Controlled Substances Part 3: Prescribing and Dispensing

Question 1

Which controlled substance schedules (if any) can each type of mid-level practitioner prescribe?

Answer 1

Nurse practitioners, optometrists and physician assistants can prescribe schedules II-V.

Question 2

List the schedules of drugs collected in the state’s prescription drug monitoring program (PDMP).

Answer 2

Schedule II - V

Question 3

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

Answer 3

Daily reporting to the Controlled Substance Monitoring Database is required

Question 4

Which healthcare professionals are authorized to access the prescription drug monitoring program (PDMP)?

Answer 4

All prescribers with DEA numbers who prescribe controlled substances and all dispensers in practice who provide direct patient care to patients in Tennessee for more than 15 days per year.

Question 5

Can controlled and non-controlled drugs be written on the same prescription form?

Answer 5

No

Question 6

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

Answer 6

Not addressed in the state law.

Question 7

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

Answer 7

All Tennessee outpatient prescriptions (not just Medicaid) must be written on tamper-resistant prescriptions that meet the Medicare requirements. These requirements do not apply to veterinarian prescriptions.

Question 8

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

Answer 8

Follows federal law
1. One or more industry-recognized features to prevent unauthorized copying.
2. One or more industry-recognized features to prevent the erasure or modification of the information.
3. One or more industry-recognized features to prevent the use of counterfeit prescription forms.

Question 9

What changes can be made, at the pharmacist’s discretion, to schedule II prescriptions?

Answer 9

The following items may NOT be changed:
1) Patient name
2) Drug name
3) Prescriber’s name

Items such as drug strength, quantity and directions for use, may be changed if the pharmacist contacts the prescriber and obtains verbal permission and documents the change.

Question 10

What changes can be made, at the pharmacist’s discretion, to schedule III - V prescriptions?

Answer 10

No restrictions specified

Question 11

Is there a time limit (i.e., days/months) that a schedule II prescription must be filled from the date of issue?

Answer 11

No

Question 12

Is there a maximum quantity or days’ supply that a patient can receive of a schedule II drug?

Answer 12

No prescription for any opioids can be dispensed in quantities greater than a 30 day supply.

Question 13

Are partial fills for schedule II prescriptions permitted at the request of the patient or prescriber?

Answer 13

Yes

Question 14

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

Answer 14

No

Question 15

What is the time limit (i.e., months) that schedule III - V prescriptions must be filled from the date of issue?

Answer 15

Must be filled within 6 months for schedule III and IV.

Question 16

What is the maximum quantity or days’ supply that a patient can receive of schedule III - V drugs?

Answer 16

No more than a 30 days’ supply can be dispensed for opioids and benzodiazepines.

Question 17

How long are refills valid for schedule III, IV and V prescriptions?

Answer 17

Tennessee follows federal law;
6 months for schedule III and IV, no expiration for schedule V

Question 18

What is the maximum number of refills allowed for schedule III, IV and V substances?

Answer 18

Tennessee follows federal law;
5 refills for schedule III and IV, no limit for schedule V

Question 19

Can a pharmacist provide an emergency filling of schedule III - V drugs without the prescriber’s authorization?

Answer 19

No

Question 20

What controlled drug schedules require identification for dispensing (e.g., schedule II only)?

Answer 20

Identification is required for any schedule II - IV opioid, benzodiazepine, zolpidem, barbiturate or carisoprodol medication being dispensed for greater than a 7-day supply.

A pharmacy staff member must ask the patient or patient’s agent to present a valid government issued ID or insurance card, unless the person is personally known to the pharmacy staff member. If the person is a minor or is homeless and does not have valid identification, the pharmacy staff member must use professional judgment in determining whether or not to dispense.

This does not apply to any controlled substance dispensed by a licensed veterinarian or drug samples dispensed by a healthcare professional.

Question 21

Are pharmacists permitted to sell select schedule V cough syrups without a prescription?

Answer 21

Yes, Tennessee follows federal law

Question 22

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 22

It is permissible under a standing order or dispensed pursuant to a valid prescription.

Question 23

What requirements must the pharmacist meet in order to furnish naloxone under the protocol (e.g., training program)?

Answer 23

A pharmacist must be able to provide documentation of completion of an opioid antagonist training program within the previous two years.

Question 24

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

Answer 24

Pharmacists or interns are required to ask the purchaser for the medical reason for the product and may refuse to sell it to them if they feel it is not for a legitimate medical reason.