Signature Exempt Prescriptions and remote prescribing

The system that generates the prescription must have been authorised by the Manatū Hauora to be integrated with the NZePS to be eligible to generate NZePS barcoded Signature Exempt Prescriptions. A list of prescribing systems that are integrated with the NZePS can be found lower down the page. 

For these prescriptions to be valid, the pharmacy must use the barcode at the point of dispensing   otherwise the signed original prescription is required.

If you currently use an NZePS integrated prescribing system and you’re not already on NZePS (i.e. generating prescriptions with an NZePS barcode), contact onlinehelpdesk@health.govt.nz with NZePS in the subject line to begin the process of prescribing with NZePS.

See Appendix 3 for a list of systems integrated with the NZePS and approved for Signature Exempt Prescriptions.

Intrahealth’s Profile for Mac, Best Practice Software, amongst others are not integrated with the NZePS and cannot produce NZePS Barcoded Signature Exempt Prescriptions.  Users will be able to generate signatureless prescriptions under the temporary authorisation for non-NZePS prescriptions if the conditions set out in the section Temporary Exemption from Signatures on Prescriptions without NZePS (no barcode) are met.

If your prescribing system does not support NZePS prescribing, send an email to onlinehelpdesk@health.govt.nz to discuss the available options.

Under the legislation a prescription without the physical, wet ink signature of an authorised prescriber is valid if:

• the prescription is a NZePS barcoded prescription; and
• the barcode is used at the point of dispensing at the pharmacy;

If these conditions are not met, you will still need to receive the signed original prescription from the prescriber.  Below are examples of valid, signature exempt NZePS prescriptions.

Barcode examples

There are a number of available secure channels to send a Signature Exempt Prescription directly to a pharmacy:

• All prescribing systems that are integrated with the NZePS should allow you to attach a Signature Exempt Prescription to an email to send it to the community pharmacy on behalf of the patient.
• Some practice management systems (PMS) and practices can use Healthlink (including Healthlink’s Secure Script product) to send the prescription to a pharmacy that also has a Healthlink EDI (mailbox). Practices should check with the pharmacy first to ensure that it is able to receive Healthlink messages or Secure Scripts.
• Group Healthcare’s reScript product is also able to send a Signature Exempt Prescription to a community pharmacy that the patient chooses.
• In the Canterbury DHB region, prescriptions can also be sent to a pharmacy using the Electronic Request Management System (ERMS) if the prescription is a NZePS barcoded prescription or meets the requirements of the Director General of Health’s authorisation of alternative form of prescription pursuant to regulation 43 of the Medicines Regulations 1984 (without an NZePS barcode) (18 October 2022) which does NOT apply to practices that use a prescribing system that is NZePS capable.

An NZePS barcoded prescription has controls that reduce the risk of a prescription being fraudulently generated or altered.  It also prevents the prescription from being dispensed multiple times at different pharmacies.

There are additional benefits over and above security that the NZePS offers to prescribers including:

• Improved safety as electronic prescriptions using the NZ Universal List of Medicines are precise, unambiguous, coded and interpretable by other systems
• Not having to handwrite prescriptions for Class A and B controlled drugs using the triplicate controlled drug prescription form (H572), so long as the prescription has a barcode and is electronically generated by the controlled drug prescriber from an approved system such as NZePS (the barcode must also be used at the point of dispensing at the pharmacy)
• Not having to send original prescriptions for barcoded prescriptions when a copy of the barcoded prescription is sent, via secure email or other forms of secure messaging, to the pharmacy and the barcode is used at the point of dispensing
• Enables prescribers to address issues of patient medicines adherence by having the ability to choose to receive notification when a patient’s medicines have not been dispensed
• Improves quality of patient medication history information as the status of the prescription can be viewed in the prescriber’s PMS, for example, as ‘Dispensed’, or if ‘Repeats remaining’
• Reduces calls from pharmacies querying prescriptions as the prescriber can write a ‘Comment for a Pharmacist’ when prescribing.

The PMS vendors have created training material on how to:

• access your PMS from home or other locations;
• generate a PDF of a prescription which can be attached to your practice email address and sent to a pharmacy;
• print from home, or any location, should you need to physically sign a prescription.

Please contact your PMS vendor to access this guidance.

The contact details of community pharmacies can be found on Healthpoint (www.healthpoint.co.nz).

Some PMS systems have updated their address books with the email addresses of community pharmacies from Healthpoint.

Separating the prescriptions emailed to your pharmacy helps you to:

• monitor one mailbox for incoming prescriptions
• manage emailed prescriptions that have already been printed and dispensed.

Healthpoint monographs provide pharmacies with separate fields for prescription email and general email addresses.

You will need to turn on email security on your prescription email account. 

