EXAM 2 lecture 13 Flashcards
Refilling prescriptions
a refill is filling the prescriptions face amount after the initial fill has been dispensed
If a prescription has 3 refills, it can be filled 4 times (1 + 3)
C2 refills
refills are NOT allowed on C2 prescriptions
C2s are good for a year from the date written
no limit for the amount a C2 can be written for, could write for 365 days
prescribers may authorize for multiple prescriptions for a patient to receive up to a 90 day supply
Prescribing multiple C2s at once
- each prescription must be written in accordance to CS prescribing responsibilities
- prescriber must date each prescription with date issued, and instructions on each prescription
- prescriber must decide that multiple prescriptions to a patient does not create a risk of diversion
- must adhere to state statutes and regulations
- must meet all other C2 prescription requirements
C3 and C4 refills
may have up to 5 refills (total of 6 fills)
prescriber may authorize additional fills on original prescription if the total refills is fewer than 5
C5 refills
no limit on refills
C3 and C4 refill documentation
all refill info must be documented by either:
- writing on the back of the prescription
- electronic prescription record
required documentation maintained and retrievable via Rx number:
- name and dosage form of CS
- date filled/refilled
- quantity
- initials of dispensing pharmacist for each fill
- total number of refills on prescription
C3 and C4 refill documentation - alternative record requirements
must include:
- original prescription number
- date of issue
- name and address of patient
- name, address, DEA of prescriber
- name, strength, dosage form, quantity prescribed of drug
- refills authorized
- refill history
C3 and C4 refill documentation - alternative record
print all CS refill info with info of the pharmacist who refilled the prescription. This must include:
- reviewed and signed by pharmacist who refilled
- and stored for a period of two years
or
Maintain a bound logbook that each pharmacist involved shall sign each day that the refill information is correct
partial filling C2s
3 circumstances:
- at request of the patient, patient representative, or prescribing practitioner
- if pharmacy cannot provide full amount of the prescription
- patient in LTCF or has a medical diagnosis for terminal illness
Partial filling C2 - at request of the patient, patient representative, or prescriber
following criteria must be met:
- not prohibited by state law
- patient, representative, or prescriber requested
- total quantity of all partial fillings does not exceed total quantity provided
- remaining portions are filled no later than 30 days from date written
- does not apply related to stock shortages or insurance limitations
Partial filling C2 - out of stock
the remainder must be read for pick up within 72 hrs of partial fill
if it cannot be ready within 72 hrs, pharmacist must notify prescriber of partial fill. And the remainder of the prescription is voided
Partial filling C2 - LTCF/Terminal illness
LTCF or terminal illness patient, it may be partially filled for up to 60 days from date issued
must document:
- date of partial fill
- quantity dispensed
- remaining quantity
- identification of dispensing pharmacist
partial filling C3, C4, C5s
can be filled if:
- total dispense quantity does not exceed total prescribed
- no amount is dispensed after prescription expires
can be dispensed in any amount and must be recorded in the same manner as refills
you can partially fill prescription more than five times
C2 emergency prescription
an emergency situation:
- immediate administration of C2 is needed
- there is no appropriate alternative, including non-controls
- its not possible for prescriber to provide written prescription
should only be fore amount needed for emergency period
must be followed by a “covering prescription” sent by the prescriber within 7 days or authorizing the emergency prescription
C2 emergency documentation and followup
- for paper covering prescription, attach the covering to emergency prescription previously dispensed
- For electronic, pharmacist must annotate the prescription
- If covering is not received, the pharmacist must notify nearest DEA office
- if you don’t receive covering prescription within 7 days, notify DEA immediately
controlled substance central fill - community pharmacy documentation
- write the words “CENTRAL FILL” at the face of original prescription
- record name, address, and DEA number of central fill pharmacy
- record their name and date of transmittal to central fill
the original prescription must be kept at local pharmacy for at least 2 years as well as record of receipt of the filled prescription
central fill pharmacy must maintain record of the following
- a copy of faxed prescription or electronic record with the name, address, and DEA# of the community pharmacy
- date prescription was received, pharmacist filling the prescription, and the date prescription was filled
- date delivered to pharmacy and method
C3, C4, C5 central fill - if the prescription has authorized refills
community pharmacy must indicate info transmiting # of refills already dispensed and remaining
central fill pharmacy must record the dates the prescription was filled and refilled
control substance prescription label requirements
- date filled
- dispending pharmacy name and address
- prescription number
- name of patient
- name of prescriber
- directions for use
- cautionary statements contained in the prescription, if any
Caution: federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed
may be on all prescription labels
required for: C2, C3, C4
controlled substance prescription label quirks
if dispensed by central fill: must include unique identifier
For C2: labeling requirements do not apply for administration in an institution as no more than a 7-day supply of medication is dispensed at a time
For C3, C4, C5: labeling requirements do not apply for administration in an institution as no more than a 34-day supply of medication, or no more than 100 dosage units, is dispensed at a time
