2 of this rule. 4.5 Exemptions from Reporting to VPMS 4.5.1 Reporting to VPMS is not required for: • Pharmacies that do not sell or dispense any Schedule II-IV controlled substances; • Out-of-State pharmacies that do not sell or dispense any Schedule II-IV controlled substances to any resident in Vermont; • A drug administered directly to a patient; • A drug dispensed by a health care provider (at a facility licensed by the Department), provided that the quantity dispensed is limited to an amount adequate to treat the patient for a maximum of 48 hours; • Veterinary Offices; or • Opioid Treatment Programs that dispense only methadone and buprenorphine. 4.5.2 A pharmacy that meets at least one of the above criteria may request an exemption from reporting from the VPMS program. The exemption shall terminate when the pharmacy dispenses any controlled substance or no longer meets the criteria for exemption. 4.5.3 The pharmacy shall renew the exemption form on an annual basis.
5.0 Requirements for Pharmacists
6.2.5 The first time a provider prescribes a benzodiazepine; 6.2.6 When a patient requests an opioid prescription or a renewal of an existing prescription for pain from an Emergency Department or Urgent Care prescriber if the prescriber intends to write a prescription for an opioid; 6.2.7 With the exception of prescriptions written from an OTP, prior to prescribing buprenorphine or a drug containing buprenorphine to a Vermont patient for the first time and at regular intervals thereafter, and: 6.2.7.1 At regular intervals thereafter, but no less than twice annually; and 6.2.7.2 No fewer than two times annually thereafter; and 6.2.7.3 Prior to writing a replacement prescription . 6.2.8 In the case of an OTP, prior to prescribing buprenorphine, methadone, or a drug containing buprenorphine to a Vermont patient for the first time, and: 6.2.8.1 Annually thereafter; and 6.2.8.2 Any other time that is clinically warranted. 6.2.9 Prior to prescribing buprenorphine or a drug containing buprenorphine that exceeds the dosage threshold approved by the Vermont Medicaid Drug Utilization Review Board and published in its Preferred Drug List [1], prescribers must receive prior approval from the Chief Medical Officer or Medical Director of the Department of Vermont Health Access or designee. Prescribers may designate a delegate or delegates to access and query the VPMS system subject to Section 7.2 of this rule. 6.4 Exemptions Patients experiencing chronic pain in the following categories are exempt from the requirements found in this section: • Chronic pain associated with cancer or cancer treatment; • Palliative care; • End-of-life and hospice care; and • Patients in skilled and intermediate care nursing facilities. 6.3 Prescriber Delegates
5.1 Pharmacist Registration with the VPMS 5.1.1 All Vermont-licensed pharmacists shall register to query the VPMS. 5.2 Pharmacist Required Querying of the VPMS All dispensers, with the exception of hospital- based dispensers dispensing a quantity of a Schedule II, III, or IV opioid controlled substance that is sufficient to treat a patient for fewer than 48 hours shall query the Vermont Prescription Monitoring System in the following circumstances: 5.2.1 Prior to dispensing a prescription for a Schedule II, III, or IV opioid controlled substance to a patient who is new to the pharmacy; 5.2.2 When an individual pays cash for a prescription for a Schedule II, III, or IV opioid controlled substance and the individual has prescription drug coverage on file; 5.2.3 When a patient requests a refill of a prescription for a Schedule II, III, or IV opioid controlled substance substantially in advance of when a refill would ordinarily be due; and 5.2.4 When the dispenser is aware that the patient is being prescribed Schedule II, III, or IV opioid controlled substances by more than one prescriber. Pharmacists may designate a delegate or delegates to access and query the VPMS system subject to Section 7.2 of this rule. 6.0 Requirements for Prescribers 6.1 Prescriber Registration with the VPMS The following professionals and entities must register with the Department to enable their access to the VPMS system: 6.1.1 All Vermont-licensed prescribers of controlled substances and their delegates; 6.1.2 The Medical Director of the Department of Vermont Health Access; and 6.1.3 Vermont’s Medical Examiners, and delegates from the Chief Medical Examiner’s Office investigating deaths in Vermont. 6.2 Prescriber-Required Querying of VPMS Prior to prescribing a controlled substance for a patient, Vermont licensed prescribers and/or their delegates must query the VPMS system in the following circumstances: 6.2.1 The first time the provider prescribes an opioid Schedule II, III, or IV controlled substance written to treat pain when such a prescription exceeds 10 pills or the equivalent; 6.2.2 When starting a patient on a Schedule II, III, 5.3 Pharmacist Delegates or IV controlled substance for nonpalliative long-term pain therapy of 90 days or more; 6.2.3 Prior to writing a replacement prescription for a Schedule II, III, or IV controlled substance; 6.2.4 At least annually for patients who are receiving ongoing treatment (treatment without meaningful interruption) with an opioid Schedule II, III, or IV controlled substance;
7.0 Access to VPMS Information
7.1 Authority to Query VPMS Directly Once registered, the following persons and entities may query VPMS directly for the following information: 7.1.1 Pharmacists who dispense controlled substances and their authorized delegates for the purpose of monitoring the prescription and dispensing history of a bona fide current patient; 7.1.2 Prescribers of controlled substances and their authorized delegates for the purpose of monitoring the prescription and dispensing history of a bona fide current patient;
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