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Iowa Board of Pharmacy Prescription Monitoring Program

pmp@iowa.gov

6200 Park Ave., Ste. 100 Des Moines, IA 50321

515-281-5944

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Iowa Prescription Monitoring Program

Pharmacy Request for Exemption from Reporting Controlled Substances and Naloxone Prescriptions

Iowa Board of Pharmacy
6200 Park Ave., Ste. 100
Des Moines, IA 50321​
melissa.carstens@iowa.gov
515-725-3492

Pharmacy Address

Iowa Code section 124.552 requires that each pharmacy that dispenses a controlled substance listed in Schedules II, III, IV or V of the Controlled Substances Act to a patient located in Iowa, and each pharmacy located in Iowa that dispenses a controlled substance to a patient located inside or outside Iowa, must submit a record of the dispensed prescription to the Iowa Prescription Monitoring Program (PMP) unless the pharmacy is specifically exempted from such reporting by Iowa Code or rule.

The pharmacy identified above requests exemption from the requirements for reporting to the Iowa PMP prescriptions for controlled substances dispensed to Iowa patients.

This exemption DOES NOT apply to the mandatory reporting of opioid antagonists (e.g., Narcan®) or non-prescription codeine containing Schedule V sales (e.g., Robitussin AC®).

The pharmacy claims exemption based on the following statement(s): (check all that apply)

A pharmacy that has been granted exemption from reporting to the Iowa PMP shall not be required to submit “zero reports” and shall not be deemed in violation of Iowa Code or rules for failure to submit a “zero report” during any period that the pharmacy continues to qualify for exemption from reporting to the Iowa PMP.

If the practice of a pharmacy that has been granted exemption from reporting to the Iowa PMP changes and the basis for the exemption is no longer valid, the pharmacy shall immediately notify the Iowa PMP administrator and shall immediately initiate reporting of qualified prescription information to the Iowa PMP. Notification to the Iowa PMP administrator shall be in writing and shall be delivered via email, fax, or other hard-copy delivery.

Signature of Pharmacist in Charge

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