CII prescriptions in Texas

[Estrace]

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what is the max days supply you can dispense in Texas ?
To my understanding, you can only dispense 30 days supply at a time but a doctor can write for up to 90 days supply but on multiple scripts and with earliest fill date written on each of them. Has the law changed ?

 

[pillpharmer]

I thought the law had changed to right up to a 90 day supply but can't call the doctor to call to change the prescription date written.

Before you could only write for a 30 day supply but could call the doctor if the script wasn't filled in the 21 day time period to have the date changed. How you can't change the date.

 

[BenJammin]

You can only dispense a 30 day supply but that doesn't stop doctors from giving the patient 3 scripts with one dated this month and the others dated for the next two months. Can't change the date once you receive it.

 

[Estrace]

You can only dispense a 30 day supply but that doesn't stop doctors from giving the patient 3 scripts with one dated this month and the others dated for the next two months. Can't change the date once you receive it.

This is exactly what I thought but every single pharmacist I texted this evening said we can dispense 90 days at a time. I'm confused.

 

[MountainPharmD]

All incorrect.

Texas Pharmacy law does not specify a days supply or quantity limit for c-ll prescriptions. Texas does specify a C-ll prescription must be filled within 21 days of issuance or the earliest fill date. Texas Pharmacy law mirrors federal with respect to the issuance of multiple C-ll prescriptions.

Federal law does not specify quantity or days supply limits or expiration of c-ll prescriptions.

From the Pharmacist Manual:

eSchedule II controlled substances require a written prescription which must be manually signed by the practitioner or an electronic prescription that meets all DEA requirements for electronic prescriptions for controlled substances. There is no federal time limit within which a schedule Prescription must be filled after being signed by the practitioner. However, the pharmacist must determine that the prescription is still needed by the patient. While some states and many insurance carriers limit the quantity of controlled substances dispensed to a 30-day supply, there are no express federal limits with respect to the quantities of drugs dispensed via a prescription. However, the amount dispensed must be consistent with the requirement that a prescription for a controlled substance be issued only for a legitimate medical purpose by a practitioner acting in the usual course of professional practice. For a schedule II controlled substance, an oral order is only permitted in an emergency situation (see Section X, Emergency Dispensing).

 

[MountainPharmD]

Instead of guessing and being confused why dont you all use your brains and go to the Texas State Board of Pharmacy website, The Texas Department of Public Safety website and the DEA website and look it up?

 

[CUninja]

All incorrect.

Texas Pharmacy law does not specify a days supply or quantity limit for c-ll prescriptions. Texas Pharmacy law mirrors federal with respect to the issuance of multiple C-ll prescriptions.

Federal law does not specify quantity or days supply limits or expiration of c-ll prescriptions.

From the Pharmacist Manual:

To clarify:

Go to Texas BOP site > Texas Controlled Substance Rules >Subchapter D > Rules 13.75 > section b

C2 prescriptions expire 21 days after date written on prescription OR 21 days after earliest fill date on DPS form, if written sequentially...another question which commonly causes confusion.

 

[Estrace]

Mountain...I used my brain and went to Texas State Board of Pharmacy website.
It said on there that a prescriber can write up to 90 days supply but on multiple prescriptions each with an earliest fill date. I also know the federal law does not specify quantity, days supply or expiration but the state law supersedes the federal law if the state law is stricter right ?

 

[rxtech2012]

Can't change name,name,name, and date. Name of patient, doctor, drug or written date(s).

 

[MountainPharmD]

Mountain...I used my brain and went to Texas State Board of Pharmacy website.
It said on there that a prescriber can write up to 90 days supply but on multiple prescriptions each with an earliest fill date. I also know the federal law does not specify quantity, days supply or expiration but the state law supersedes the federal law if the state law is stricter right ?

That only applies to the issuance of multiple prescriptions. There is no law that limits the quantity or days supply on a single prescription. You can fill a single prescription for any quantity and days supply the doctor writes for. Remembering of course you have a corresponding responsibility to ensure the prescription was written for a legitimate medical purpose and all that.

 

[MountainPharmD]

Here is some more Texas fun. Can you fill a C-II prescription in Texas written by an out of state doctor ?

 

[BenJammin]

Here is some more Texas fun. Can you fill a C-II prescription in Texas written by an out of state doctor ?

