9.2 Partial Fills of Schedule II Prescriptions

Partial fill is not a Schedule II refill

Quick Answer: No CII refills. 21 CFR 1306.13 still allows partial fills, and the reason for the partial fill picks the clock. Pharmacy cannot supply the full quantity → remainder within 72 hours of the first partial, then notify the prescriber. Patient or practitioner request (CARA) → remainder within 30 days of the issue date. Emergency oral CII remainder → 72 hours after the oral prescription is issued. LTCF or terminally ill → partials for 60 days from issue, with the required notation. Connecticut has not published a tighter remainder rule, so federal law applies.

Candidates lose this item when they treat every leftover oxycodone quantity as a “refill” (forbidden) or apply the 72-hour pharmacy-out-of-stock clock to a patient who asked for ten tablets of a thirty-tablet prescription (that is the 30-day CARA clock). Learn the fact pattern, then pick the clock.

21 U.S.C. § 829(a) and 21 CFR 1306.12 say no CII prescription may be refilled. CGS § 21a-250 incorporates that federal limit. A partial fill is a dispensing of less than the quantity prescribed against the same prescription. The leftover tablets are not a new refill authorization. 21 U.S.C. § 829(f) (CARA, 2016) and DEA’s 2023 amendment of 21 CFR 1306.13 (effective August 21, 2023) spell out when that leftover may still be dispensed.

CARA applies only if the partial fill is not prohibited by State law. Connecticut has not published a prohibition on patient- or practitioner-requested CII partial fills, and it has not published a remainder period shorter than the federal clocks. On a Connecticut MPJE item, apply 21 CFR 1306.13 unless the stem cites a Connecticut remainder statute — and none is currently on the books for this purpose.

Match the fact pattern to the clock

Keep those four rows separate. A Stamford pharmacy that is short 20 oxycodone tablets is row one. A patient who asks to take only 10 of 30 because of leftover bottles at home is row two. A hospice patient in a West Hartford LTCF is row four. An emergency oral morphine remainder is the 72-hour issuance clock, not the 30-day written-date clock.

(a) Pharmacy cannot supply — 72 hours from the first partial

21 CFR 1306.13(a) is the classic “we are out of stock” rule. A partial fill of a CII is permissible if the pharmacist is unable to supply the full quantity called for in a written or emergency oral prescription and notes the quantity supplied on the face of the written prescription, on the written record of the emergency oral prescription, or in the electronic prescription record. The remaining portion may be filled within 72 hours of the first partial filling. If that remainder is not or cannot be filled within 72 hours, the pharmacist shall notify the prescribing individual practitioner. No further quantity may be supplied beyond 72 hours without a new prescription.

Exam traps inside subsection (a):

• The 72 hours run from the first partial, not from the written date (unless those happen to be the same afternoon).
• Notifying the prescriber is mandatory when the remainder will be missed. Notifying does not extend the 72 hours.
• Filling the remainder on day four because “the truck came late” is a new-prescription problem, not a delayed partial.
• Subsection (a) is not the authority for a patient who simply prefers fewer tablets. That is subsection (b).

(b) Patient or practitioner request — 30 days from the written date (CARA)

21 CFR 1306.13(b) implements CARA. A CII may be partially filled if all of the following are true: state law does not prohibit it; the prescription is written and filled in accordance with the CSA, DEA rules, and state law; the partial is requested by the patient, by one acting on the patient’s behalf (parent or legal guardian of a minor, or an adult patient’s caregiver named in a medical power of attorney), or by the practitioner who wrote the prescription; and the cumulative quantity of all partials does not exceed the quantity prescribed.

If those conditions are met, remaining portions, if filled, must be filled not later than 30 days after the date on which the prescription is written. That is an issue-date clock. A prescription written March 1, first partial March 20, still dies for remaining tablets on March 31, not 30 days after March 20.

Emergency oral exception inside (b): remaining portions of a partially filled emergency oral CII must be filled not later than 72 hours after the prescription is issued. Do not give that patient the 30-day written-date window.

DEA’s 2023 rule also tells how the request is documented. A practitioner who wants specified partial quantities writes them on the prescription (or communicates them on an emergency oral). After consultation, a practitioner may later authorize a partial; the pharmacist notes “Authorized by Practitioner to Partial Fill,” the practitioner’s name, date and time, and the pharmacist’s initials. A patient (or qualifying caregiver/parent) may request a partial in person, in a signed writing, or by phone. The pharmacist notes who requested the partial, the date, and the quantity dispensed, and keeps a dispensing record with the same data 21 CFR 1306.22(c) requires for CIII–IV refill records. If the practitioner already specified a partial amount, the patient may not demand a larger amount than the practitioner specified.

