7.4 Partial Filling of Prescriptions: Non-Controlled, Schedule II & Schedules III–V

7.4 Partial Filling of Prescriptions: Non-Controlled, Schedule II & Schedules III–V

[!IMPORTANT] Core Exam Concept: "Partial fill" describes four legally distinct situations that share a name and nothing else. The controlling variable is why the prescription was partially filled and what schedule the drug occupies. Alabama has no partial-fill rule of its own, so the federal clocks in 21 C.F.R. §§ 1306.13 and 1306.23 control, layered on top of Alabama's recordkeeping requirements in Ala. Admin. Code r. 680-X-2-.15. Memorize the clocks as a set — 72 hours, 30 days, 60 days, six months — because MPJE items are built by swapping one for another.

A partial fill is not a refill. A refill is a new dispensing event authorized in advance by the prescriber; a partial fill is the completion, in pieces, of a single authorized quantity. That distinction drives the recordkeeping: a partial fill can never increase the total quantity the prescriber authorized.

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1. Non-Controlled Legend Drugs

Federal law places no restriction on partially filling a prescription for a non-controlled legend drug, and Alabama adopts none. The practice is governed by professional judgment and by the accuracy of the pharmacy record.

• Common Triggers: stock shortage, a manufacturer backorder, an insurance day-supply edit, or a patient who wants only enough to test tolerability before committing to a 90-day quantity.
• The "Owe" Slip: The pharmacy must record the quantity actually dispensed and the balance owed, so that the remaining quantity plus the dispensed quantity never exceeds the authorized total. Rule 680-X-2-.15(1)(g) requires the record to capture the quantity dispensed originally and on each refill; a partial fill that is not entered accurately corrupts that field.
• Prescription Expiration Still Applies: The balance can only be picked up while the underlying prescription remains valid. The Alabama Board of Pharmacy states plainly that "there is no expiration date for a prescription for any non-controlled, legend drug," so the operative limits are the prescriber's own authorization and the pharmacist's professional judgment about whether the therapy is still appropriate.

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2. Schedule II — Pharmacist Cannot Supply the Full Quantity (21 C.F.R. § 1306.13(a))

This is the classic "out of stock" partial fill.

+-----------------------------------------------------------------------------------------+
|        SCHEDULE II PARTIAL FILL -- INSUFFICIENT STOCK (21 C.F.R. 1306.13(a))            |
+-----------------------------------------------------------------------------------------+
|  Step 1  Pharmacist supplies the portion on hand                                        |
|  Step 2  Pharmacist NOTES THE QUANTITY SUPPLIED on the FACE of the written prescription |
|          (or in the electronic record for an EPCS order)                                |
|  Step 3  Remaining portion MAY be supplied within 72 HOURS of the first partial fill    |
|  Step 4  If the remainder is NOT supplied within 72 hours, the pharmacist SHALL NOTIFY  |
|          THE PRESCRIBING PRACTITIONER                                                   |
|  Step 5  No further quantity may be supplied beyond 72 hours WITHOUT A NEW PRESCRIPTION |
+-----------------------------------------------------------------------------------------+

Three details decide most exam items on this rule:

1. The clock runs from the partial filling, not from the date written. A prescription written Monday and partially filled Thursday gives the pharmacy until Sunday.
2. Notification is mandatory, not optional. If the balance cannot be supplied in 72 hours, the pharmacist shall notify the prescriber. A pharmacy that simply lets the owe-slip lapse has violated the rule even though it dispensed nothing improper.
3. The remainder is forfeited, not deferred. After 72 hours the balance is void. The prescriber must issue a new Schedule II prescription; the pharmacist may not dispense the balance on day four.

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3. Schedule II — Requested by the Patient or Prescriber (21 C.F.R. § 1306.13(b), CARA 2016)

The Comprehensive Addiction and Recovery Act of 2016 (CARA) created a second, opioid-stewardship pathway. A Schedule II prescription may be partially filled at the request of the patient or the practitioner who wrote it, provided:

• Partial filling is not prohibited by state law — Alabama does not prohibit it, and the Alabama Board of Pharmacy's own guidance confirms that Schedule II partial fills at the request of the patient or prescriber are permitted with the remaining portions filled within 30 days of the original date;
• The prescription is written and filled in accordance with the CSA and DEA regulations;
• The total quantity dispensed in all partial fillings does not exceed the total quantity prescribed; and
• The remaining portions are filled not later than 30 days after the date on which the prescription was written.

