EPT for the Treatment of Chlamydia trachomatis: Frequently Asked Questions for Pharmacists

What is Expedited Partner Therapy (EPT)?

Expedited Partner Therapy (EPT) is a strategy for treating the sex partners of persons diagnosed with Chlamydia trachomatis (Ct). EPT allows health care providers to provide patients with medication or a prescription to deliver to his/her sex partner(s) without a prior medical evaluation or clinical assessment of those partners.

Is EPT legal for any other sexually transmitted infections (STIs)?

No. EPT was legalized in New York State (NYS) on January 23, 2009 for Ct infections only.

What is the recommended treatment for Ct using EPT?

The recommended EPT treatment for Ct is 1gm of Azithromycin in a single oral dose.

What is Chlamydia?

Ct is the most commonly reported bacterial STI nationwide and in New York State (NYS). Repeat Ct infections increase the risk of adverse outcomes such as Pelvic Inflammatory Disease (PID), infertility, and ectopic pregnancy. Having an untreated sex partner is an important risk factor for reinfection, so treating the sex partners of a person diagnosed with Ct is critical to interrupting the spread of Ct and reinfection.

What are the benefits of EPT?

Randomized controlled trials have found EPT to decrease rates of Ct reinfection among index patients and increase the proportion of sex partner's reported to be treated for Ct.

What is the prescription format for providing EPT?

Whenever a health care provider provides EPT using a prescription, the prescription shall include: (1) name and address of the health care provider/establishment in which it was dispensed; (2) date the prescription was issued; (3) name and dosage of the medication; (4) directions for the use of the drug by the patient; (5) number of refills (which will be "zero"); (6) the designation "EPT" must be written in the body of the prescription form above the name of the medication and dosage for all prescriptions issued; (7) if the name, address, and date of birth of the sex partner are available at the time the prescription is written, this should be written in the designated area of the prescription form; and (8) if the sex partner's name, address, and date of birth are not available at the time the prescription is written, the written designation of "EPT" shall be sufficient for the pharmacists fill the prescription; if needed, this information can be obtained when the patient's sex partner or designee drops off or picks up the prescription at the pharmacy.

Is "EPT" sufficient for the pharmacist to fill the prescription?

According to NYS Public Health Law Section 2312, a pharmacist can legally fill a prescription with the designation of "EPT" even when a sex partner's name, address, and date of birth are not listed on the prescription. However, if needed, the pharmacist can request this information when the prescription is dropped off or picked up at the pharmacy.  

Is liability for providers and pharmacists addressed in this legislation?

A health care provider who reasonably and in good faith renders EPT in accordance with Public Health Law section 2312 and section 23.4, and a pharmacist who reasonably and in good faith dispenses drugs pursuant to a prescription written in accordance with Public Health Law section 2312 and section 23.4, shall not be subject to civil or criminal liability or be deemed to have engaged in unprofessional conduct.

Who will assume the cost for the sex partner's medication?

Medication costs may be self-pay (paid by the person who picks up the prescription) or paid by the sex partner's health insurance. The health department or some medical offices may choose to dispense medications to both patients and partners at no cost instead of writing a prescription.

To whom should medication be billed?

Billing the sex partner's prescription under the patient's name would be considered fraudulent.

If a sex partner is allergic to Azithromycin what are the alternatives?

Other states have been using EPT for approximately 8 years and no adverse events and/or life threatening allergic reactions have been reported to date. If the sex partner is known to be allergic to azithromycin, erythromycin, clarithromycin, or any macrolide or ketolide, azithromycin should not be given and the partner should be instructed to see a physician for appropriate treatment. Providers using EPT are required by law to give patients educational materials to give to his/her sex partner(s). These materials will address allergic reactions, potential side effects, and contraindications to taking azithromycin. Patients and their partners should call 311 for more information.

What if the sex partner is taking a medication that interacts with Azithromycin?

The partner should be referred to a physician or emergency room for appropriate treatment.

How should pharmacists conduct patient record keeping for "EPT" prescriptions?

EPT prescriptions should be documented/filed like any other non-controlled substances prescriptions.

What are the educational material requirements for patients provided with EPT?

Each patient provided with antibiotics or a prescription for EPT in accordance with section 2312 of the Public Health Law must be given informational materials for the patient to give to his/her sex partner(s). Each patient shall be counseled by his/her health care provider to inform his/her sex partner(s) that it is important to read the information contained in the materials prior to the partner’s taking the medication.