I believe so but it requires some kind of correspondence with DPS. I don't know, hospital world doesn't have to deal with that lol

 

[CUninja]

Here is some more Texas fun. Can you fill a C-II prescription in Texas written by an out of state doctor ?

Of course you can. It's not going to be on a DPS script...you just have to have some sort of agreement with the board and follow that agreement.

 

[MackandBlues]

The correct answer is on the multiple C2 prescriptions:
May issue multiple prescriptions as long as the following apply
Up to a 90 day supply (NO limit on quantity)
Must be fore a legitimate medical purpose
Must include the earliest date on which a pharmacy may fill
Will not cause risk of diversion or abuse

See Texas Controlled Substance Act Sec 481.074 I paraphrased

 

[MountainPharmD]

Of course you can. It's not going to be on a DPS script...you just have to have some sort of agreement with the board and follow that agreement.

Sort of answered the question. It is not as easy as your response.

 

[Estrace]

The correct answer is on the multiple C2 prescriptions:
May issue multiple prescriptions as long as the following apply
Up to a 90 day supply (NO limit on quantity)
Must be fore a legitimate medical purpose
Must include the earliest date on which a pharmacy may fill
Will not cause risk of diversion or abuse

See Texas Controlled Substance Act Sec 481.074 I paraphrased

That's what I do too until everyone started telling me I can do 90 days.
If a doctor writes for : adderall 20 Mg #100 1 PO tid. you are only getting 90 tabs as far as I'm concerned. I didn't see where it says we can dispense 90 days at a time. It actually warned doctors not take advantage of the multiple rx thing and only see their patients once a every 90 days.

 

[MackandBlues]

.

 

[MackandBlues]

To quote the exact law:

d-1) Notwithstanding Subsection (d), a prescribing practitioner may issue multiple prescriptions authorizing the patient to receive a total of up to a 90-day supply of a Schedule II controlled substance if🙁1) each separate prescription is issued for a legitimate medical purpose by a prescribing practitioner acting in the usual course of professional practice;(2) the prescribing practitioner provides instructions on each prescription to be filled at a later date indicating the earliest date on which a pharmacy may fill each prescription;(3) the prescribing practitioner concludes that providing the patient with multiple prescriptions in this manner does not create an undue risk of diversion or abuse; and(4) the issuance of multiple prescriptions complies with other applicable state and federal laws.

 

[MountainPharmD]

That's what I do too until everyone started telling me I can do 90 days.
If a doctor writes for : adderall 20 Mg #100 1 PO tid. you are only getting 90 tabs as far as I'm concerned. I didn't see where it says we can dispense 90 days at a time. It actually warned doctors not take advantage of the multiple rx thing and only see their patients once a every 90 days.

Why? Show me the law that states on a single prescription you are limited to filling a certain days supply.

What does the law concerning the issuance of multiple prescriptions at the same time have to do with filling one stand alone prescription?

The law is not difficult. You make it more difficult by misinterpreting it, applying laws for one situation to a completely different one or just make up laws and insert wording that is not there. If you tell me I cannot do something because that is the law then pony up and pull out the exact law and show me.

 

[owlegrad]

Why? Show me the law that states on a single prescription you are limited to filling a certain days supply.

What does the law concerning the issuance of multiple prescriptions at the same time have to do with filling one stand alone prescription?

The law is not difficult. You make it more difficult by misinterpreting it, applying laws for one situation to a completely different one or just make up laws and insert wording that is not there. If you tell me I cannot do something because that is the law then pony up and pull out the exact law and show me.

Don't you know if the law doesn't explicitly allow a pharmacist to do something that means it is illegal? 😕

 

[CUninja]

Sort of answered the question. It is not as easy as your response.

Not sure what details you are looking for? Rule 13.82 specifically talks about this...as long as the presciber can prescribe C-II's in their own state, then they are good in Texas.

