The Partial Fill and the Lost Bottle
A patient presents a Schedule II prescription for amphetamine salts 20 mg, 90 tablets, one daily. The pharmacy has only 30 tablets in stock. The prescriber is unavailable, and the patient says she needs the medication today. The pharmacist dispenses a partial fill of 30 tablets and documents it. Two weeks later, the patient returns and says she lost the bottle and needs the remaining 60 tablets. The pharmacist reviews the record and sees the partial fill was properly documented and that the patient signed for the 30 tablets. The patient is insistent and says she will run out before her next appointment.
1. Was the pharmacist permitted to dispense a partial fill of this Schedule II prescription?
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Yes, under limited circumstances. Federal law permits a partial fill of a Schedule II prescription if the pharmacist is unable to supply the full quantity, provided the pharmacist notes the quantity supplied on the prescription and the remaining portion is filled within 72 hours. If the remaining portion is not filled within 72 hours, the pharmacist must notify the prescriber, and the remaining portion may not be filled unless the prescriber authorizes a new prescription. The pharmacist should have documented the partial fill and the date, and should have arranged to complete the fill within 72 hours or notified the prescriber. The pharmacist should review whether those steps were taken.
2. Can the pharmacist dispense the remaining 60 tablets now, two weeks later, because the patient lost the first bottle?
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No. The 72-hour window for completing the partial fill has long passed, and the patient's loss of the medication does not create authority to dispense the remaining quantity. The pharmacist cannot replace a lost controlled substance on the same prescription. The pharmacist should not dispense the remaining 60 tablets without a new prescription from the prescriber. The pharmacist should contact the prescriber to explain the situation and determine whether a new prescription is appropriate, and should document the conversation. The pharmacist should also consider whether the loss should be reported or documented according to pharmacy policy and Arkansas requirements.
3. What should the pharmacist tell the patient, and what documentation should be made?
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The pharmacist should explain that the remaining quantity cannot be dispensed on the original prescription because the partial-fill window has closed and the loss of medication does not authorize a replacement. The pharmacist should offer to contact the prescriber to discuss options and should not promise a replacement. The pharmacist should document the patient's report of the loss, the date, the original partial fill, the quantity dispensed, and the steps taken to contact the prescriber. If the prescriber issues a new prescription, the pharmacist should verify it and document the new prescription separately. The pharmacist should also follow pharmacy policy on lost or stolen controlled substances and any applicable reporting requirements.