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CPJE
CS part 3: Prescribing and Dispensing
| Question | Answer |
|---|---|
| DEA number required | • Physician (MD/DO) • Dentist (DDS/DMD) • Podiatrist (DMP) • Veterinarian (DVM) • Mid-level practitioner • Other practitioner authorized by another jurisdictior Or must meet an exemption |
| Independent Prescribing CS | • Physicians • Dentists • Podiatrists • Veterinarians • Optometrists • Prescribe controlled substances independently within scope of practice |
| Optometrist (OD) "T" at the end of llicense number | May prescribe codeine, hydrocodone, and tramadol only (max 3-day supply) |
| Prescribing CS With a Physician-Directed Protocol | • Nurse practitioner (NP), Physician's assistant (PA), Advanced practice pharmacist: schedule II-V • Naturopathic doctors (NDE preceding their license number, INDE indicates their ability): schedule III-V. |
| Naturopathic doctors | Also have limited independent prescribing for certain drugs: epinephrine, natural or synthetic hormones like testosterone and OTC products |
| E- Rx: Two-factor authentication with two of what | • Know - Password or response to a question • Have - Hard token separate from computer • Are - Biometric such as iris or fingerprint scan |
| How long does a CS Rx valid | 6 months |
| What is Required for a CS Written Prescription? | • California security form • Valid 6 months • Include prescriber DEA number • Signed and dated on the day the prescription is issued |
| California Security Form Requirements | • unauthorized copying: "void" appears when photocopied, Presence of watermarks • Erasure / modification: Check boxes / quantity and/or refills • Prevent counterfeit forms: serial No. & barcode, Thermochromic ink, microprint |
| Exceptions to Using California Security Form | • Terminally ill (life ≤ 1 year) - Prescriber must write "11159.2 exemption" on prescription • Declared emergency when CA BOP issues notice of exemption: Prescriber must write "11159.3 exemption" or similar, no more than a 7-day supply, no refills |
| Oral CS Prescriptions for Schedule II | Emergency only (Include all required prescription information) |
| Oral CS Prescriptions for Schedule III-V | Allowed anytime (Include all required prescription information) |
| Faxed CS Prescriptions for Schedule II, Allowed: | • In health care facilities (eg, long-term care facility) • For patients in hospice |
| Faxed CS Prescriptions for Schedule III-V | Allowed anytime |
| Valid DEA Numbers | Starts with 2 letters, ends with 7 numbers |
| DEA starts w A/B/F/G: | hospital, clinic, practitioner, teaching institution, pharmacy |
| DEA starts w M: | Mid-level practitioner (eg, nurse practitioner, physician assistant, optometrist) |
| DEA starts w P/R: | Manufacturer, distributor, researcher, analytical lab, importer, exporter, reverse distributor, narcotic treatment program |
| DEA Second letter: | first letter of the prescriber's last name |
| "Red Flags" of Diversion - Patients | • Behavior • Groups • Multiple pts w same address • Age or presentation (eg, young pt w chronic pain meds) • No logical connection to an illness or condition • Multiple prescribers w duplicate therapy ("doctor shopping") • Distance • Cash |
| "Red Flags" of Diversion - Prescriptions | • Irregularities on the face of the prescription • Unusually large quantities of drug prescribed • Initial prescription written for a strong opioid • "Cocktail" (eg, opioid, benzodiazepine, muscle relaxant) prescribed • Frequent early refills |
| "Cocktail" | opioid, benzodiazepine, muscle relaxant |
| "Red Flags" of Diversion - Prescribers | • Pending legal action against a prescriber • Prescription not within the scope of practice • Similar of identical prescriptions for multiple patients |
| Prescribers' responsibility prior prescriptions for schedule II-IV | • Must review past 12 month fill history before prescribing the first time & every 6 months |
| Pharmacies' responsibility prior dispensing schedule II-IV | • Encouraged to check CURES • Submit dispensing data to CURES within 1 working day after dispensing |
| Out-of-State Prescriptions for schedule II can be filled in CA | YES: • Meet requirements of that state • MD registered to DEA • CA pharmacies mail schedules to pt at out of state address |
| Out-of-State Prescriptions for schedule III - V can be filled in CA | YES: • Meet requirements of that state • MD registered to DEA • CA pharmacies can dispense directly to the pt |
| Partial Filling of Schedule II Rx | • Pharmacy cannot supply full quantity. Must fill remainder w/t 72 hrs • Patient or prescriber requests partial fill: May be filled (multiple times) up to 30 days |
| when Rx of schedule III - V expired | 6 months |
| TRUE or FALSE: Schedule III - V is allowed to refill Up to 5 times; max of 120 days | FALSE • Only schedule III and IV must refill Up to 5 times; max of 120 days. • Schedule V has no limit while Rx is still valid |
| Does Rx of schedule III - V require to use a security form when faxing? | NO. Use regular prescription form so that it does not say void all over it when the pharmacy receives the fax. |
| How many partial fill allowed for C III - V | There is no limit, to how many partials that can be dispensed as long as the quantity does not exceed the total prescribed amount. |
| Recordkeeping of Refills - using Electronic System | Must verify that refill data was correct by either of the following methods: • Sign and date hard copy printout (provided to the pharmacy within 72 hours) • Sign a statement in a logbook or separate file |
| Recordkeeping of Refills - using Paper System | Document the following on the back of the prescription: • Dispensing pharmacist initials • Date of refill • Amount of drug dispensed |
| How many time does allow to transfer Rx for schedule | • Schedule II: NO refill, NO transfer • Schedule III - V: ONE, except for chain. MUST be completed btw 2 licensed pharmacists |
| What does the transferring Pharmacy need to document? | • Pharmacy name and address • DEA number • Names of transferring and receiving pharmacists • Date of transfer • Write void on the face of the original hard copy |
| Quillivant XR® Oral Suspension | methylphenidate HCI |
| FDA-approved indications - Methadone | Methadone is a schedule Il narcotic FDA-approved for pain, opioid use disorder (OUD), and opioid withdrawal |
| Methadone 40 mg soluble tablet - approved indication | Approved for opioid addiction (Lower doses of methadone are occasionally seen in pharmacies to treat pain) |
Created by:
dao.vo11017