Multiple CII prescriptions in CA

[soyroger]

One of our faculty emailed us with an update to CA law regarding multiple scripts for CII's. Just curious to know how you think this will effect you (those working in CA), if at all? Here's the description from the CPhA legislative update.




Effective December 19, 2007, prescribers will be authorized to write multiple prescriptions on the same day to be filled sequentially for schedule II controlled substances. The Drug Enforcement Agency (DEA) issued the final rule on Monday, November 19. The new regulatory language is below. We are clarifying with the California Board of Pharmacy how these changes will work with California law and will provide more information in next week's Update.

New regulatory language:

21 CFR § 1306.12 Refilling prescriptions; issuance of multiple prescriptions.
(a) The refilling of a prescription for a controlled substance listed in Schedule II is prohibited.
(b)(1) An individual 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 provided the following conditions are met:
(i) Each separate prescription is issued for a legitimate medical purpose by an individual practitioner acting in the usual course of professional practice;
(ii) The individual practitioner provides written instructions on each prescription (other than the first prescription, if the prescribing practitioner intends for that prescription to be filled immediately) I indicating the earliest date on which a pharmacy may fill each prescription;
(iii) The individual practitioner concludes that providing the patient with multiple prescriptions in this manner does not create an undue risk of diversion or abuse;
(iv) The issuance of multiple prescriptions as described in this section is permissible under the applicable state laws; and
(v) The individual practitioner complies fully with all other applicable requirements under the Act and these regulations as well as any additional requirements under state law.
(2) Nothing in this paragraph (b) shall be construed as mandating or encouraging individual practitioners to issue multiple prescriptions or to see their patients only once every 90 days when prescribing Schedule II controlled substances. Rather, individual practitioners must determine on their own, based on sound medical judgment, and in accordance with established medical standards, whether it is appropriate to issue multiple prescriptions and how often to see their patients when doing so.

3. Section 1306.14 is amended by adding a new paragraph (e) to read as follows:

21 CFR § 1306.14 Labeling of substances and filling of prescriptions.
(e) Where a prescription that has been prepared in accordance with section 1306.12(b) contains instructions from the prescribing practitioner indicating that the prescription shall not be filled until a certain date, no pharmacist may fill the prescription before that date.

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[Old Timer]

This is a change in Federal Law or regulations. CFR is for Code of Federal Regulations.

This has been an on again/off again issue for the DEA and the psychiatric community. Kids see and MD and they must come back each month to get a new RX. They finally resolved it this way.... I assume most states will either follow suit or if their laws are silent, leave the Federal regs as the final say...

 

[glitch]

it's been like this in texas, i've seen plenty of 90 day supply's for cII's, mainly just for adhd drugs and serious chronic pains and cancer patients. The rules of for CII's apply to claravis too.

 

[amartins02]

Even then it doesn't mean anything if the state law is more strict. In Mass. they just place the other scripts on hold until its needed and release 30 day supplies at a time.

 

[Old Timer]

Even then it doesn't mean anything if the state law is more strict. In Mass. they just place the other scripts on hold until its needed and release 30 day supplies at a time.

You are missing the point. If you have a patient who is on Adderall XR 20 mg daily and he sees the doctor on January 1, it was previously illegal in the United States of America for the prescriber to write three prescriptions for the patient and give them at one time. The patient was required to come back each month and get a new prescription. Refills are NOT permitted on C-II drugs and the view of the DEA was that by giving multiple hard copies you were in effect violating the no refill clause of the CSA.

There are many reasons why this happened and they are not important now, just so you know, you cannot prescribe more than a 90 day supply of C-II drugs at one time even spread over multiple prescriptions.