Let's Be ClearImprove Naloxone Access

Treat the standing order as you would any other prescription. Pharmacists should follow all usual steps as they would any other prescription, such as record keeping, documentation, billing, and labeling requirements. The differences are:

• - Barnes (including NPI#) is listed as the prescriber for the medication
• - The Eligibility Assessment Form must be completed with the eligible individual before dispensing naloxone
• - You must provide printed educational material when counseling the patient (learn more in Step 5)

Participating pharmacies must keep a printed copy of the statewide standing order on premises.

If your facility plans to dispense naloxone under the standing order,  join the statewide participating pharmacy list by completing the participation form on the bottom of this page. 

This information will be used to generate a public list of pharmacies, making it easier for those seeking naloxone to obtain it. It will also allow us to contact your pharmacy should there be changes to the standing order.

Pharmacies choosing to dispense naloxone under the statewide standing order must complete at least one hour of training related to naloxone dispensing and administration. Suitable trainings include, but are not limited to:

• - Overdose Prevention and Naloxone Rescue Kits for Prescribers and Pharmacists
  Online educational program that models how to provide a patient with overdose education and a naloxone rescue kit, provided by the Boston University School of Medicine
• - Module 22: Preventing Opioid Overdose with Education and Naloxone Rescue Kits
  Free online course that educates on opioid overdose and prescribing naloxone, provided by the Providers Clinical Support System

Any program that provides the pharmacist with at least one hour of naloxone education is sufficient.

Pharmacies must complete an Eligibility Assessment Form for every individual receiving naloxone.

Assessment forms must be:

• - Filled out with the eligible individual, before dispensing naloxone
• - Maintained with pharmacy records for at least two years
• - Available for inspection and copying by the South Dakota Board of Pharmacy

Patients who receive naloxone under the standing order must receive verbal and written education about:

• - Signs of an overdose
• - Overdose response steps
• - How to use naloxone

The SD Department of Social Services has developed naloxone Brochures for pharmacy use. These brochures can be requested and shipped to your facility at no cost.

Pharmacies play a huge role in helping us distribute and monitor the number of naloxone kits dispensed. Please fill out a quick quarterly report so we can track the number of kits distributed in South Dakota.

Reporting Periods:

January 1 – March 31
Due April 30

April 1 – June 30
Due July 31

July 1 – September 30
Due October 31

October 1 – December 31
Due January 31

Naloxone reimbursement is available for individuals without:

• - Insurance (including Medicaid) or a 3rd party payor source; or
• - The ability to pay due to financial circumstances

Pharmacies seeking direct deposit of reimbursement must submit a substitute W-9.

For pharmacy enrollment for reimbursement or invoices, please email  DSSBHINDMED@state.sd.us

For standing order and eligibility criteria, email letsbeclear@state.sd.us.

 Substitute W-9 Form

Review Guidelines