Controlled Substances Flashcards
Official Scripts for CIIs
- Written scripts for CIIs require _____ form
- Exemptions to form….
- Hospital restrictions….
Written scripts for CIIs = must be written on TX Official Prescription Form
- Issued to prescribers by TX Board, security features
Sept 2018 = new forms given, old forms invalid after 06/01/2019
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Exemptions to Official Prescription Form:
- Hospital inpatient med orders
- Hospital patients requiring emergency CII upon discharge (limited to 7-day supply + must get from hospital pharmacy)
- Inmates (correctional facility)
- Animals admitted to animal hospitals
- Therapeutic optometrists administering topical cocaine (eye drops)
Controlled Substances: Perpetual Inventory Requirements
- What are requirements for CIIs?
- What are requirements for all controlleds?
- Required for CIIs in Class C (Institution) pharmacies
- ————————————————————————— - Required for all controlleds in remote pharmacies
- Required for all controlleds in Class C Ambulatory Surgical Centers (ASCs)
- Required for all controlleds in Class F (Freestanding Emergency Medical Facility) pharmacies
CII Scripts: General Restrictions
- Written scripts
- Verbal scripts
- Must be filled within _____
- When written, must be issued on TX Official Prescription Form, signed by practitioner
- Verbal scripts for CII not permitted unless in emergency = must be communicated only by doctor
- No refills
- Under TX law, CII script must be filled within 21 days after date issued or first authorized fill date
Written Controlled Prescriptions
- What are additional TX requirements?
- Manually signed by practitioners + dated on date issued
- Must contain:
(a) patient name + address
(b) drug name / strength / dosage
(c) quantity prescribed
(d) name / address / DEA of prescriber
(e) if written early = earliest date can be filled
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Additional Requirements in TX: - DOB / age of patient
- Practitioner’s telephone # at place of business
- Intended use of drug (required for all scripts, not just controlleds)
- Written on Official TX Prescription Form
Mandatory Electronic Scripts for Controlleds
- When is it not required?
- ## TX made mandatory for all scripts for controlleds to be electronic starting 01/01/2021Not required to be electronic if:
- Script by veterinarian
- Cases where electronic script not possible
- Prescriber outside of TX
- When prescriber + dispenser in same location + same license
- Impractical to do electronic script in timely manner; delay would cause adverse impact to patient
Compounded Controlleds
Concentration Limits (per 100 mL) = CIII vs CV
Codeine vs opium (TX is stricter)
Can purchase CV products OTC?
CODEINE:
- CV = 200 mg / 100 mL
- CIII = 1.8 g / 100 mL (90 mg dosage unit)
OPIUM:
- CV (Federal) = 100 mg/100 mL
- CV (TX) = 50 mg/100 mL
- CIII = 500 mg/100 mL (25 mg dosage unit)
- Most CV products with opium cannot be purchased without prescription in TX
- CIII substances require prescription
Faxed Scripts for CIIs (TX is stricter)
- Faxes not valid for CIIs
- Ordinarily, DEA allows faxes for injectable narcotics, LTCF patients, narcotics in hospice patients
- But TX does not allow it
- Verbal, written, electronic scripts for CIIs
- Only in emergencies can doctor do verbal with pharmacist
Perpetual inventory required in TX for…
- Which types of pharmacies?
- CIIs?
- All controlleds?
Perpetual inventory required in TX for:
- CIIs in Class C (Institutional)
- All controlleds stored in remote location under remote pharmacy
- All controlled in Class C Ambulatory Surgical Centers (ASC)
- All controlleds in Class F (Freestanding Emergency Medical Facility) pharmacies
CII - CV controlled substances issued by:
Out-of-state APRN / PA
Acceptable prescription forms:
- Written = NO
- Verbal / telephonic = NO
- Fax = NO
- Electronic = NO
NO FORMS ACCEPTED FOR THIS TYPE OF PROVIDER
CIII - CV controlled substances issued by:
Canadian / Mexican practitioner
Acceptable prescription forms:
- Written = NO
- Verbal / telephonic = NO
- Fax = NO
- Electronic = NO
NO FORMS ACCEPTED FOR CONTROLLEDS, LIKE OUT-OF-STATE APRN OR PA
Authorized TX APRNs / PAs may issue CIIs for…
- Hospice patients
- Hospitalized patients
- Emergency department patients
- Terminally ill patient receiving hospice treatment from qualified hospice provider
- Patient hospitalized from 24 hours or greater, provided that CII filled at in-patient pharmacy
- Patient receiving emergency services in hospital ED, provided that CII filled at in-patient pharmacy
Controlleds = Locked Storage for CIIs
(very different in TX)
- Which facilities are required to have locked storage?
TX Board of Pharmacy requires locked storage for CIIs for the following:
- Class C (Institutional)
- Class C - S
- Class C - Ambulatory Surgical Center (ASC)
- Class F (Freestanding Emergency Medical Facility)
Controlled Script Requirements (very different in TX)
- Acute pain
- E-prescribing
- Verbals
- Intended use
- Age / DOB
- Prescriber telephone #
- Acute pain = 0 refills, 10-day supply
- Mandatory electronic prescribing
- Written scripts only allowed if cannot send electronically
- Verbal scripts = allowed in emergency (CII, CIII-CV)
- Intended use required on TX scripts (required on all scripts)
- Name and quantity of drug + practitioner telephone # required on all scripts in TX
- Age / DOB required on all controlled scripts in TX
Multiple Scripts for CIIs
- No more than ___
- Dates
- Must fill within _____
- Can receive no more than 90-day supply of CII
- Must have earliest fill date on each script
- Must be dispensed (per TX law) within 21 days of earliest fill date indicated
- Doesn’t have to be presented within 21 days of
receiving - 90-day limit applies to CIIs = legally no quantity limit on single controlled script in TX
CIII - CV controlled substances issued by TX physician, dentist, vet, podiatrist, optometric glaucoma specialist
(independent authority)
- Written, verbal, electronic, faxed, transferred
Acceptable prescription forms:
- Written = YES
- Verbal / telephonic = YES
- Fax = YES (if manually signed paper script)
- Electronic = YES (if electronic system complies with DEA rules)
- Script transferred for initial fill = NO
- Authorized refills transferred between pharmacies = YES (one-time basis)
- *Centrally filled script may only be returned to outsourcer pharmacy for delivery to patient**
