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Topic Federal State Who wins
Patient counselling requirements OBRA-90 requires counselling be offered to Medicaid patients only.

Both a verbal and printed offer to counsel must be made for all outpatient prescriptions. If the drug is not delivered directly to the patient, the offer must be in writing and provided for toll-free telephone access to the pharmacist. This does not apply as a requirement for inpatient prescriptions.

Rule 64B16-27.820 Patient counselling

State
Multiple medications on the same blank No restriction Each blank must only have medications from same class prescribed State
Tamper resistant pad requirements All written Medicaid outpatient prescriptions

Counterfeit resistant prescription pads are required for:

Schedule

  • II

  • III

  • IV

  • V (893.065)

Veterinary prescriptions are exempt

Both*
Checking prescriptions for Controlled Substances No requirement for the initials of the pharmacist filling the prescription & the date filled be written on the face of the prescription The pharmacist must write the initials & the date filled on the face of all controlled substance prescriptions State
Oral Prescriptions for CIII No restrictions

Oral prescriptions for Schedule III medications are limited to:

  • 30 day supply including refills

State

CII Emergency Prescriptions

Verbal

Limited to the amount necessary to treat the patient during the emergency period

72 hour supply (3 days)

upon conditions in 893.04.(1)(f).

State**
Expiration date on CII Prescriptions

No expiration on Schedule II prescriptions

However… 60 days from date issued for long term care (LTC) patients and terminal illness

21 CFR 1306.13

Schedule II prescriptions expire 1 year from the date of the original prescription

Rule 64B16-27.211 Prescription Refills

But…

60 days for LTC and terminal illness

State

*Federal law only requires “tamper-resistant pads”; State law makes specific requirements:

  • Pre-printed Physician’s name, address, and category of licensure

    • Including the practitioner’s federal registry number for controlled substances

  • Security protections

    • Background green or blue resist reproduction

    • The blank must be printed on watermarked paper

    • The blank must resist erasures and alterations

    • The following words, “void” or “illegal” to appear on any photocopy or reproduction

**Typically, the more stringent ruling is followed, instances could follow where less than 72 hours may be needed for the emergency period. Also, note that this is for the purposes of verbal prescriptions.

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