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Pharmacist FAQs

Frequently Asked Questions for Pharmacists on Transferring Prescriptions

 

Q:  May a pharmacy transfer an “on file” prescription for a controlled substance that the pharmacy never dispensed?

A:  Pharmacists continue to call Board staff with understandable confusion on whether and how “on file” controlled substance prescriptions that were never filled may be transferred.

In April 2017, word began swirling that DEA viewed transfers of “on file” controlled substances as not allowed.  On July 7, 2017, Loren Miller, Associate Section Chief, Liaison and Policy Section, Diversion Control Division, Drug Enforcement Administration sent an email to Carmen Catizone, Executive Director of the National Association of Boards of Pharmacy, setting forth DEA’s view on the matter.

In that email (found here --  http://www.ncbop.org/PDF/LMillerDEAGuidanceTransferofOnFileCSPrescriptions.pdf), Mr. Miller states the view that 21 CFR 1306.25 allows a pharmacy, “once it has filled an original prescription for a controlled substance in Schedule III-V,” to “transfer the original prescription information to another DEA registered pharmacy for the purposes of allowing that second pharmacy to then dispense any remaining valid refills . . . .”  Mr. Miller further stated that “an allowance currently does not exist for the forwarding of an unfilled prescription from one DEA registered retail pharmacy so that it may be filled at another DEA registered pharmacy.”

Mr. Miller then stated that, based on “the preamble” of an “interim final rule,” it is DEA’s “policy” that an electronic prescription for a controlled substance of any schedule may be “forwarded from one DEA registered retail pharmacy to another DEA registered retail pharmacy” even if that prescription had not been filled.

To say that DEA’s positions in this matter create a mess is a gross understatement.  First, while Mr. Miller’s reading of 21 CFR 1306.25 is textually plausible, it represents a departure from decades of standard pharmacy practice and there has been no suggestion from DEA or anyone else that the standard practice of transferring “on file” but unfilled (as opposed to once-filled) controlled substance prescriptions has caused or materially contributed to controlled substance abuse or misuse.  Second, neither Mr. Miller’s email nor any language in the preamble he references contains so much as a hint as to what an appropriate mechanism for “forwarding” (and documenting the forwarding of) an unfilled electronic controlled substance prescription would be.  Third, Mr. Miller’s email does not explain why “forwarding” an unfilled electronic controlled substance prescription is substantively different than transferring an unfilled controlled substance prescription, whether electronic, verbal, or written.  Fourth, DEA’s position creates not only an incentive, but a practical necessity, for patients  seeking to change their pharmacy of choice to obtain duplicate controlled substance prescriptions from their caregiver.  Interpretations and policies that guarantee duplicate prescriptions for controlled substances in multiple pharmacies hardly seems consistent with the Controlled Substance Act’s purpose to create a controlled, closed distribution system and minimize controlled substance abuse and misuse.

All that said, however, DEA has shown no inclination to reconsider or clarify these positions.  Where does that leave us?

(1)  Though “forwarding” of unfilled electronic controlled substance prescriptions is available by “policy,” the lack of any guidance from DEA on how a “forwarding” should occur and be documented means that most pharmacies and pharmacists are reluctant to entertain the practice.  And who can blame them?

(2)  For unfilled verbal prescriptions for a Schedule III-V controlled substances, DEA’s position means that there is no mechanism for moving them from one pharmacy to another.

(3)  For unfilled paper prescriptions for a Schedule III-V controlled substances, a pharmacy could return the original to the patient to physically carry to another pharmacy.  Board staff understand completely the practical problems of this approach.

Some pharmacists have inquired why Board staff, the Board, or the North Carolina legislature have taken this position.  As the above makes clear, none of the three are to blame.  The present state of affairs is attributable solely, and entirely, to the DEA.  Board staff will, of course, update pharmacists if the DEA sees reason and backs away from these positions.  Until then, send your cards, letters, and calls to the DEA. 

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Q: Is a pharmacy required to transfer a prescription upon a patient’s request?

A: Board Rule .1806 (21 NCAC 46.1806) governs the transfer of prescriptions, specifically stating that “[t]he transfer of prescription information for the purpose of refill dispensing is permissible between pharmacies” so long as other requirements in the rule are met.  From time to time, Board staff field calls from pharmacists who assert that because the rule says a transfer is “permissible,” a pharmacist is not obligated to transfer a prescription upon the request of a patient or someone communicating a request on behalf of a patient.  Board staff does not agree with this interpretation.  The rule’s use of “permissible” simply makes clear that transfers are lawful.  Moreover, a patient’s choice of pharmacy provider must not be impeded by refusal to transfer.  Refusal to transfer can lead to a delay in care for a patient, with the attendant risk of harm to the patient.  Such harm to a patient would be a potential violation of Rule .1806 and a potential basis for finding negligence in the practice of pharmacy.

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Q: May a pharmacy transfer prescription drugs to another pharmacy?

A: North Carolina Wholesale Prescription Drug Distributors Laws provide (N.C.G.S. 106-145.2(10)(e)): "The sale, purchase, or trade of a prescription drug or an offer to sell, purchase or trade a prescription drug for emergency medical reasons. Emergency medical reasons include transfers of prescription drugs by a retail pharmacy to another retail pharmacy to alleviate a temporary shortage when the gross dollar value of the transfer does not exceed 5% of the total prescription drug sales revenue of either the transferor or transferee pharmacy during a 12 consecutive month period."

Transfers between pharmacies that fall outside these guidelines would require a North Carolina wholesaler license. Note that the simple sale of excess stock to another pharmacy would be a wholesale activity. Pharmacists should also be aware that federal pedigree requirements could bear on transfers. And transfer of controlled substances between pharmacies requires compliance with all pertinent provisions of the federal Controlled Substances Act and associated regulations.

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Q: May a technician, certified technician, or pharmacy student transfer or receive transfers of prescriptions for controlled substances?

A: Under federal law, an original prescription for a C-III, C-IV, or C-V substance may be transferred for refill on a one-time basis. If pharmacies electronically share a “real-time, on-line database,” then those sharing pharmacies “may transfer up to the maximum refills permitted by law and the prescriber’s authorization.” 21 C.F.R. § 1306.25(a).

Federal law, however, requires that any transfer of a C-III, C-IV, or C-V prescription be “communicated directly between two licensed pharmacists . . . .” 21 C.F.R. § 1306.25(a)(1).

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Q: Can prescriptions be transferred more than once in North Carolina?

A: Yes, provided that refill authorizations still exist and there are restrictions on controlled substances. Prescriptions for non-controlled drugs can be transferred from one store to another indefinitely providing that refill authorizations do exist.

Federal rules (1306.25(a)) permit multiple transfers of controlled substances, provided that authorization exists, only for those pharmacies that share a real time on-line electronic database. Other pharmacies are limited to one transfer only under federal rules.

 

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