6.1 Refill Limits, Sequential Schedule II Prescriptions & Partial Fills
Key Takeaways
- A Schedule II prescription may never be refilled (M.G.L. c. 94C, § 23; 21 CFR 1306.12) and becomes invalid 30 days after the date of issuance in Massachusetts.
- Under 247 CMR 9.04 Schedules III, IV AND V share the same ceiling in Massachusetts — no fill or refill more than six months after issuance, maximum five refills; only Schedule VI carries a one-year window.
- A practitioner may issue multiple sequential Schedule II prescriptions on the same day for up to a 90-day total supply, each bearing the true issuance date plus written 'do not fill until' instructions.
- Federal law permits a 60-day partial fill window for a patient in a long-term care facility or with a terminal illness, with 'LTCF patient' or 'terminally ill' recorded on the prescription (21 CFR 1306.13).
- Where a pharmacy cannot supply the full quantity, the balance must be supplied within 72 hours; if it cannot be, the pharmacist must notify the prescriber and no further quantity may be supplied without a new prescription.
Refill Limits, Sequential Schedule II Prescriptions & Partial Fills
The Refill Ceiling by Schedule
| Schedule | Refills | Outer limit on filling | Source |
|---|---|---|---|
| II | None, ever | Invalid 30 days after issuance | M.G.L. c. 94C, § 23; 21 CFR 1306.12 |
| III | Max 5 | No fill or refill more than 6 months after issuance | 247 CMR 9.04; 21 CFR 1306.22 |
| IV | Max 5 | 6 months after issuance | 247 CMR 9.04; 21 CFR 1306.22 |
| V | Max 5 | 6 months after issuance | 247 CMR 9.04 |
| VI | As authorised | 1 year from the date of issue | 247 CMR 9.04 |
[!WARNING] Schedule V follows III and IV in Massachusetts. Federal law imposes no refill ceiling on Schedule V, which leads many candidates to assume a one-year, refill-as-authorised rule. 247 CMR 9.04 groups Schedule V with Schedules III and IV: six months, five refills. The one-year window belongs only to Schedule VI.
Whichever comes first. A Schedule III–V prescription dies on the earlier of the fifth refill or the six-month anniversary of issuance. A prescription written 3 January with five refills is dead on 3 July whether or not any refills remain.
Count from issuance. Every window runs from the date the practitioner issued the prescription, never from the first fill or the day the patient handed it over.
Sequential Schedule II Prescriptions
Because Schedule II can never be refilled, federal law provides a substitute. A practitioner may issue multiple prescriptions on the same day authorising, in total, up to a 90-day supply of a Schedule II controlled substance, provided:
- each prescription is issued for a legitimate medical purpose in the usual course of professional practice;
- each bears the actual date of issuance;
- the practitioner gives written instructions on each subsequent prescription stating the earliest date on which it may be filled; and
- the practitioner concludes that this does not create an undue risk of diversion or abuse.
In Massachusetts each individual prescription in the series is still governed by the 30-day validity rule in c. 94C, § 23, which is why the "do not fill until" dates and the 30-day windows have to be planned together.
Partial Fills: Three Different Regimes
| Regime | Trigger | Window for the balance | Documentation |
|---|---|---|---|
| Massachusetts patient request (M.G.L. c. 94C, § 18) | The patient asks for a lesser quantity — the pharmacist shall comply | Initial partial dispensing within 5 days of the issue date; balance within 30 days of the issue date | Date, quantity dispensed, quantity remaining, dispensing pharmacist |
| CARA patient or prescriber request (federal) | Patient or prescriber requests a partial fill of a Schedule II | Balance within 30 days of issuance | As above |
| LTCF or terminally ill patient (21 CFR 1306.13) | Patient resides in a long-term care facility or has a terminal illness | Up to 60 days from issuance | Record "LTCF patient" or "terminally ill" on the prescription |
| Pharmacy out of stock (21 CFR 1306.13) | The pharmacy cannot supply the full quantity | 72 hours | If the balance cannot be supplied in 72 hours the pharmacist must notify the prescriber, and no further quantity may be supplied without a new prescription |
[!CAUTION] The three clocks are the whole question. 5 days to start a Massachusetts patient-requested partial fill; 30 days to finish it; 60 days for an LTCF or terminally ill patient; 72 hours for an out-of-stock partial. Mixing them up is the single most common error on this topic.
In every regime the total dispensed across all partial fills may not exceed the quantity prescribed, and each partial fill is recorded in the same manner as a refill.
Partial fills of Schedules III–V
A Schedule III, IV or V prescription may be partially filled provided each partial fill is recorded in the same manner as a refill, the total dispensed does not exceed the total prescribed, and no dispensing occurs after the six-month window closes.
Worked Traps
- A Schedule III prescription with five refills, presented for the fourth refill seven months after it was written. Expired at six months. Refills remaining is irrelevant.
- A pharmacy partially fills a Schedule II because it is short of stock, and the patient returns on day four for the balance. The 72-hour out-of-stock window has closed. The pharmacist must notify the prescriber; a new prescription is needed for the balance.
- A hospice patient's Schedule II prescription is partially filled on day 45 after issuance. Permitted under 21 CFR 1306.13 if "terminally ill" is recorded on the prescription — the 60-day window applies.
- A prescriber adds one refill to a Schedule II prescription "for convenience." Void. No authority, state or federal, permits a Schedule II refill.
In Massachusetts, what is the maximum period during which a Schedule V prescription may be filled or refilled?
A Massachusetts pharmacy has only 20 of the 60 tablets on a Schedule II prescription and partially fills it. Four days later the stock arrives and the patient returns for the balance. What may the pharmacist do?
A practitioner wishes to provide a 90-day course of a Schedule II stimulant. Which arrangement complies with federal and Massachusetts law?