Filling Prescriptions

For Controlled Substances

In general:

The order must be filled as written, unless the prescriber consents to a substitution of a generic equivalent. It should match the strength, dosage form and amount specified on the prescription. 

Pharmacists cannot obstruct patients from obtaining legally prescribed drugs, except in 3 cases:

• If the pharmacist determines dispensing would be contrary to the law or would adversely affect the patient's medical condition based on their professional training and judgment
• If the drug is not in stock, in which case the pharmacist would be required to arrange for the drug to be delivered to the patient in a timely manner, transfer the prescription or return the prescription to the patient.
• If the pharmacist has previously informed their employer in writing that they refuse to fill a specific drug based on ethical, moral, or religious grounds. 

Dosage Limits:

There are no dosage limits on any drug, but pharmacists should use their best judgment when approached with a prescription for an unusually high quantity or duration. They should contact the prescriber if the order seems irregular or otherwise questionable. For tips on evaluating the validity of a controlled substance prescription see the "Report Forgery" tab above. 

Label Requirements:

• Brand or generic name of drug
• Manufacturer's name
• Directions for use
• Patient name
• Name of prescriber
• Date of issue
• Name and address of pharmacy (or furnisher)
• A prescription number
• Strength
• Quantity
• Expiration date
• Indication for use if patient requests and it is provided on the prescription
• Warnings about taking the drug in combination with alcohol, impairment of ability to drive, etc.
• Physical description of medication (color, shape, ID code)

A patient may request that the pharmacy provide a prescription drug container label using 12-point font rather than the minimum of 10-point font for patient name, drug name, strength, directions, and drug indication. 

The label on Schedule II, III, and IV controlled substance prescriptions must contain a caution that it is illegal to transfer the drug to any person other than the person for whom it was prescribed. 

Partial Fills:

For information on partial fills of controlled substance prescriptions see the "Expiration Date and Time Limits" tab above. 

Refills:

Prescriptions for all drugs and controlled substances, except Schedule II's, may be refilled with prescriber authorization. 

Schedule II- 

• cannot be refilled, patient must get a new prescription from the prescriber.

Schedule III or IV- 

• prescription can only be refilled up to 5 times for no longer than a 6-month time period from the date of issue and all of the refills added up together cannot exceed a 120 day supply. 
• the date of each refill must be noted on the back of the prescription or in another appropriate record.
• the prescriber may authorize additional refills on the original prescription through an oral refill authorization transmitted to the pharmacist.
• An automated system may be used for storage and retrieval of refill information if the database includes all necessary information, provides for online retrieval, and is checked for accuracy.

Schedule V-

• refills can be treated in the same manner as a regular medication. 

Picture Sources:
http://www.urmc.rochester.edu/pharmacy/refill.cfm
http://www.womenshealth.gov/aging/drugs-alternative-medicine/how-to-read-drug-labels.cfm
http://www.mountainside-medical.com/products/Controlled-Substance-Pharmacy-Label-For-Medication.html
http://corporate.novantonline.org/ProgramsServices/EmployeeConnections/Pharmacy/PrescriptionRefills.aspx