§329-38 - Prescriptions.

§329-38 Prescriptions. (a) No controlled substance in schedule II may bedispensed without a written prescription of a practitioner, except:

(1) In the case of anemergency situation, a pharmacist may dispense a controlled substance listed inschedule II upon receiving oral authorization from a prescribing practitioner;provided that:

(A) The quantityprescribed and dispensed is limited to the amount adequate to treat the patientduring the emergency period (dispensing beyond the emergency period must bepursuant to a written prescription signed by the prescribing practitioner);

(B) If the prescribing practitioner isnot known to the pharmacist, the pharmacist shall make a reasonable effort todetermine that the oral authorization came from a registered practitioner,which may include a callback to the prescribing practitioner using the phonenumber in the telephone directory or other good faith efforts to identify theprescriber; and

(C) Within sevendays after authorizing an emergency oral prescription, the prescribingpractitioner shall cause a written prescription for the emergency quantityprescribed to be delivered to the dispensing pharmacist. In addition toconforming to the requirements of this subsection, the prescription shall havewritten on its face "Authorization for Emergency Dispensing". Thewritten prescription may be delivered to the pharmacist in person or by mail,and if by mail, the prescription shall be postmarked within the seven-dayperiod. Upon receipt, the dispensing pharmacist shall attach this prescriptionto the oral emergency prescription, which had earlier been reduced to writing. The pharmacist shall notify the administrator if the prescribing practitionerfails to deliver a written prescription to the pharmacy within the allottedtime. Failure of the pharmacist to do so shall void the authority conferred bythis paragraph to dispense without a written prescription of a prescribingindividual practitioner. Any practitioner who fails to deliver a writtenprescription within the seven-day period shall be in violation of section329-41(a)(1); or

(2) When dispenseddirectly by a practitioner, other than a pharmacist, to the ultimate user. Thepractitioner in dispensing a controlled substance in schedule II shall affix tothe package a label showing:

(A) The date ofdispensing;

(B) The name,strength, and quantity of the drug dispensed;

(D) The name of thepatient;

(E) The "useby" date for the drug, which shall be:

(i) The expirationdate on the [manufacturer's] or principal labeler's container; or

(ii) One year fromthe date the drug is dispensed, whichever is earlier; and

(F) Directions foruse, and cautionary statements, if any, contained in the prescription or asrequired by law.

A complete andaccurate record of all schedule II controlled substances ordered, administered,prescribed, and dispensed shall be maintained for five years. Prescriptionsand records of dispensing shall otherwise be retained in conformance with therequirements of section 329-36. No prescription for a controlled substance inschedule II may be refilled.

(b) A schedule IIcontrolled substance prescription shall:

(1) Be filled within sevendays following the date the prescription was issued to the patient; and

(2) Be supplied to apatient only if the prescription has been filled and held by the pharmacy fornot more than seven days.

(c) The transfer of original prescriptioninformation for a controlled substance listed in schedule III, IV, or V for thepurpose of dispensing is permissible between pharmacies on a one time basisonly. However, pharmacies electronically sharing a real-time, online databasemay transfer up to the maximum refills permitted by law and the prescriber'sauthorization. Transfers are subject to the following requirements:

(1) The transfer shall becommunicated directly between two licensed pharmacists, and the transferringpharmacist shall:

(A) Write orotherwise place the word "VOID" on the face of the invalidatedprescription;

(B) Record on thereverse of the invalidated prescription the name, address, and DEA registrationnumber of the pharmacy to which it was transferred and the name of thepharmacist receiving the prescription information; and

(2) The pharmacistreceiving the transferred prescription information shall reduce to writing thefollowing:

(A) Write orotherwise place the word "transfer" on the face of the transferredprescription;

(B) Record allinformation required to be on a prescription, including:

(i) The date ofissuance of original prescription;

(ii) The originalnumber of refills authorized on original prescription;

(iii) The date oforiginal dispensing;

(iv) The number ofvalid refills remaining and dates and locations of previous refills;

(v) The pharmacy'sname, address, DEA registration number, and original prescription number fromwhich the prescription information was transferred;

(vi) The name oftransferor pharmacist; and

(vii) The pharmacy'sname, address, and Drug Enforcement Administration registration number, alongwith the prescription number from which the prescription was originally filled;

(3) Both the original andtransferred prescription shall be maintained for a period of five years fromthe date of last refill; and

(4) Any pharmacyelectronically accessing a prescription record shall satisfy all informationrequirements of a manual mode prescription transferal.

