Transferring a Stimulant Prescription Across State Lines
A 28-year-old woman moves from Maryland to Newark, Delaware, and brings an empty bottle for amphetamine/dextroamphetamine extended-release 20 mg, #30, with one refill remaining. The prescription was electronically sent to a Maryland pharmacy 3 weeks ago and 30 capsules were dispensed. She asks a Delaware pharmacy to “transfer the remaining refill” because her Maryland pharmacy is 90 minutes away and she started a new job. The Delaware pharmacist contacts the Maryland pharmacy and confirms the prescription is authentic, has one refill left, and was last filled 21 days ago. The patient’s Delaware driver’s license is current, and she provides the Maryland pharmacy’s phone number. The prescriber is licensed in Maryland and DEA-registered in Maryland but not in Delaware. The patient is calm, has no early-refill history on the Delaware PMP, and says she cannot get a new appointment for 6 weeks.
1. Can the remaining refill be transferred to the Delaware pharmacy? Explain.
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No. Amphetamine/dextroamphetamine extended-release is a Schedule II controlled substance. Federal regulations at 21 CFR 1306.25 permit the transfer of prescription information between pharmacies only for Schedule III, IV, and V prescriptions, and only for the purpose of refill dispensing. Schedule II prescriptions may not be transferred between pharmacies. Delaware follows the federal controlled-substance framework, so the Delaware pharmacy cannot accept the Maryland pharmacy’s records as authority to dispense the remaining refill.
The fact that the prescription is authentic and has a refill remaining does not change the result. The correct options are for the patient to obtain a new prescription from a prescriber authorized to prescribe in Delaware, or to return to the Maryland pharmacy for the refill. The pharmacist should explain the rule clearly and avoid suggesting that a “courtesy fill” is available. The pharmacist should also consider whether the Maryland prescriber is DEA-registered in Delaware; a new prescription for a controlled substance dispensed in Delaware generally requires the prescriber to be DEA-registered in the state where the prescription is dispensed and authorized under Delaware law. The pharmacist should document the request, the explanation given, and any referral.
2. How would the analysis change if the medication were testosterone cypionate, a Schedule III controlled substance, with one refill remaining?
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The analysis would change because Schedule III prescriptions may be transferred once between pharmacies for refill dispensing under 21 CFR 1306.25, provided the transfer is permitted by the states involved and is done pharmacist-to-pharmacist. The transferring pharmacist must record the transfer, including the transferring pharmacy’s name and address, the receiving pharmacy’s name and address, the date of transfer, and the transferring pharmacist’s name. The receiving pharmacist must record the same information and must not transfer the prescription again. The original prescription is then voided at the transferring pharmacy.
For a Delaware pharmacy to fill the transferred refill, the prescription must still be valid and the prescriber must be authorized to prescribe the controlled substance in Delaware. The Maryland prescriber’s lack of Delaware DEA registration is a potential obstacle; the pharmacist should verify the prescriber’s DEA registration in the state where the controlled substance will be dispensed before completing the transfer. If that registration is not in place, the transfer should not be completed. The pharmacist should also confirm that the prescription has not expired under the applicable rules and that the patient’s PMP review does not reveal unresolved red flags. Documentation of the one-time transfer must be retained by both pharmacies.