[!WARNING] The 72-hour rule and the 30-day rule are not interchangeable. They are triggered by different facts. If the pharmacy is short of stock, the clock is 72 hours and the remainder dies after that. If the patient or prescriber asked for a smaller quantity — the surgical patient who wants 10 tablets of a #40 prescription — the clock is 30 days from the date written. A question that says "the patient requested only a few days' worth" is a CARA question, not a stock-shortage question.

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4. Schedule II — LTCF Residents and Terminally Ill Patients (21 C.F.R. § 1306.13(c))

A Schedule II prescription written for a resident of a Long Term Care Facility (LTCF) or for a patient the prescriber has determined to be terminally ill may be partially filled in units as small as clinically appropriate.

The 60-day window pairs naturally with the Alabama fax rule. Under Ala. Admin. Code r. 680-X-3-.10(2), a Schedule II prescription for a long-term care patient (including hospice patients) or for a home infusion / I.V. pain therapy patient may be transmitted by facsimile and the facsimile serves as the original written prescription — so an LTCF Schedule II can arrive by fax and then be partially filled across 60 days.

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5. Schedules III, IV, and V (21 C.F.R. § 1306.23)

Partial filling of a Schedule III–V prescription is permitted if all three conditions hold:

1. Each partial filling is recorded in the same manner as a refilling;
2. The total quantity dispensed in all partial fillings does not exceed the total quantity prescribed; and
3. No dispensing occurs more than six (6) months after the date on which the prescription was issued.

Because each partial is recorded like a refill, the Alabama daily verification duty attaches. Under r. 680-X-2-.15(2), a pharmacist refilling a Schedule III–V prescription must verify the entered refill data either by (a) signing and dating a hard-copy printout of each day's controlled substance refill data, which the pharmacy must receive within 72 hours of the dispensing date, or (b) signing a daily statement in a bound log book or separate file attesting that the day's entered refill information has been reviewed and is correct.

+-----------------------------------------------------------------------------------------+
|                        THE FOUR PARTIAL-FILL CLOCKS AT A GLANCE                         |
+---------------------------+--------------+------------------------------------------------+
| Situation                 | Clock        | Runs from                                      |
+---------------------------+--------------+------------------------------------------------+
| C-II, pharmacy short      | 72 HOURS     | The partial filling (then notify prescriber)   |
| C-II, patient/prescriber  | 30 DAYS      | The DATE THE PRESCRIPTION WAS WRITTEN          |
|   requested (CARA)        |              |                                                |
| C-II, LTCF or terminally  | 60 DAYS      | The DATE OF ISSUE                              |
|   ill                     |              |                                                |
| C-III / C-IV / C-V        | 6 MONTHS     | The DATE OF ISSUE (shared with the refill cap) |
| Non-controlled            | None federal | Professional judgment + accurate records       |
+---------------------------+--------------+------------------------------------------------+

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6. Worked Example: Reading the Arithmetic

A prescriber issues oxycodone 5 mg, #60, no refills on March 3. The pharmacy has 20 tablets.

• If the shortage is the reason: dispense 20, note "20 dispensed" on the face of the prescription, and supply the 40-tablet balance by March 6 (72 hours). Not supplied by then? Notify the prescriber; the balance is void and a new Schedule II prescription is required.
• If the patient asked for only 20 tablets after surgery: this is a CARA partial. The 40-tablet balance may be filled at any point through April 2 — 30 days after March 3 — and the running total may never exceed 60 tablets.
• If the patient is an LTCF resident and the prescription is marked "LTCF patient": the 60-day window runs to May 2, with each partial recorded by date, quantity, remaining quantity, and dispensing pharmacist.
• If the drug were hydrocodone... it would still be Schedule II. Do not reflexively apply the six-month rule to hydrocodone combination products; they were rescheduled to C-II in 2014.

[!CAUTION] The trap that catches strong candidates: a Schedule II prescription can never be refilled, but it can be partially filled. Options that say "Schedule II drugs may never be dispensed in more than one transaction" are wrong. So are options that let a partial fill push the cumulative quantity above what the prescriber authorized.