Actual Old Timer you more or less provided evidence to the contrary yourself by posting the DEA regs.
(b) A prescription for a Schedule II controlled substance written for a patient in a Long Term Care Facility (LTCF) or for a patient with a medical diagnosis documenting a terminal illness may be filled in partial quantities to include individual dosage units.
The DEA does not state that you can't partial bill, only partial fill without one of these three conditions being true, insufficient quantity, LTCF pt or terminal illness.
If the prescriber states that this is a terminal illness (which shouldn't be hard in cancer patients that are above the insurance limits), then you may partially fill the prescription per Section 1306.13.2. Further if you partially fill then you must follow Section 1306.13.3 for the computer print out.
So the process is (according to the DEA) upon realizing you need to split the Rx:
1) Call MD varify that it's a terminal case, if yes, continue.
2) Write terminal case on Rx.
3) Annotate Rx # and fill quantity, bill insurance.
4) Fill remainder, annotate Rx#, remainder fill quantity and bill customer.
5) Update everything in the profile.
Assuming the local board of pharmacy doesn't have specific regulations against it, then there should not be a problem. If the board of pharmacy has problems, it's likely patients could band together and force an injunction to overturn it, since the DEA has won more then a couple court cases indicating their supremacy over drug law vis-a-vie Mary Jane laws. I tried to determine how the DEA defined terminal illness, however their site sucks what I could find is
this manual:
A pharmacist need not fear DEA action if he/she dispenses
controlled substances in good faith pursuant to a prescription
issued for a legitimate medical purpose. It is the position of the
DEA that controlled substances should be prescribed and
dispensed when there is a legitimate medical need.
Inappropriate prescribing and dispensing of controlled
substances, including opioid analgesics, may lead to drug
diversion and abuse by individuals who seek these drugs for
purposes other than legitimate medical use. However,
pharmacists should recognize that drug tolerance and physical
dependence may develop as a consequence of the patients
sustained use of opioid analgesics for the legitimate treatment of
chronic pain. It is also important to understand that the quantity of
drugs prescribed and frequency of prescriptions filled alone are
not indicators of fraud or improper prescribing.
A pharmacists professional judgement is the first step in
determining the appropriate course of action when the pharmacist
is presented with a prescription that appears questionable. The
pharmacists judgement, in consultation with the prescriber, is the
best way to verify that the prescription is for a legitimate medical
need. The pharmacist, in cooperation with the prescribing
practitioner, has a responsibility to continue to monitor the patient
receiving the controlled substance in order to prevent abuse or
diversion.
After looking through the case law, it's not great, but it's big enough to drive a semi through it at the federal level. If, based on prescriber diagnosis and professional judgement, you act in good faith (i.e. reasonably based on the information at hand), then you should be protected from federal prosecution until notified of a problem. In actuality the DEA can probably piss on you if they really felt like it just to jerk you around, so I'd use this rule sparingly and document the hell out of the practice.
Can this be abused absolutely, but no more then what's currently on the books. It's an interesting topic to debate how far you're willing to go, having just watched a friend's dad die from cancer that had migrated to the bone and spine, I wouldn't think twice about giving him every mole of CII required to cover his pain. Joe blow walking in off the street, not in a million years. Situational ethics for the win!