Failure to complywith this subsection shall void the authority of the pharmacy to transferprescriptions or receive a transferred prescription to or from anotherpharmacy.

(d) A pharmacy andan authorized central fill pharmacy may share information for initial andrefill prescriptions of schedule III, IV, or V controlled substances. Thefollowing requirements shall apply:

(1) A pharmacy mayelectronically transmit, including by facsimile, prescriptions for controlledsubstances listed in schedule III, IV, or V to a central fill pharmacy. Thepharmacy transmitting the prescription information shall:

(A) Ensure that allinformation required to be on a prescription pursuant to subsection (g) istransmitted to the central fill pharmacy either on the face of the prescriptionor electronically; and

(B) Keep a recordof receipt of the filled prescription, including the date of receipt, themethod of delivery (private, common, or contract carrier) and the identity ofthe pharmacy employee accepting delivery; and

(2) The central fillpharmacy receiving the transmitted prescription shall:

(A) Keep for fiveyears a copy of a prescription received by facsimile or an electronic record ofall the information transmitted by the pharmacy, including the name, address,and DEA registration number of the pharmacy transmitting the prescription;

(B) Keep a recordof the date of receipt of the transmitted prescription, the name of thelicensed pharmacists filling the prescription, and the dates the prescriptionwas filled or is refilled; and

(e) No controlledsubstance in schedule III, IV, or V may be dispensed without a written,facsimile of a written, or oral prescription of a practitioner, except when acontrolled substance is dispensed directly by a practitioner, other than apharmacist, to an ultimate user. The practitioner, in dispensing a controlledsubstance in schedule III, IV, or V, shall affix to the package a labelshowing:

(1) The date ofdispensing;

(2) The name, strength,and quantity issued of the drug;

(3) The dispensingpractitioner's name and business address;

(4) The name of thepatient;

(5) The "use by"date for the drug, which shall be:

(A) The expirationdate on the manufacturer's or principal labeler's container; or

(B) One year fromthe date the drug is dispensed, whichever is earlier;

(6) Directions for use;and

(7) Cautionary statements,if any, contained in the prescription or as required by law.

A complete and accuraterecord of all schedule III, IV, and V controlled substances administered,prescribed, and dispensed shall be maintained for five years. Prescriptionsand records of dispensing shall be retained in conformance with therequirements of section 329-36 unless otherwise provided by law. Prescriptionsmay not be filled or refilled more than three months after the date of theprescription or be refilled more than two times after the date of the prescription,unless the prescription is renewed by the practitioner.

(f) Theeffectiveness of a prescription for the purposes of this section shall bedetermined as follows:

(1) A prescription for acontrolled substance shall be issued for a legitimate medical purpose by anindividual practitioner acting in the usual course of the practitioner'sprofessional practice. The responsibility for the proper prescribing anddispensing of controlled substances shall be upon the prescribing practitioner,but a corresponding responsibility shall rest with the pharmacist who fills theprescription. An order purporting to be a prescription issued not in the usualcourse of professional treatment or for legitimate and authorized researchshall not be deemed a prescription within the meaning and intent of thissection, and the person who knowingly fills such a purported prescription, aswell as the person who issues the prescription, shall be subject to thepenalties provided for violations of this chapter;

(2) A prescription may notbe issued to allow an individual practitioner to obtain controlled substancesfor supplying the individual practitioner for the purpose of general dispensingto patients;

(3) A prescription may notbe issued for the dispensing of narcotic drugs listed in any schedule for thepurpose of "detoxification treatment" or "maintenancetreatment" except as follows:

