§40.141 — How does the MRO obtain information for the verification decision? As the MRO, you must do the following as you make the determinations needed for a verification decision:
(a) You must conduct a medical interview. You must review the employee's medical history and any other relevant biomedical factors presented to you by the employee. You may direct the employee to undergo further medical evaluation by you or another physician. |
(b) If the employee asserts that the presence of a drug or drug metabolite in his or her specimen results from taking prescription medication (i.e., a legally valid prescription consistent with the Controlled Substances Act), you must review and take all reasonable and necessary steps to verify the authenticity of all medical records the employee provides. | (1) You may contact the employee's physician or other relevant medical personnel for further information. | (i) If you decide to contact the employee's pharmacy to authenticate whether the prescription offered by the employee was filled by the pharmacy, you or staff under your operational control can contact the pharmacy. |
| (ii) If you utilize staff to perform the inquiry in paragraph (b)(1)(i) of this section, you must ensure operational control over the hiring, firing, evaluation of the staff and you must oversee the performance of the function of contacting a pharmacy to authenticate specific prescription(s) (e.g., outline or script what the staff will ask the pharmacy; occasionally monitor calls to assure quality control; or other methods to ensure the staff are properly conducting the calls with the pharmacies). |
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| (2) You may request an HHS-certified laboratory with validated protocols (see §40.81(c)) to conduct testing for D,L stereoisomers of amphetamine and methamphetamine or testing for tetrahydrocannabivarin (THC-V) when verifying lab results, as you determine necessary. |
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[65 FR 79526, Dec. 19, 2000, as amended at 82 FR 52245, Nov. 13, 2017; 88 FR 27645, May 2, 2023]
§40.141 — DOT Regulatory Guidance
Question 1: Is a Medical Review Officer (MRO) permitted to accept an employee's prescription for medication obtained over the Internet? Guidance: An MRO is authorized to accept an employee's prescription for medication obtained over the Internet only if there is proof that a legitimate doctor-patient relationship had been established.
The following four elements generally serve as an indication that a legitimate doctor-patient relationship has been established:
- A patient has a medical complaint;
- A medical history has been taken;
- A physical examination has been performed; and
- Some logical connection exists between the complaint, the medical history, the physical examination, and the drug prescribed.
Standing alone, the completion of an online questionnaire reviewed later by a pharmacy-employed doctor fails to establish a proper doctor-patient relationship.
The MRO should, at a minimum, consider the following items when verifying the test result:
- The name, physical location, and state(s) of licensure of the prescribing practitioner;
- Whether the employee was professionally evaluated for the current medical complaint by the prescribing practitioner, and the last time the employee was in direct contact with the prescribing practitioner;
- Whether the employee initiated the request to the pharmacy for a particular medication; and
- Whether a proper doctor-patient relationship existed.
It is the employee's responsibility to provide sufficient documentation to address MRO inquiries as to whether there was a legitimate doctor-patient relationship.