substance prescriptions, which is critical amid an opioid overdose crisis that spiked as the COVID-19 pandemic hit the United States. Already used by
virtually all pharmacies, EPCS saw an 18% jump in the number of enabled prescribers in 2021. 110
Schedule II controlled substance prescribing considerations Schedule II controlled substances require a written, signed prescription, except where states have enacted laws allowing EPCS. There is no federal law limiting when a signed prescription expires. A verbal order
Under federal law, a prescriber may issue multiple prescriptions authorizing the patient to receive up to a 90-day supply of a Schedule II controlled substance based on the following conditions: ● Each separate prescription is issued for a legitimate medical purpose by an individual practitioner acting in the usual professional practice. ● The prescriber provides written instructions on each prescription, indicating the earliest date on which a pharmacy may fill each prescription. The first prescription does not need a fill date on it if the prescriber intends for that prescription to be filled immediately. ● The practitioner concludes that providing the patient with multiple prescriptions in this manner does not create a risk of diversion or abuse. ● Issuing multiple prescriptions is permissible under applicable state laws. ● The practitioner complies with all other requirements of the CSA and any other provisions of state law. Regardless of the method of transmission of a controlled substance prescription—by hand delivery, facsimile, phone call, or electronically—DEA regulations make it clear that the legal responsibility for issuing a valid prescription that “conform[s] in all essential respects to the law and regulations” rests upon the prescribing practitioner. However, a pharmacist is responsible for properly prescribing and dispensing controlled substances: ● A practitioner prescribing Schedule II controlled substances to be compounded for direct administration to a patient by parenteral, intravenous, intramuscular, subcutaneous, or intraspinal infusion may transmit the prescription by facsimile. ● Practitioners prescribing Schedule II controlled substances for residents of long-term care facilities may transmit a prescription by facsimile to the dispensing pharmacy. The practitioner’s agent may also transmit the prescription to the pharmacy. ● A practitioner prescribing a Schedule II narcotic- controlled substance for a patient enrolled in a hospice care program certified and paid for by Medicare under Title XVIII or a hospice program licensed by the state may transmit a prescription to the dispensing pharmacy by facsimile. The practitioner or agent may transmit the prescription to the pharmacy and will note on the prescription that it is for a hospice patient.
is permitted only in an emergency for Schedule II controlled substances. Written prescriptions for a Schedule II controlled substance may not be refilled. While there is no federal quantity limit for Schedule II controlled substance prescriptions, many states have enacted legislation limiting quantities for opioid prescriptions. As of 2018, 33 states passed legislation limiting it, guidance, or other requirements related to prescribing opioids. 111 In general, this legislation limits first-time opioid prescriptions for acute pain to a supply for a certain number of days (i.e., 3, 5, 7, or 14 days) or dosage limits (i.e., morphine milligram equivalents, MMEs); most states set exceptions for chronic pain treatment, cancer pain, and palliative care. In addition, some states have also set limits for minors. 112 controlled substance be dispensed by a pharmacy only according to a written prescription, except in emergencies, and prohibits Schedule II prescriptions from being refilled. Thus, in most cases, a pharmacist must receive the original, manually signed paper or electronic prescription before dispensing a Schedule II controlled substance. 93 Therefore, a prescriber may transmit a Schedule II prescription to the pharmacy via facsimile to expedite the filing. However, the original Schedule II prescription must be presented to the pharmacist for review before the controlled substance is dispensed. In an emergency, a practitioner may call in a prescription for a Schedule II controlled substance to the pharmacy. The pharmacist may dispense the medication, provided the quantity prescribed and dispensed is limited to enough to treat the patient only during the emergency period. The prescribing practitioner must provide the pharmacist a written and signed prescription within seven days. The pharmacist must notify the DEA if the prescription is not received in that timeframe. The DEA has granted three exceptions to the facsimile prescription requirements for Schedule II controlled substances. As a result, the facsimile of a Schedule II prescription may serve as the original prescription as follows.
Facsimile and oral prescriptions for Schedule II controlled substances Generally, a valid Schedule II controlled substance prescription is not allowed to be transmitted via facsimile. The CSA requires that a Schedule II
Book Code: TN24CME
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