(A) Theadministering or dispensing directly (but not prescribing) of narcotic drugslisted in any schedule to a narcotic drug-dependent person for"detoxification treatment" or "maintenance treatment" shallbe deemed to be "in the course of a practitioner's professional practiceor research" so long as the practitioner is registered separately with thedepartment and the federal Drug Enforcement Agency as required by section329-32(e) and complies with Title 21 Code of Federal Regulations Section 823(g)and any other federal or state regulatory standards relating to treatmentqualification, security, records, and unsupervised use of drugs; and

(B) Nothing in thissection shall prohibit a physician or authorized hospital staff fromadministering or dispensing, but not prescribing, narcotic drugs in a hospitalto maintain or detoxify a person as an incidental adjunct to medical orsurgical treatment of conditions other than addiction;

(4) An individualpractitioner shall not prescribe or dispense a substance included in scheduleII, III, IV, or V for that individual practitioner's personal use, except in amedical emergency; and

(5) A pharmacist shall notdispense a substance included in schedule II, III, IV, or V for thepharmacist's personal use.

(g) Prescriptionsfor controlled substances shall be issued only as follows:

(1) All prescriptions forcontrolled substances shall originate from within the State and be dated as of,and signed on, the day when the prescriptions were issued and shall contain:

(A) The first andlast name and address of the patient; and

(B) The drug name,strength, dosage form, quantity prescribed, and directions for use. Where aprescription is for gamma hydroxybutyric acid, methadone, or buprenorphine, thepractitioner shall record as part of the directions for use, the medical needof the patient for the prescription.

The controlledsubstance prescriptions shall be no larger than eight and one-half inches byeleven inches and no smaller than three inches by four inches. A practitionermay sign a prescription in the same manner as the practitioner would sign acheck or legal document (e.g., J.H. Smith or John H. Smith) and shall use bothwords and figures (e.g., alphabetically and numerically as indications ofquantity, such as five (5)), to indicate the amount of controlled substance tobe dispensed. Where an oral order is not permitted, prescriptions shall bewritten with ink or indelible pencil or typed, shall be manually signed by thepractitioner, and shall include the name, address, telephone number, andregistration number of the practitioner. The prescriptions may be prepared bya secretary or agent for the signature of the practitioner, but the prescribingpractitioner shall be responsible in case the prescription does not conform inall essential respects to this chapter and any rules adopted pursuant to thischapter. In receiving an oral prescription from a practitioner, a pharmacistshall promptly reduce the oral prescription to writing, which shall include thefollowing information: the drug name, strength, dosage form, quantityprescribed in figures only, and directions for use; the date the oralprescription was received; the full name, DEA registration number, and oralcode number of the practitioner; and the name and address of the person forwhom the controlled substance was prescribed or the name of the owner of theanimal for which the controlled substance was prescribed.

Acorresponding liability shall rest upon a pharmacist who fills a prescriptionnot prepared in the form prescribed by this section. A pharmacist may add apatient's missing address or change a patient's address on all controlledsubstance prescriptions after verifying the patient's identification and notingthe identification number on the back of the prescription. The pharmacistshall not make changes to the patient's name, the controlled substance beingprescribed, the quantity of the prescription, the practitioner's DEA number, orthe practitioner's signature;

(2) An intern, resident,or foreign-trained physician, or a physician on the staff of a Department ofVeterans Affairs facility or other facility serving veterans, exempted fromregistration under this chapter, shall include on all prescriptions issued bythe physician:

(A) Theregistration number of the hospital or other institution; and

(B) The specialinternal code number assigned to the physician by the hospital or otherinstitution in lieu of the registration number of the practitioner required bythis section.

