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Board staff details duty-to-consult regulation and common violations; members discuss reimbursement and proactive consults
Summary
Deputy Executive Officer Julie Ansell told the committee on Oct. 16 that CCR 16-1707.2 requires pharmacists to offer oral consultation in defined circumstances and that investigations show recurring failures to meet those obligations.
Deputy Executive Officer Julie Ansell told the Enforcement & Compounding Committee on Oct. 16 that pharmacists— duty to consult is a central patient-safety mechanism but that board investigators continue to document repeated compliance gaps.
"A pharmacist shall provide oral consultation to a patient under specified conditions," Ansell said, citing California Code of Regulations 16-1707.2: consultation is required upon request, when professionally necessary, for prescriptions not previously dispensed, and when directions change. The rule also requires pharmacies to provide a written notice of the right to consultation for mail-order or delivered prescriptions and to maintain specified phone availability for callbacks.
Staff presented examples of substantiated consultation violations investigated in recent fiscal years: failing to provide consultation on a new prescription; a technician directing a patient to a consultation window but not calling the pharmacist; failing to provide consultation when directions changed; delivering a mailed prescription without adequate notice or missing phone numbers on the notice; and failure to provide timely pharmacist phone access for delivered medications. Ansell explained that outcomes range from education or letters of admonishment to citations with fines or referral to the Attorney General for egregious or repeated conduct.
The committee discussed operational and policy barriers that make consistent consultation difficult. Member Sung Oh argued for exploring payment models for consultation and for explicit regulatory language permitting proactive pharmacist outreach. "If we can figure out a way for our pharmacists to be compensated for consultations provided, I am confident that we would never have this issue," Oh said. Members also raised workflow and staffing questions, and Licensee Member Nicole Thiebaud noted that many dispensing systems can require a pharmacist override to release a prescription—an operational tool some pharmacies use to ensure consultation.
Public commenters emphasized reimbursement, interoperability and technician training. Sean Kim of the California Pharmacists Association urged better bidirectional health information exchange and reimbursement pathways beyond dispensing fees. Steven Gray urged the board to track consultation trends and enforcement outcomes over time. Pharmacy technician Chasney Johnson asked that technician interactions better encourage consultations and cited front-line customer-service practices that can discourage patients from accepting consults.
Staff reminded the committee that the board maintains consumer-facing resources (notice-to-consumer poster, language access notices and a requirement that pharmacies offer interpretive services). Members asked staff to continue educational outreach and to consider whether regulatory language could explicitly allow modern, proactive workflows while protecting patients.
