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

1) Nurse Practitioners: Schedules III, III-N, IV and V. In some cases, their credentials may also include the authority to prescribe drugs in Schedules II and/or II-N

2) Physician Assistants: Schedules II, II-N, III, III-N, IV and V

3) Medical psychologists: Schedules II-N, III-N, IV and V

Key: II-N and III-N denote non-narcotic drugs in schedules II and III respectively.

Question 2

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

Answer 2

Schedules II - V (mandatory reporting)

Question 3

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

Answer 3

Daily (next business day)

Question 4

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

Answer 4

1) Persons authorized to prescribe or dispense controlled substances or drugs of concern, and their delegates, for the purpose of providing medical or pharmaceutical care for their patients, or for verifying their prescription records;

2) Designated representatives from the professional licensing, certification, or regulatory agencies of this state or another state charged with administrative oversight of those professionals engaged in the prescribing or dispensing of controlled substances or other drugs of concern;

3) Designated representatives from the Louisiana Medicaid program regarding Medicaid program recipients;

4) Designated representatives of the board or any vendor or contractor establishing or maintaining the prescription monitoring program;

5) Prescription monitoring programs located in other states, through a secure interstate data exchange system or health information exchange system approved by the board.

Question 5

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

Answer 5

Not addressed in LA law

Question 6

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

Answer 6

Yes, limited to 4 drugs or devices per written prescription form

Question 7

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

Answer 7

No

Question 8

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

Answer 8

1) One or more industry-recognized features designed to prevent unauthorized copying of a completed or blank prescription form

2) One or more industry-recognized features designed to prevent the erasure or modification of information written on the prescription pad by the prescriber

3) One or more industry-recognized features designed to prevent the use of counterfeit prescription form

Question 9

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

Answer 9

May change or add anything except patient’s name, date, drug or signature.

Question 10

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

Answer 10

Not addressed in LA law

Question 11

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

Answer 11

90 days

Question 12

What is the maximum quantity or days’ supply that a patient can receive of a schedule II drug?

Answer 12

90 days

Question 13

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

Answer 13

Yes

Question 14

What are the additional requirements for an emergency oral schedule II prescription compared to federal law?

Answer 14

In the case of an emergency situation, a pharmacist may dispense a controlled substance listed in Schedule II upon receiving oral authorization of a prescribing individual practitioner, provided that:

1) The quantity prescribed and dispensed is limited to the amount adequate to treat the patient during the emergency period (dispensing beyond the emergency period must be pursuant to a written prescription signed by the prescriber)

2) Prescription must be reduced to written form immediately

3) If the prescriber is not known to the pharmacist, he shall make a reasonable effort to determine that the oral authorization came from a registered prescriber.

4) Within seven days after authorizing an emergency oral prescription, the prescriber shall cause a written prescription for the emergency quantity prescribed to be delivered to the dispensing pharmacist.

Question 15

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

Answer 15

Schedules III and IV: 6 months
Schedule V: 1 year

Question 16

Is there a maximum quantity or days’ supply that a patient can receive of schedule III - V drugs?

Answer 16

No

Question 17

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

Answer 17

6 months from the issue date

Question 18

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

Answer 18

Can be refilled up to 5 times

Question 19

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

Answer 19

Yes

Question 20

What is the maximum days’ supply that can be dispensed for an emergency refill of schedule III – V drugs without prescriber authorization?

Answer 20

Up to a 72 hour supply

Question 21

Is patient identification required to dispense controlled drugs?

Answer 21

Yes, for patients unknown to the pharmacy staff

Question 22

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

Answer 22

Identification is required for any controlled substance prescription unless the person picking up the prescription is known to the pharmacy staff

Question 23

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

Answer 23

No

Question 24

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 24

It is permissible under a standing order

Question 25

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

Answer 25

No