The hospital or otherinstitution shall forward a copy of this special internal code number list tothe department as often as necessary to update the department with anyadditions or deletions. Failure to comply with this paragraph shall result inthe suspension of that facility's privilege to fill controlled substanceprescriptions at pharmacies outside of the hospital or other institution. Eachwritten prescription shall have the name of the physician stamped, typed, orhand-printed on it, as well as the signature of the physician;

(3) An official exemptedfrom registration shall include on all prescriptions issued by the official:

(A) The official'sbranch of service or agency (e.g., "U.S. Army" or "Public HealthService"); and

(B) The official'sservice identification number, in lieu of the registration number of thepractitioner required by this section. The service identification number for aPublic Health Service employee shall be the employee's social security or othergovernment issued identification number.

Each prescriptionshall have the name of the officer stamped, typed, or handprinted on it, aswell as the signature of the officer; and

(4) A physician assistantregistered to prescribe controlled substances under the authorization of asupervising physician shall include on all controlled substance prescriptionsissued:

(A) The DEAregistration number of the supervising physician; and

(B) The DEAregistration number of the physician assistant.

Each writtencontrolled substance prescription issued shall include the printed, stamped,typed, or hand-printed name, address, and phone number of both the supervisingphysician and physician assistant, and shall be signed by the physicianassistant. The medical record of each written controlled substanceprescription issued by a physician assistant shall be reviewed and initialed bythe physician assistant's supervising physician within seven working days.

(h) A prescriptionfor controlled substances may only be filled by a pharmacist acting in theusual course of the pharmacist's professional practice and either registeredindividually or employed in a registered pharmacy, central fill pharmacy, orregistered institutional practitioner. A central fill pharmacy authorized tofill prescriptions on behalf of a pharmacy shall have a contractualrelationship with the pharmacy that provides for this activity or shall share acommon owner with the pharmacy. A central fill pharmacy shall not prepareprescriptions for any controlled substance listed in schedule II.

(i) Partial fillingof controlled substance prescriptions shall be determined as follows:

(1) The partial filling ofa prescription for a controlled substance listed in schedule II is permissibleif the pharmacist is unable to supply the full quantity called for in a writtenor emergency oral prescription and the pharmacist makes a notation of thequantity supplied on the face of the written prescription (or written record ofthe emergency oral prescription). The remaining portion of the prescription maybe filled within seventy-two hours of the first partial filling; provided thatif the remaining portion is not or cannot be filled within the seventy-two-hourperiod, the pharmacist shall notify the prescribing individual practitioner. No further quantity shall be supplied beyond seventy-two hours without a newprescription;

(2) The partial filling ofa prescription for a controlled substance listed in schedule III, IV, or V ispermissible; provided that:

(A) Each partialfilling is recorded in the same manner as a refilling;

(B) The totalquantity dispensed in all partial fillings does not exceed the total quantityprescribed;

(D) Theprescription is refilled no more than two times after the initial date of theprescription, unless the prescription is renewed by the practitioner; and

(3) A prescription for aschedule II controlled substance written for a patient in a long-term carefacility or for a patient with a medical diagnosis documenting a terminalillness may be filled in partial quantities to include individual dosageunits. If there is any question whether a patient may be classified as havinga terminal illness, the pharmacist shall contact the practitioner prior topartially filling the prescription. Both the pharmacist and the prescribingpractitioner have a corresponding responsibility to assure that the controlledsubstance is for a terminally ill patient. The pharmacist shall record on theprescription whether the patient is "terminally ill" or a"long-term care facility patient". For the purposes of this section,"TI" means terminally ill and "LTCF" means long-term carefacility. A prescription that is partially filled and does not contain thenotation "TI" or "LTCF patient" shall be deemed to have beenfilled in violation of this section. For each partial filling, the dispensingpharmacist shall record on the back of the prescription (or on anotherappropriate record, uniformly maintained, and readily retrievable) the date ofthe partial filling, quantity dispensed, remaining quantity authorized to bedispensed, and the identification of the dispensing pharmacist. The totalquantity of schedule II controlled substances dispensed in all partial fillingsshall not exceed the total quantity prescribed, nor shall a prescription bepartially filled more than three times after the initial date of theprescription. Schedule II controlled substance prescriptions for patients in along-term care facility or patients with a medical diagnosis documenting aterminal illness shall be valid for a period not to exceed thirty days from theissue date unless sooner terminated by the discontinuance of medication.

