I am confused on the Control Substance dispensing portion of C2 and C3-4 for California
According to Rxprep: Federal and California do not put any quantity limit for C2 drugs, but dont they issue a days supply limit? Their is a limit i am assuming for 30 days or less. The DEA also allowed prescribers to write multiple rxs which are filled sequentially but are NOT predated/post dated (must have same issue date) and cannot exceed 90 days supply. For example:
A doctor writes for Fentanyl 25mcg Patch Q72 hours with issue date of 7-18-2018. He can technically write for 2 additional rx's in california security form for fentanyl with the 2 additional stating the earliest fill date: not to fill earlier than 8-18-2018 and 9-18-2018. Is that Correct?
Edit: I just realized I answered a completely different question earlier lol. I thought you were asking about CII partial fills for some reason, it's too early in the morning lol. Anyways, I believe your are correct.
Source:
SECTION IX-XIV
What I originally answered (thinking you were asking about partial CII fills)
Well, as of right now, my understanding is that when you do a partial fill for a CII, then you have 72 hours to dispense the remaining portion and the prescription expires. This can be done only if you're pharmacy runs out of the medication, but knows they will get more in the next 72 hours.
Source:
http://www.pharmacy.ca.gov/laws_regs/1745_15dmt.pdf
However, this law will change on July 1st, 2018 (see below):
Section 4052.10 is added to the Business and Professions Code, to read: (a) A pharmacist may dispense a Schedule II controlled substance, as listed in Section 11055 of the Health and Safety Code, as a partial fill if requested by the patient or the prescriber. (b) If a pharmacist dispenses a partial fill on a prescription pursuant to this section, the pharmacy shall retain the original prescription, with a notation of how much of the prescription has been filled, until the prescription has been fully dispensed. The total quantity dispensed shall not exceed the total quantity prescribed. (c) Subsequent fills, until the original prescription is completely dispensed, shall occur at the pharmacy where the original prescription was partially filled. The full prescription shall be dispensed not more than 30 days after the date on which the prescription was written. Thirtyone days after the date on which the prescription was written, the prescription shall expire and no more of the drug shall be dispensed without a subsequent prescription. (d) The pharmacist shall record in the state prescription drug monitoring program only the actual amounts of the drug dispensed. (e) The pharmacist shall record the date and amount of each partial fill in a readily retrievable form and on the original prescription, and shall include the initials of the pharmacist who dispensed each partial fill. (f) A pharmacist may charge a professional dispensing fee to cover the actual supply and labor costs associated with dispensing each partial fill associated with the original prescription. (g) This section shall not be construed to limit the authority of the Department of Managed Health Care, pursuant to Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code. (h) This section is not intended to conflict with or supersede any other requirement established for the prescription of a Schedule II controlled substance. (i) For purposes of this section, the following definitions apply: (1) “Original prescription” means the prescription presented by the patient to the pharmacy or submitted electronically to the pharmacy. (2) “Partial fill” means a part of a prescription filled that is of a quantity less than the entire prescription. (j) This section shall become operative on July 1, 2018
Source:
http://www.pharmacy.ca.gov/laws_regs/new_laws.pdf
This basically means that after July 1st 2018; a pharmacist may partially fill a CII on request of a patient or prescriber (ex. when a patient cannot afford the full price of the medication) and this places a 30 day expiration date on the prescription. So, once the partial fill is done, the patient has 30 days to either request partially fills again or completely fill the prescription.
For C3's it states refilled up to 5 times within 6 months of date written and ALL refills taken together cannot exceed 120 days supply. The original fill does not count as a 'refill' towards the 120 days supply.
Example: Tylenol #3: 1-2 Tabs BID Prn Pain. #120 with 5 refills. Issue Date 5-18-2018. Patient can come back 5 additional times or will the patient reach a limit with 4 additional refill due to days supply limit?
Yes, I think California just follows Federal law for this. So that's correct for C3 and C4 medications, but C5 medications do not have this limit if I recall correctly. This means you can only fill 4 more refills before you hit the day supply limit of 120 days, so that last 5th refill is invalid. So with your example, that #120 tablets will be a 30 day supply and the doctor authorized 5 more refills. Well that means (not including the original fill) that is a 150 day supply, which exceeds the 120 days supply limit, so that 5th refill cannot be filled and is invalid.
Source:
2005 California Health and Safety Code Sections 11200-11201 :: :: Article 4. :: Refilling Prescriptions
Partial Filling. If patient comes in for the same Tyl #3 Rx, and only wants 20 tablets. The patient can come back to get another 20 tablets and another 20 tablets until original quantity has been reached to 120. Those 20 partial tablets do NOT count towards a refill, am i correct?
Yes, correct, if a patient only gets a partial fill, it doesn't count towards the refill. My understanding is that a refill is defined as the full amount per fill authorized by the doctor. In your example, that would be #120 tablets for a 30 day supply, so if the patient picking up for the first time; only wants #20 tablets then the patient still has #100 tablets left for that fill.
Source: I got none, I just remember reading this somewhere.
I hope this helps!
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