Controlled Substances Part 3: Prescribing and Dispensing

Question 1

Which controlled substance schedules can each type of mid-level practitioner prescribe?

Answer 1

APRNs (Np’s and midwives) can prescribe schedules 2-5 based on delegated authority. The delegating prescriber’s name and DEA number must appear on the prescription with the APRN’s name and DEA number.

Physician assistants can prescribe schedule 2-5 controlled substances independently

Question 2

List the schedules of drugs collected in the states prescription drug monitoring program.

Answer 2

Schedules 2-5

Question 3

In what timeframe must a pharmacy submit the records of dispensed controlled substances to the states PDMP?

Answer 3

The pharmacy must submit the records daily

Question 4

Which healthcare professionals are authorized to access the PDMP?

Answer 4

Licensed prescribers (including vets) and pharmacists can access data

Question 5

Is there a limit to the number of medications that can be written on one prescription form?

Answer 5

Yes

Non-controlled drugs:
4 per prescription form if handwritten
6 per prescription form if computer-generated

Controlled drugs:
Limits not specified in state law

Question 6

Other than prescriptions for Medicaid patients, what prescriptions require tamper-resistant security forms?

Answer 6

All controlled substance prescriptions

Question 7

What security elements must be present on tamper-resistant security forms?

Answer 7

1) The quantity must be in both written and numerical terms. A written prescription is in compliance if it contains preprinted numbers representative of the quantity next to which is a box or line the prescriber may check.
2) Must be written in ink or indelible pencil

Question 8

What changes can be made, at the pharmacists discretion, to schedule 2 prescriptions?

Answer 8

After consultation with and agreement from the prescriber, a pharmacist may add or change a patients address, a dosage form, a drug strength, a drug quantity, a direction for use, or an issue date with regard to a prescription. A pharmacist must note the details of the consultation and agreement on the prescription.

A pharmacist cannot change the patients name, controlled substance prescribed (unless authorized to dispense a lower cost generically equivalent drug product) or the prescribers signature with regard to a prescription.

Question 9

What changes can be made, at the pharmacists discretion, to schedule 3-5 prescriptions?

Answer 9

After consultation with and agreement from the prescriber, a pharmacist may add or change a patients address, dosage form, drug strength, quantity, SIG, or an issue date. Must make a note.

A pharmacist cannot change the patients name, controlled substance prescribed (unless authorized to dispense a lower cost generically equivalent drug product) or the prescribers signature with regard to a prescription.

Question 10

What is the time limit that a schedule 2 prescription must be filled from the date of issue?

Answer 10

A prescription for a schedule 2 cannot be filled more than 90 days after it was written

Question 11

Is there a max quantity or days supply that a patient can receive of a schedule 2 drug?

Answer 11

No

Question 12

Are partial fills for schedule 2s permitted at request of the patient or prescriber?

Answer 12

Yes

Question 13

Are there any additional requirements for an emergency oral schedule 2 compared to federal law?

Answer 13

No, Michigan follows the federal law

Question 14

What is the time limit that a schedule 3-5 must be filled from the date of issue?

Answer 14

3 and 4: 6 months

5: 12 months (same as non-controlled)

Question 15

Is there a max quantity or days supply that a patient can receive of schedule 3-5 drugs?

Answer 15

No

Question 16

How long are refills valid for schedule 3,4, and 5 prescriptions?

Answer 16

3 and 4: 6 months

5: 12 months

Question 17

What is the max number of refills allowed for a schedule 3, 4, and 5 substances?

Answer 17

3 and 4: 5

5: No limit

Question 18

Can a pharmacist provide an emergency filling of a schedule 3-5 drug without the prescribers authorization?

Answer 18

No

Question 19

What controlled drug schedules require identification for dispensing?

Answer 19

Identification is required for any controlled substance prescription

Question 20

What are the state-specific requirements for selling select schedule 5 cough syrups without a prescription?

Answer 20

1) Not more than 240mL (8 ounces) or 48 solid doses of a substance containing opium or more than 120 mL (4 ounces) or 24 solid doses of any other substance to the same purchaser in any 48-hour period
2) The purchaser is at least 18 years of age and must show proof of identification
3) Affix a label that shows the date, the dispensing pharmacists name and address of the place of practice in which the substance is dispensed
4) Maintain a record of the dispensing in the same manner as required for schedule 5 prescription medications

Question 21

Is naloxone distribution by a pharmacist permissible in all situations, or is it pursuant to a standing order, a protocol or authorization from a prescriber?

Answer 21

It is permissible under a state-wide standing order

Question 22

Are there any requirements a pharmacist must meet in order to furnish naloxone under the protocol?

Answer 22

No

Question 23

Other than exceeding the quantity limit, are there any conditions in which a psuedoephedrine sale can be rejected?

Answer 23

No