Controlled Substance Prescriptions
When should this information be transmitted ?
NO later than 15th day of the next month following the month in the which the controlled substance was dispensed.
True or False In New York State, initial prescriptions for chronic pain are limited to a seven (7) day supply
NO only for initial (?) prescriptions for acute pain
C2 and Benzodiazepine can it be refilled?
NO, Never
It is legal to fill a controlled substance prescription known to be issued for the purpose of keeping an addict or habitual user comfortable by maintaining his/her customary use?
No, you will have penalties
If you receive a controlled substance prescription that is missing information, what do you do?
Obtain the missing information orally from the prescriber and enter it on the prescription along with your signature and the date
What information can be added to a controlled substance prescription by a pharmacist without contacting the prescriber?
The patient's name, address and gender
Why does New York State limit opioid prescribing to a 7 day supply for initial acute pain prescription?
This is done in an attempt to reduce the overprescribing of opioids
True or False Except in certain circumstances, prescriptions for controlled substances cannot be written in quantities exceeding a 30 day supply
True
How many refills may be issued for a C-III 3, C-IV 4 (non benzodiazepine), or C-5 controlled substance?
Up to 5 refills When the Rx is more than a 30 day supply then only 1 refill may be issued
Does a maximum daily dose have to be indicated on all controlled substance prescriptions?
YES
Dr. Smith has been prescribing Hydrocodone/Acetaminophen 5/300 mg for Bob for the past several months, Bob is out of refills and Dr. Smith on vacation. Can the physician filling in for Dr. Smith renew Bob's prescription?
Yes as long as Bob's patient record warrants continued prescribing of the drug or the physician was able to consult with Dr. Smith to ensure the necessity of continued controlled substance prescribing.
Can a pharmacy ever accept a C-2 or a benzodiazepine prescription via facsimile?
Yes but only if the following criteria are met: The faxed image shows the prescription was written on an official New York State prescription form The medication is to be compounded for infusion, or it is for a patient enrolled in hospice program or Residential Health Care facility (RHCF) that is contracted with the pharmacy The prescriber writes "hospice patient" or "RHCF patient" on face of prescription ( not required for prescriptions to be compounded for infusion). Prescriber furnishes the pharmacy with the original official New York State prescription within 72 hours Note: The original prescription should be attached to the faxed copy and filled in the controlled substance prescription records. Also, remember that starting March 27, 2016 all prescriptions MUST be issued via E prescription unless the situation specifically qualifies as one of the exceptions (5)
Can a prescriber orally authorize changes to a C2 or benzodiazepine prescription?
Yes, indicate the changes on the prescription and write your initials next to each change; however, you still cannot change the prescriber's signature, the date written and signed, the drug name or the patient's name Note: Also, record the reason for the changes, and sign and date the prescription
What drugs are categorized as benzodiazepines?
all benzodiazepine names end in Olam or Epam Chlordiazepoxide Ethyl Loflazepate Haloxazolam
What specific information must be included on all prescription for controlled substances?
1. Patient's full name, address, age, and gender 2. Prescriber's name address, DEA number, and phone number 3. Drug name 4. Drug strength 5. Dosage form 6. Quantity prescribed (must be expressed in numerical and written form) 7. Directions for use (at minimum, must include the dose, dosing frequency, and maximum daily dose). 8. Number of refills authorized (not applicable to C2 and benzodiazepines; also must be expressed in numerical and written form). 9. Prescriber's hand written signature or electronic sig for E prescriptions 10. Date written *IF the ultimate user is an animal, must include the species of animal and the name and address of the owner.
Some information on a controlled substance prescription cannot be added orally by the prescriber, including:
1. Prescriber's signature 2. Date written and signed 3. Medication Name. 4. Quantity to be dispensed 5. Patient's name
What information from controlled substance prescriptions must be electronically transmitted to the NYDOH?
1. Prescription (Rx) number assigned by the pharmacy 2. NPI number of the pharmacy 3. Patient name, address, date of birth, and gender 4. Date filled 5. NDC number of drug dispensed 6. Metric quantity dispensed 7. Day's supply 8. Prescriber's DEA number 9. Date written 10. Serial number on the official prescription form 11. Payment method 12. Number of refills authorized (if applicable) 13. Refill number (if applicable)
A prescription for a C-3, C-IV (non benzodiazepine), or C-V controlled substances is valid for __ after the date the prescription was signed by the prescriber?
6 months
If the prescriber fails to furnish the original official new york state prescription within 72 hours, the pharmacist must notify the NYDOH in writing with ___?
7 days from the date of DISPENSING
Effective July 22 2016, a prescriber cannot initially prescribe more than a ___ of opioid medication for acute pain
7 days supply ** Subsequent prescriptions for the same acute pain are not limited to a 7 day supply
Additional prescriptions for the same controlled substance cannot be issued to the same patient within 30 days of the date the previous prescription was issued, unless the patient has exhausted all but a ___ day supply provided by any previously issued prescription.
7 seven day ** If earlier filling is NOT authorized by the prescriber, CIII, CIV (non benzodiazepine), and C-V prescriptions cannot be refilled earlier than seven (7) days prior to the date the previously dispensed supply should be exhausted
Typically, a practitioner is limited to prescribing up to 30 day supply for controlled substances, but for what conditions can a practitioner prescribe a 3 months supply (or 6 month supply for anabolic steroids)?
Code A: Panic disorder Code B: Attention Deficit Hyperactive Disorder (ADHD) Code C: Chronic debilitating neurological conditions Code D: Relief of pain caused by chronic or incurable disease Code E: Narcolepsy Code F: Male hormone deficiency, gynecologic conditions (with anabolic steroid treatment) or chronic gonadotropin, metastatic breast cancer, anemia, and angioedema ** Prescriber must indicate the name of the condition or the associated code on the face of the prescription if the prescription of controlled substance is more than 30 days of supply
In new york state, refills can never be issued for certain categories of medication. What are those categories?
Controlled 2 substances AND Benzodiazepines
The responsibility for proper prescribing and dispensing of a controlled substance rests on the prescriber, but a ____ rests on the pharmacist who fills the prescription.
Corresponding responsibility
When refilling a prescription what information must be documented on the prescription?
Amount dispensed Date dispensed Signature of dispensing pharmacist
To issue prescriptions for controlled substances a practitioner must possess a _____?
DEA registration number Exception: Exempt officials (military physicians)
New York law requires all prescriptions ( including controlled sub prescriptions) to be issued ____
Electronically *Effective march 27. 2016 with exceptions noted at the top of the next page
True or False In New York state, it is legal to prescribe and/or fill an order for schedule 1 controlled substance
False
True or False The initial prescribing of a controlled substance may occur prior to examination of the patient by the practitioner
False May be up to a 5 (five) day supply may be issued if it is an emergency AND a prescriber-patient relationship already exists.
Controlled substances must be issued only for
Legitimate medical purposes
How should a pharmacist interpret "PRN refills" on a controlled substance prescription?
PRN means ZERO Refills in NY.
Exception of non electronic prescriptions are
Prescriptions written by Veterinarians. Temporary technological failure precludes electronic prescribing Prescribers who have a waiver or renewal of a waiver (waivers are valid for 1 year) No more than 5 days supply of medication in situations where the prescriber determines e prescribing to impractical and would adversely impact the patient's medical condition The prescription will be dispensed by an out of state pharmacy Prescribers who certify to the NYDOH that they will not issue more than 25 prescriptions per 12 months (includes controlled and non controlled substances)
