Controlled Substance Prescription: Emergency Oral and Partial Fill
A patient presents to a community pharmacy in Anchorage on a Friday with a written prescription for oxycodone 30 mg, #120, from a physician in Washington state. The prescription is dated 10 days ago. The patient says they just moved to Alaska and their pain is severe. The pharmacist verifies the prescriber's DEA registration is active and the prescription is otherwise valid. The patient requests a partial fill of 30 tablets because they cannot afford the full amount. The pharmacist knows Alaska has a prescription drug monitoring program (PDMP) and that federal rules allow partial filling of Schedule II prescriptions under certain conditions. The pharmacy's wholesaler will not deliver until Monday.
1. Can the pharmacist legally fill this Schedule II prescription in Alaska? Explain the federal and state requirements that apply, including any issues with the out-of-state prescriber and the date of the prescription.
Read the worked answer
Under federal law (21 CFR 1306.05), a Schedule II prescription must be written by a practitioner registered with DEA and must be for a legitimate medical purpose. The prescriber is DEA-registered in Washington, which is valid nationwide; DEA registration is not limited to the state of practice. However, Alaska law (12 AAC 52.240) requires that a prescription for a controlled substance be written by a practitioner licensed in Alaska or exempt, and the pharmacist must verify the prescriber's authority. Alaska generally recognizes out-of-state prescribers if they are DEA-registered and the prescription is for a legitimate medical purpose, but the pharmacist should confirm the prescriber's Alaska license status or that they are otherwise authorized. The prescription is 10 days old; federal law does not set an expiration date for Schedule II prescriptions, but Alaska law (12 AAC 52.240) states that a Schedule II prescription is void if not filled within 7 days of issuance, unless the prescriber indicates otherwise. Since it is 10 days old, the pharmacist cannot fill it without prescriber confirmation. The pharmacist should contact the prescriber to verify and obtain a new prescription or authorization. Additionally, the pharmacist must check the PDMP before dispensing. Therefore, the pharmacist cannot legally fill as presented; must resolve the 7-day issue and verify prescriber authority.
2. If the prescription is reissued and valid, how should the pharmacist handle the partial fill request? What are the recordkeeping requirements?
Read the worked answer
Under federal law (21 CFR 1306.13), a pharmacist may partially fill a Schedule II prescription if the pharmacist is unable to supply the full quantity, but must note the quantity supplied on the prescription and must fill the remainder within 72 hours; if not filled within 72 hours, the pharmacist must notify the prescriber and no further quantity may be supplied beyond 72 hours without a new prescription. However, the patient is requesting a partial fill due to cost, not inability to supply. Federal law does not permit partial fills at patient request for Schedule II. Alaska law (12 AAC 52.240) may have additional provisions. The pharmacist cannot partially fill solely because the patient cannot afford it; must either dispense full quantity or not at all. If the pharmacy cannot supply the full quantity, the partial fill rule applies. Since the pharmacy has the full quantity (or can get it Monday), the pharmacist should explain that partial fill for cost is not allowed for Schedule II. The pharmacist could suggest the patient seek a prescription for a lower quantity or discuss with prescriber. If a partial fill is done due to insufficient stock, the pharmacist must record the date, quantity dispensed, and quantity remaining on the prescription, and notify the prescriber if remainder not picked up within 72 hours.