Moving Two Prescriptions: One That Can Travel and One That Cannot
Pharmacist B at a Springfield pharmacy takes a call from a patient relocating from St. Louis. The patient wants two prescriptions moved to B's store: (1) amphetamine/dextroamphetamine 20 mg, #60, written 9 days ago, never filled, marked no refills; and (2) alprazolam 0.5 mg, #90, written 4 months ago, filled once at the original pharmacy with two refills remaining. The original pharmacy is open, licensed, and reachable. B's store holds a Missouri pharmacy license and its own DEA registration. B's technician asks whether the other pharmacist can just read both prescriptions over the phone and whether B has to keep anything in writing. The patient's identity has been verified in person.
1. Which of the two prescriptions may be transferred, and on what authority?
Read the worked answer
The amphetamine/dextroamphetamine cannot be transferred. The alprazolam can.
- Schedule II: DEA does not permit transfer of a Schedule II prescription between pharmacies for initial filling or otherwise. There is no telephone-transfer mechanism. The patient must obtain a new prescription from the prescriber and present it to B's pharmacy (paper or EPCS). Nine days old and unfilled makes no difference - age is not the obstacle; the schedule is.
- Schedule IV (alprazolam): transferable. For a prescription with refills remaining, the transfer is permitted up to the number of refills remaining (here, two). A one-time transfer for an initial fill of a CIII–V prescription is also permitted, but only once.
The transfer must be pharmacist-to-pharmacist; a technician may gather information but the transferring and receiving pharmacists own the act. Reading the alprazolam order over the phone is the normal mechanism, but it must be documented on both ends.
2. What must each pharmacy record, and what happens to the original prescription?
Read the worked answer
Transferring pharmacy (St. Louis) must record on the original, which stays on file there:
- Date of transfer;
- Name and address of the receiving pharmacy;
- Name of the receiving pharmacist;
- Its own notation that the prescription was transferred (e.g., "VOID - transferred"), so no further refills are dispensed against it.
Receiving pharmacy (Springfield) must record:
- The word "transfer";
- Original prescription number and original date of issue;
- Name and address of the transferring pharmacy;
- Name of the transferring pharmacist;
- The refills remaining and the date of transfer.
B's record must be readily retrievable for the required retention period and must be able to be handed off again if the patient later moves. The original prescription number (not a new one the receiving store invents) is the anchor for the audit trail.
3. The alprazolam was written 4 months ago with two refills left. What is B's exposure on the refills, and what should B tell the patient?
Read the worked answer
A Schedule III–V prescription may be refilled up to five times, but not after 6 months from the date of issue. This one was written 4 months ago, so the two remaining refills must be dispensed within the next 2 months; after that the prescription is dead regardless of what the label says.
B should:
- Enter the fill and both remaining refills with the original issue date driving the 6-month cutoff, not the transfer date.
- Tell the patient plainly that the alprazolam runs out in about two months and a new prescription will be needed - the patient is moving and will otherwise discover this at the worst time.
- Set expectations for the amphetamine: no transfer, so the prescriber must send a new prescription to Springfield; B should not promise to "call and get it moved."
Recording refills against a transfer date rather than the original issue date is a common and easily detected error.