(j) A prescription for aschedule II controlled substance may be transmitted by the practitioner or thepractitioner's agent to a pharmacy by facsimile equipment; provided that theoriginal written, signed prescription is presented to the pharmacist for reviewprior to the actual dispensing of the controlled substance, except as noted insubsections (k), (l), and (m). The original prescription shall be maintainedin accordance with section 329-36. A prescription for a schedule III, IV, or Vcontrolled substance may be transmitted by the practitioner or thepractitioner's agent to a pharmacy by facsimile; provided that:

(1) The information shallbe communicated only between the prescribing practitioner or the prescriber'sauthorized agent and the pharmacy of the patient's choice. The originalprescription shall be maintained by the practitioner in accordance with section329-36;

(2) The information shallbe communicated in a retrievable, recognizable format acceptable to theintended recipient and shall include the physician's oral code designation andthe name of the recipient pharmacy;

(3) No electronic system,software, or other intervening mechanism or party shall alter thepractitioner's prescription, order entry, selection, or intended selectionwithout the practitioner's approval on a per prescription per order basis. Facsimile prescription information shall not be altered by any system, software,or other intervening mechanism or party prior to receipt by the intendedpharmacy;

(4) The prescriptioninformation processing system shall provide for confidentiality safeguardsrequired by federal or state law; and

(5) Prescribingpractitioners and pharmacists shall exercise prudent and professional judgmentregarding the accuracy, validity, and authenticity of any facsimileprescription information. The facsimile shall serve as the original writtenprescription for purposes of this section and shall be maintained in accordancewith section 329-36.

(k) A prescriptionprepared in accordance with subsection (g) written for a narcotic listed inschedule II to be compounded for the direct administration to a patient byparenteral, intravenous, intramuscular, subcutaneous, or intraspinal infusion,but does not extend to the dispensing of oral dosage units of controlledsubstances, may be transmitted by the practitioner or the practitioner's agentto the pharmacy by facsimile. The original prescription shall be maintained bythe practitioner in accordance with section 329-36. The pharmacist shall noteon the face of the facsimile prescription in red ink "HomeInfusion/IV" and this facsimile shall serve as the original writtenprescription for purposes of this section and it shall be maintained inaccordance with section 329-36.

(l) A prescriptionprepared in accordance with subsection (g) written for a schedule II substancefor a patient enrolled in a hospice care program certified or paid for by medicareunder Title XVIII or a hospice program that is licensed by the State may betransmitted by the practitioner or the practitioner's agent to the dispensingpharmacy by facsimile. The original prescription shall be maintained by thepractitioner in accordance with section 329-36. The practitioner orpractitioner's agent shall note on the prescription that the patient is ahospice patient. The pharmacist shall note on the face of the facsimileprescription in red ink "HOSPICE" and this facsimile shall serve asthe original written prescription for purposes of this section and it shall bemaintained in accordance with section 329-36.

(m) A prescriptionprepared in accordance with subsection (g) written for a schedule II controlledsubstance for a resident of a state-licensed long-term care facility may betransmitted by the practitioner or the practitioner's agent to the dispensingpharmacy by facsimile. The original prescription shall be maintained by thepractitioner in accordance with section 329-36. The pharmacist shall note onthe face of the facsimile prescription in red ink "LTCF" and thisfacsimile shall serve as the original written prescription for purposes of thissection and it shall be maintained in accordance with section 329-36. [L 1972,c 10, pt of §1; am L 1973, c 206, §1; am L 1979, c 194, §5; am L 1984, c 25,§2; am L 1986, c 214, §6; am L 1988, c 59, §4; am L 1991, c 159, §§10 to 12; amL 1996, c 206, §2; am L 1997, c 280, §3; am L 1999, c 90, §2 and c 252, §4; amL 2002, c 165, §3; am L 2003, c 151, §8; am L 2006, c 69, §3; am L 2008, c 131,§3 and c 186, §4; am L 2009, c 117, §5]