(c) LTCF or terminally ill — 60 days from issue

21 CFR 1306.13(c) is a different legal theory: the prescription may be filled in partial quantities, including individual dosage units, for a patient in a Long Term Care Facility or a patient with a medical diagnosis documenting a terminal illness. If there is any question whether the patient is terminally ill, the pharmacist must contact the practitioner before partially filling. Both the pharmacist and the practitioner have corresponding responsibility to assure the CII is for a terminally ill patient. The pharmacist must record on the prescription whether the patient is “terminally ill” or an “LTCF patient.” A partial fill without that notation is treated as filled in violation of the Act. Each partial records date, quantity dispensed, remaining quantity, and the dispensing pharmacist’s identification. Total quantity of all partials still cannot exceed the quantity prescribed. The prescription is valid not more than 60 days from the issue date unless the medication is discontinued sooner.

Emergency oral CII — two different 72-hour duties

Connecticut is stricter than federal law on the written follow-up of an emergency oral CII, and that duty is not the partial-fill remainder clock.

• Partial-fill remainder (federal CARA / 1306.13(b)(2)): leftover tablets from a partially filled emergency oral CII must be dispensed, if at all, within 72 hours after the oral prescription is issued.
• Written confirmation of the oral order (CGS § 21a-249(e)): the prescriber must get a proper prescription to the pharmacy within 72 hours after the oral order has been given. Federal 21 CFR 1306.11 still uses 7 days for that follow-up; Connecticut’s 72-hour confirmation is the more restrictive rule and controls in this jurisdiction.
• Pharmacy-out-of-stock remainder (1306.13(a)): 72 hours from the first partial, with a duty to notify the prescriber if the rest cannot be supplied.

Three 72-hour sentences, three start times. An oral emergency CII for a weekend trauma patient that the pharmacy can fill only in part is both an (a) stock problem and an (b) emergency-oral remainder problem — the remainder still cannot outrun 72 hours from issuance. The prescriber’s written confirmation of the oral order is a separate Connecticut 72-hour filing duty under § 21a-249(e).

Which clock applies — a working list

• Out of stock on a routine written oxycodone: 1306.13(a) — remainder in 72 hours from the first partial; notify if you will miss it.
• Patient asks to fill 7 of 28 tablets of a written CII: 1306.13(b) — remaining fills by day 30 from the written date.
• Prescriber writes “dispense 10 now, remainder as requested” on a 30-count CII: still (b); patient cannot demand more per partial than the prescriber specified; last tablet still by day 30 from issue.
• Emergency oral hydromorphone, pharmacy short: remainder by 72 hours from issuance; Connecticut written confirmation of the oral order also due in 72 hours.
• Nursing-home resident, oxycodone 5 mg, “LTCF patient” noted: unit-dose partials for 60 days from issue under 1306.13(c).
• Hospice patient at home with documented terminal illness: 60-day clock if the prescription is noted “terminally ill.” Missing the notation is a CSA violation, not a paperwork courtesy.
• Day 31 after a CARA partial, patient wants the rest: new prescription. The original is closed.
• Calling leftover CII tablets a “refill”: always wrong.

Realistic Connecticut scenarios

A New London pharmacy has only 15 of 30 oxycodone 5 mg tablets in the CII safe on a Tuesday morning. The pharmacist dispenses 15, notes 15 supplied, and tells the patient to return Wednesday for the rest. That remainder is a 72-hour / subsection (a) problem. If the wholesaler slips to Friday, the pharmacist notifies the prescriber and does not drip out the last 15 on Friday against the original prescription.

A Hamden dental patient hands over a 20-count oxycodone prescription written that morning and says, “Give me eight; I still have some at home from last year.” That is a patient-requested partial under 1306.13(b). The remaining 12, if filled at all, must be filled by 30 days from today’s written date. Offering them in week six is a new-prescription conversation, not a late partial. Corresponding responsibility still applies to the original 20-count (see section 9.3); a partial fill does not clean a medically unjustified quantity.

A Danbury LTCF sends a 30-day oxycodone order. The pharmacy notes “LTCF patient” and sends a 7-day cassette, then another, staying within the prescribed total and within 60 days of issue. Omitting the notation while still sending cassettes is the 1306.13(c) violation DEA wrote the regulation to catch.

Official anchors

• 21 CFR 1306.13 — CII partial fills: unable to supply (72 hours), CARA patient/practitioner request (30 days / emergency oral 72 hours), LTCF/terminally ill (60 days).
• 21 U.S.C. § 829 — no CII refills; CARA partial-fill subsection (f).
• CGS § 21a-249(e) — emergency oral CII written confirmation within 72 hours (stricter than the federal 7-day follow-up).