P.S. I would venture to say that Title 37, Part 1, Ch 13, Sub D, Rule 13.73d specifically limits C-II's to a maximum of 90 day supply. Here is the exact wording from the Administrative code

"(d) Issuance of multiple Schedule II prescriptions. A practitioner may issue multiple prescriptions authorizing a patient to receive a total up to a 90-day supply of a Schedule II controlled substance provided:

(1) each separate prescription is issued for a legitimate medical purpose while practitioner is acting in the usual course of professional practice;

(2) the practitioner provides written instructions on each prescription (other than the first prescription; the first prescription is intended to be filled within 21 days of issuance) indicating the earliest date on which a pharmacy may fill each prescription;

(3) the practitioner concludes that providing the patient with multiple prescriptions in this manner does not create an undue risk of diversion or abuse;

(4) the individual practitioner complies fully with all other applicable requirements under the Health and Safety Code, Chapter 481 and these regulations. "

I read this to say - whether a doctor write a single script or multiple scripts, a 90 day maximum exists. Why else would language exist where only multiple prescriptions are limited to a 90 day supply and not single ones? There is no common sense to that...I think we should call the state board and ask this specific question.

 

[MountainPharmD]

P.S. I would venture to say that Title 37, Part 1, Ch 13, Sub D, Rule 13.73d specifically limits C-II's to a maximum of 90 day supply.

I am not asking what you would venture to say, or what you think is correct or what you think makes sense. You are telling me that there is a law that specifically states a C-II has a maximum days supply limitation of 90. Find the law and show me.

 

[MountainPharmD]

I read this to say - whether a doctor write a single script or multiple scripts, a 90 day maximum exists. Why else would language exist where only multiple prescriptions are limited to a 90 day supply and not single ones? There is no common sense to that...I think we should call the state board and ask this specific question.

Again it is not about how you read it, or what you think makes sense. I do not need to call the State Board.....I can read.

You want to debate what makes sense? Why does every State have different laws governing the same medications. Why is it left up to the States to regulate the practice of pharmacy? Why do some states have stricter laws than federal law and some do not?

 

[MountainPharmD]

Don't you know if the law doesn't explicitly allow a pharmacist to do something that means it is illegal? 😕

It is a gift unique to the pharmacy profession. The ability to bend, twist, stretch, add to, take away from and complete fabricate if necessary laws to justify whatever it is you are refusing to do.

 

[MountainPharmD]

"(d) Issuance of multiple Schedule II prescriptions. A practitioner may issue multiple prescriptions authorizing a patient to receive a total up to a 90-day supply of a Schedule II controlled substance "

To save everyone some time the continued referencing and quoting of the rules governing the issuance of multiple prescriptions at the same time is quite clear and not relevant to this discussion.

I walk into your pharmacy with a single prescription for #120 generic Adderall XR 30 mg capsules 1 qd. What do you do and why? Justify your answer by quoting the specific law, rule, regulation or policy that specifically backs up your decision.

 

[CUninja]

Again it is not about how you read it, or what you think makes sense. I do not need to call the State Board.....I can read.

You want to debate what makes sense? Why does every State have different laws governing the same medications. Why is it left up to the States to regulate the practice of pharmacy? Why do some states have stricter laws than federal law and some do not?

The 10th amendment to the US Constitution is why the practice of pharmacy is left to the states. One would expect different states to have different laws.

The fact that I cannot prove my position to your liking does not cloud the fact that you cannot disprove my position either.

Show me in the law where it is specifically mentioned that one can dispense more than a 90 day supply...after all, this is what you are asking me to do. Shouldn't you be held to the same standard?

 

[bob1234]

Anyone ever have patients who live out of the country almost year round get their entire year's worth of meds when they are back in the states? I believe they had been dispensed their meds for the entire year including CII, but I could be mistaken.

Why not call the state board? Are you afraid it will make you look incompetent?

 

[All4MyDaughter]

The 10th amendment to the US Constitution is why the practice of pharmacy is left to the states. One would expect different states to have different laws.

The fact that I cannot prove my position to your liking does not cloud the fact that you cannot disprove my position either.

Show me in the law where it is specifically mentioned that one can dispense more than a 90 day supply...after all, this is what you are asking me to do. Shouldn't you be held to the same standard?

The issue is addressed in the federal law. Where the state law is silent, federal law prevails. Federal law does not limit the quantity or days supply of any single C-II prescription. If that issue is not specifically addressed in Texas law, federal law stands.

Mountain is right. The multiple prescriptions issued on the same date for up to a 90 day supply topic is not relevant to this discussion. The purpose of that regulation is to allow the patient to receive OVER TIME a 90 day supply without the necessity of monthly office visits.

I think most of the answers you are looking for will be found here: http://www.deadiversion.usdoj.gov/faq/mult_rx_faq.htm

 

[MountainPharmD]

The 10th amendment to the US Constitution is why the practice of pharmacy is left to the states. One would expect different states to have different laws.

