Emergency Refill Versus Controlled Substance Refill

Ohio permits a one-time emergency refill of a noncontrolled maintenance medication when the prescriber cannot be reached. Levothyroxine is a noncontrolled maintenance drug, and the prescriber's office is closed for several days, so the threshold facts are present. The pharmacist should limit the quantity to a 30-day supply, which is the typical Ohio limit, and should not use the provision repeatedly for the same prescription. The pharmacist must make a good-faith effort to contact the prescriber, counsel the patient, and notify the prescriber of the emergency dispensing. The pharmacist should also confirm that the patient has an established history with the medication and that there is no indication of misuse. The emergency refill is a bridge, not a new prescription, so the pharmacist should not create refills or extend the original prescription beyond the emergency supply.

No. Ohio's emergency refill authority is limited to noncontrolled medications. Alprazolam is a Schedule IV controlled substance, so the emergency refill statute does not apply. The prescription has no refills remaining, and the pharmacist cannot refill a controlled substance without prescriber authorization. The pharmacist should explain the legal limit to the patient, offer to contact the prescriber when the office opens, and provide appropriate counseling or referral for the panic symptoms. The pharmacist should not dispense a partial supply as an emergency refill unless a valid prescriber authorization exists. Documenting the request and the refusal protects the pharmacist and shows that the decision was based on the controlled-substance status of the drug, not on a judgment about the patient's character.

The pharmacist should document the date and time of the request, the drug, strength, dosage form, quantity dispensed, and directions. The record should show the attempts to reach the prescriber, including phone numbers called and times, and the reason the prescriber could not be reached. The pharmacist should note the patient's history with the medication, the counseling provided, and the patient's acknowledgment. The record should identify the pharmacist who made the decision and should state that the supply is a one-time emergency refill. The prescriber should be notified afterward, and the notification should be documented. The pharmacist should also retain the original prescription record and avoid altering the original refill authorization. This documentation supports compliance and helps the next pharmacist understand what was dispensed and why.