9.2 Schedule II Partial Fills, Emergency Oral Orders & Methadone Emergency Orders
Key Takeaways
When a pharmacy cannot supply the full Schedule II quantity, the remainder must be filled within 72 hours or it cannot be supplied, and the pharmacist must notify the prescriber (21 CFR 1306.13(a)).
A Utah Schedule II prescription may be partially filled at the request of the patient or the prescriber, with the remainder filled no later than 30 days after issuance (Utah Code § 58-17b-610.7; 21 U.S.C. § 829(f)).
For long-term care or terminally ill patients, Schedule II prescriptions may be partially filled for up to 60 days from issuance (21 CFR 1306.13(b)).
Utah limits an emergency oral Schedule II prescription to a 72-hour supply, and the prescriber must have examined the patient within 30 days, be treating a chronic condition, or be covering for another practitioner (R156-37-605).
For each Schedule II partial fill, Utah requires the pharmacy to record the date, quantity supplied, and quantity remaining under the prescription number (R156-17b-610.7).
9.2 Schedule II Partial Fills, Emergency Oral Orders & Methadone Emergency Orders
Blueprint items 2.1 and 3.4 cover controlled-substance issuance requirements and "exceptions to dispensing." Schedule II exceptions come from federal law (21 CFR 1306.11 and 1306.13; 21 U.S.C. § 829(f)) and Utah law (§ 58-17b-610.7; R156-17b-610.7; R156-37-605).
Three kinds of Schedule II partial fills
| Situation | Who asks | Deadline for the remainder | Source |
|---|---|---|---|
| