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I appreciated the lucid discussion of off-label prescribing by Largent et al1 in the Archives. I was, however, disappointed that the authors did not mention the very difficult position in which off-label prescribing places the pharmacist.
It is important to consider that the drug utilization review (DUR) provisions of the Omnibus Budget Reconciliation Act of 1990 (OBRA ’90) required pharmacists to evaluate physicians' prescription orders prior to dispensing to ensure that prescribed medications are “appropriate, medically necessary, and are not likely to result in adverse events.”2 Following the implementation of this law in 1993, these DUR provisions were written into virtually every state pharmacy practice act, thereby making them a legal responsibility of pharmacists. This responsibility specifically includes evaluating the appropriateness of prescribed medication for the patient.
Rupp MT. The Pharmacist's Role in Off-label Prescribing. Arch Intern Med. 2010;170(7):658. doi:10.1001/archinternmed.2010.70