You may also wish to contact the general practices in your vicinity to ensure they have your up-to-date prescription email address so that they can update their practice address books. It is also important to ensure your pharmacy details on HealthPoint are up to date with the correct email addresses.

It is important to be vigilant and ensure you are confident that you are sending or receiving prescriptions from a valid general practice or pharmacy email address.  If you have any doubts you can:

• check Healthpoint for the email address. All information on Healthpoint is updated quarterly to ensure it is up-to-date;
• if the email address is not on Healthpoint, then phone the practice or pharmacy to confirm.

Some PMS systems are working on updating their address books directly from Healthpoint. 

Any systems that cannot integrate with the NZePS yet, but that include all of the required information under this authorisation, can be used to generate a prescription.  This includes but is not limited to: hospital discharge and some outpatient prescribing, community prescribing from dentists, some midwives and allied health clinicians. This temporary authorisation recognises an alternative form of prescription that is not signed personally by a prescriber, with their usual signature, as valid when all the following conditions are met:

• The prescription is generated and/or sent by an electronic system that requires the prescriber to log on with a unique ID and password
• The prescription does not include Controlled Drugs (Class A, B or C) but can include Class C exempt or partially exempt controlled drugs as defined by the Misuse of Drugs Act 1975. See Appendix 2 for Class C Controlled Drugs (NOT exempt or partially exempt).
• The prescription includes all of the following:
  • The prescriber’s registration authority number (e.g. MCNZ) that uniquely identifies the prescriber
  • The contact details of the prescriber to enable the pharmacy to contact the prescriber to verify, identify or request amendments to the prescription and
  • The following statement “This prescription meets the requirement of the Director-General of Health’s authorisation of October 2022 for prescriptions not signed personally by a prescriber with their usual signature”.
• The prescription must be in a format that cannot be easily altered by anyone other than the prescriber (e.g. PDF, photograph) and
• The prescription must be sent directly to the community pharmacy using a secure, electronic system that identifies the prescriber’s name and facility. The following would satisfy this requirement:
  • A secure email system that identifies the prescriber and the healthcare facility through its email address. 

• A secure clinical communication system that links prescriber and pharmacies such as the Electronic Request Management System (ERMS)

• The electronic prescription and the message are kept on file and submitted as required by the Integrated Community Pharmacy Services Agreement (ICPSA) as a criterion for payment.

This authorisation will expire on 31 October 2024.

Regulations relating to the prescribing and dispensing of Controlled Drugs are made under the Misuse of Drugs Act and the Director-General does not have the ability to authorise an alternative form of prescription under those regulations. Unless the prescription is an NZePS barcoded prescription, prescriptions for controlled Drugs (Class A, B and C – except for exempt or partially exempt Class C Controlled Drugs), as defined by the Misuse of Drugs Act, must still meet the requirements in the Misuse of Drugs Regulations:

• NZePS Class A, B and Class C prescriptions do not require a physically signed prescription to be sent to pharmacy.
• Non-NZePS Class B prescriptions (no barcode) require the Controlled Drug triplicate prescription forms (H572) to be completed and sent to pharmacy.
• Non-NZePS Class C (except for exempt or partially exempt Class C Controlled Drugs) require a wet-ink signed copy of the original prescription to be sent to pharmacy.

Exempt or partially exempt Class C Controlled Drugs as defined by the Misuse of Drugs Act 1975 are covered by these Signature Exempt authorisations.  See Appendix 2 for Class C Controlled Drugs (NOT exempt or partially exempt).  Class A and B drugs will continue to require a signed triplicate prescription form (H572) if not prescribed via NZePS.  Class C (NOT exempt or partially exempt controlled drugs) will require a signed prescription form but do not require a triplicate prescription form (H572).

The Universal List of Medicines has the classifications of most medicines available in New Zealand.  If the NZULM has not been integrated into your prescribing systems, you can also search for a medicine online by going to https://nzf.org.nz/nzf_2477.

Controlled Drugs are also listed in the following schedules of the Misuse of Drugs Act 1975which can be accessed online:

• Class A – Schedule 1 http://www.legislation.govt.nz/act/public/1975/0116/latest/DLM436576.html?search=ts_act_misuse+of+drugs_resel&p=1
• Class B – Schedule 2

http://www.legislation.govt.nz/act/public/1975/0116/latest/DLM436586.html?search=ts_act_misuse+of+drugs_resel&p=1

• Class C – Schedule 3

http://www.legislation.govt.nz/act/public/1975/0116/latest/DLM436723.html?search=ts_act_misuse+of+drugs_resel&p=1

Appendix 2 of this FAQ also has a list of Class C controlled drugs.

