Controlled Substances Part 3: Prescribing and Dispensing Flashcards
Which controlled substance schedules (if any) can each type of mid-level practitioner prescribe?
Nurse practitioners, optometrists and physician assistants can prescribe schedules II-V.
List the schedules of drugs collected in the state’s prescription drug monitoring program (PDMP).
Schedule II - V
In what timeframe must a pharmacy submit the records of dispensed controlled substances to the state’s PDMP?
Daily reporting to the Controlled Substance Monitoring Database is required
Which healthcare professionals are authorized to access the prescription drug monitoring program (PDMP)?
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.
Can controlled and non-controlled drugs be written on the same prescription form?
No
Is there a limit to the number of medications that can be written on one prescription form?
Not addressed in the state law.
Other than prescriptions for Medicaid patients, what prescriptions require tamper-resistant security forms?
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.
What security elements must be present on tamper-resistant security forms?
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.
What changes can be made, at the pharmacist’s discretion, to schedule II prescriptions?
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.
What changes can be made, at the pharmacist’s discretion, to schedule III - V prescriptions?
No restrictions specified
Is there a time limit (i.e., days/months) that a schedule II prescription must be filled from the date of issue?
No
Is there a maximum quantity or days’ supply that a patient can receive of a schedule II drug?
No prescription for any opioids can be dispensed in quantities greater than a 30 day supply.
Are partial fills for schedule II prescriptions permitted at the request of the patient or prescriber?
Yes
Are there any additional requirements for an emergency oral schedule II prescription compared to federal law?
No
What is the time limit (i.e., months) that schedule III - V prescriptions must be filled from the date of issue?
Must be filled within 6 months for schedule III and IV.
What is the maximum quantity or days’ supply that a patient can receive of schedule III - V drugs?
No more than a 30 days’ supply can be dispensed for opioids and benzodiazepines.
How long are refills valid for schedule III, IV and V prescriptions?
Tennessee follows federal law;
6 months for schedule III and IV, no expiration for schedule V
What is the maximum number of refills allowed for schedule III, IV and V substances?
Tennessee follows federal law;
5 refills for schedule III and IV, no limit for schedule V
Can a pharmacist provide an emergency filling of schedule III - V drugs without the prescriber’s authorization?
No
What controlled drug schedules require identification for dispensing (e.g., schedule II only)?
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.
Are pharmacists permitted to sell select schedule V cough syrups without a prescription?
Yes, Tennessee follows federal law
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?
It is permissible under a standing order or dispensed pursuant to a valid prescription.
What requirements must the pharmacist meet in order to furnish naloxone under the protocol (e.g., training program)?
A pharmacist must be able to provide documentation of completion of an opioid antagonist training program within the previous two years.
Other than exceeding the quantity limit, are there any conditions in which a pseudoephedrine sale can be rejected?
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.
