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[Missha]

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[zelman]

Elavil is antidepressant, but if the patient is using the drug to treat diabetic neuropathy, is it permissible to dispense a 90-day supply (if the original prescription was 30 day supply + refills, and the patient was doing fine on the first fill) without the prescriber's authorization, per 4064.5 in the state of California?

Thank you in advance for your input.

4064.5. Dispensing a 90-Day Supply of a Dangerous Drug or Device; Requirements and Exceptions
(a) A pharmacist may dispense not more than a 90-day supply of a dangerous drug other than a controlled substance pursuant to a valid prescription that specifies an initial quantity of less than a 90-day supply followed by periodic refills of that amount if all of the following requirements are satisfied:...

(e) This section shall not apply to psychotropic medication or psychotropic drugs as described in subdivision (d) of Section 369.5 of the Welfare and Institutions Code.

Section 369.5 of the Welfare and Institutions Code:
(d) Psychotropic medication or psychotropic drugs are those medications administered for the purpose of affecting the central nervous system to treat psychiatric disorders or illnesses.  These medications include, but are not limited to, anxiolytic agents, antidepressants, mood stabilizers, antipsychotic medications, anti-Parkinson agents, hypnotics, medications for dementia, and psychostimulants.

No. Antidepressants are explicitly named as being psychotropics, without considering the indication for use. If that last sentence wasn't part of the law, things might be different.

 

[BidingMyTime]

I would err on the side of caution (especially since you presumably don't have access to the patient's chart to see what the doctor has documented....ie maybe the doctor has told you and the pt that the pt has neuralgia so he's being treated with amitriptyline, but in the chart the doctor notes that pt has psychosomatic pain, so he's treating him with amitriptyline.) Especially with drugs like amitriptyline that are *only* FDA approved for psychiatric illnesses (regardless of the fact that they everyone knows they are used for other reasons.)

Or move to IL, where every prescription, including C's (CII excluded) can be converted to a 90 day supply.

 

[Sine Cura]

You probably noticed the definition of "psychotropic" is odd. Riluzole would fall in this category because of CNS effects. ("These medications include, but are not limited to...") There are certainly psychiatric sequelae of Alzheimer's, a neurodegenerative disease... What about anything related to addiction? Suboxone, Chantix, etc.

Just CYA and get authorization for a 90-day supply.