• Exempt and partially exempt Class C Controlled Drugs are defined in the Misuse of Drugs Regulations 1977 in Schedule defined by the Misuse of Drugs Act 1975
  • Exempt Class C controlled drugs listed in Part 6 of Schedule 3

http://www.legislation.govt.nz/act/public/1975/0116/latest/DLM436723.html#DLM436765

• Partially Exempt Class C Controlled Drugs that is named in clauses 1 to 5 of Part 3 of Schedule 3 of the Act

http://www.legislation.govt.nz/act/public/1975/0116/latest/DLM436723.html#DLM436732 or a preparation of pseudoephedrine that is named in clause 6 of Part 3 of Schedule 3 of the Act or in a modified or sustained release formulation that delivers no more than 240 mg of pseudoephedrine in a 24-hour period.

No, handwritten prescriptions must be signed by the authorised prescriber.

Under the Director-General authorisation of alternative form of prescription pursuant to regulation 43 of the Medicines Regulations 1984 (18 October 2022) which provides for an Exemption for Signatures on Prescriptions without NZePS (without an NZePS barcode), a prescription without the physical, wet ink signature of an authorised prescriber is valid if it meets the conditions set out under the question above: How can I generate a Signature Exempt Prescription?

The example prescription below shows an example of a valid non-barcoded prescription (non-NZePS) without a signature, under this temporary authorisation, if it is sent in a format that cannot be easily altered by anyone other than the prescriber (e.g. PDF, photograph), AND is sent directly to the community pharmacy using a secure, electronic system that identifies the prescriber’s name and facility AND the prescription does NOT contain a Controlled Drug (Class A, B and C – except for exempt or partially exempt Class C Controlled Drugs).

Example

Regulations relating to the prescribing and dispensing of Controlled Drugs are made under the Misuse of Drugs Act and the Director-General does not have the ability to authorise an alternative form of prescription under those regulations. Prescriptions for controlled Drugs (Class A, B and C – except for exempt or partially exempt Class C Controlled Drugs), as defined by the Misuse of Drugs Act, must still meet the requirements in the Misuse of Drugs Regulations:

• NZePS Class A, B and Class C prescriptions are signature exempt and do not require a physically signed prescription to be sent to pharmacy.
• Non-NZePS Class B prescriptions (no barcode) require the Controlled Drug triplicate forms to be completed, wet-ink signed and sent to pharmacy.
• Non-NZePS Class C prescriptions (except for exempt or partially exempt Class C Controlled Drugs) require a wet-ink signed copy of the original prescription to be sent to pharmacy.

Exempt or partially exempt Class C Controlled Drugs as defined by the Misuse of Drugs Act 1975 are covered by these Signature Exempt authorisations.  See Appendix 2 for Class C Controlled Drugs (NOT exempt or partially exempt).  Class A and B drugs will continue to require a signed triplicate prescription form (H572) if not prescribed via NZePS.  Class C (NOT exempt or partially exempt controlled drugs) will require a signed prescription form but do not require a triplicate prescription form (H572).

Any systems or processes that include all of the required information under this authorisation can be used to generate a prescription.  This includes but is not limited to prescriptions generated by hospital-based systems e.g. SMT (Orion’s Soprano Medical Templates).

There are some key requirements that must be met in systems and processes that send the prescription including:

• be sent in a format that is difficult for anyone other than the prescriber to amend. This can include:
  • PDF
  • Photograph
• be sent through a secure electronic communication system e.g. Secure email
• The South Island Electronic Request Management System (ERMS).
• ensures that only authorised prescribers are able to send and that clearly identifies the prescriber and their healthcare facility.
• the system is not a NZePS accredited system.

The contact details of community pharmacies can be found on Healthpoint (www.healthpoint.co.nz).

Some PMS systems have updated their address books with the email addresses of community pharmacies.

Separating the prescriptions emailed to your pharmacy helps you:

• monitor one mailbox for incoming prescriptions
• manage emailed prescriptions that have already been printed and dispensed.

Healthpoint monographs provide pharmacies with separate fields for prescription email and general email addresses.

You will need to turn on email security on your prescription email account.

You may also wish to contact the general practices in your vicinity to ensure they have your up-to-date prescription email address so that they can update their practice address books.

It is important to be vigilant and ensure you are confident that you are sending or receiving prescriptions from a valid general practice or pharmacy email address.  If you have any doubts check:

• Healthpoint for the email address. Healthpoint is currently contacting every pharmacy to update their prescription email addresses
• if the email address is not on Healthpoint, then phone the practice or pharmacy to confirm
• if an alternative system is used to send the prescription e.g. The South Island Electronic Request Management System (ERMS), Healthlink, then it should clearly identify the prescriber and the facility. 

Some PMS systems are working on updating their address books directly from Healthpoint. 

The Director-General authorisation of an alternative form of prescription pursuant to regulation 43 of the Medicines Regulations 1984 (18 October 2022) which provides for an Exemption for Signatures on Prescriptions without NZePS (without an NZePS barcode) will expire on 31 October 2024.