The fact that I cannot prove my position to your liking does not cloud the fact that you cannot disprove my position either.

Show me in the law where it is specifically mentioned that one can dispense more than a 90 day supply...after all, this is what you are asking me to do. Shouldn't you be held to the same standard?

It has nothing to do with proving it to my liking. You can't prove your position at all.

Does State and Federal pharmacy law detail every single thing you can or cannot do? No and that is the point. If State or Federal law does not specifically prohibit an activity you cannot stretch, create, modify or make up a law to justify your position.

The fact is there is no law either State of Texas, DPS or Federal that specifically states a C-II prescription can only be dispensed for a max quantity and days supply of 90 proves my point.

 

[Estrace]

The issue is addressed in the federal law. Where the state law is silent, federal law prevails. Federal law does not limit the quantity or days supply of any single C-II prescription. If that issue is not specifically addressed in Texas law, federal law stands.

Mountain is right. The multiple prescriptions issued on the same date for up to a 90 day supply topic is not relevant to this discussion. The purpose of that regulation is to allow the patient to receive OVER TIME a 90 day supply without the necessity of monthly office visits.

I think most of the answers you are looking for will be found here: http://www.deadiversion.usdoj.gov/faq/mult_rx_faq.htm

So what's the point in writing a multiple rx for a 90 days supply when the doctor can easily write the patient a 90 days supply on one script. 99% of CII scripts are writtten for a month supply anyway, you want to tell me doctors prefer to waste their rx pad rather than just give the patient one script for 90 days supply ?

 

[All4MyDaughter]

So what's the point in writing a multiple rx for a 90 days supply when the doctor can easily write the patient a 90 days supply on one script. 99% of CII scripts are writtten for a month supply anyway, you want to tell me doctors prefer to waste their rx pad rather than just give the patient one script for 90 days supply ?

They may not want the patient to have 90 days worth of medication in their possession at one time. Insurance may not pay for a 90 days supply.

 

[MountainPharmD]

So what's the point in writing a multiple rx for a 90 days supply when the doctor can easily write the patient a 90 days supply on one script. 99% of CII scripts are writtten for a month supply anyway, you want to tell me doctors prefer to waste their rx pad rather than just give the patient one script for 90 days supply ?

Who cares? It is up to the doctor to decide what they are going to write for and how they will do it. Understanding the reason why has nothing to do with determining what we are legally able to dispense.

Understand the why does come into play when using your professional judgement in evaluating the prescription. That is a whole other topic of discussion and has nothing to do with the current discussion.

Now go back and re-read your last response. Are you seriously wondering why? You are a practicing pharmacist correct? Think about it for a minute.....

 

[txpharmguy]

Yes, however the prescriber has to be registered without Texas Department of Public Safety and write them on the "official" prescription pad. This is common in border towns..

 

[Rxnupe]

They may not want the patient to have 90 days worth of medication in their possession at one time. Insurance may not pay for a 90 days supply.

mountain is correct- various reason why MD doesn't write 90 days at a time- also with Medicaid scripts for 90 days you MUST get an override- for each 90 day prescription.

 

[Whereismynorco]

for the sake of MPJE, Dr can write a C2 rx for 90 days supply and pharmacist can fill one rx for 90 days legally. Am i correct??

 

[sosoo]

for the sake of MPJE, Dr can write a C2 rx for 90 days supply and pharmacist can fill one rx for 90 days legally. Am i correct??

no. for the sake of mpje, "if" texas law has a 30 day supply limit, you cannot dispense 90 day supply. only "if" texas law specified 90 day supply limit, then you can dispense 90 day supply. and yes, no texas pharmacist on this forum can pinpoint on texas board website what the real answer is.

 

[CountBy5s]

no. for the sake of mpje, "if" texas law has a 30 day supply limit, you cannot dispense 90 day supply. only "if" texas law specified 90 day supply limit, then you can dispense 90 day supply. and yes, no texas pharmacist on this forum can pinpoint on texas board website what the real answer is.

No limit to amount to be dispensed. You can legally dispense 2000 nocro or a 365 day supply at one time. No limit. Insurance sets these limits. But you better have really good reason to dispense it. Obviously you won't run into this problem. But it is in no way illegal. Yes this question. Will be on the MPJE. Don't confuse common 30 day or 90 day practice with actual law.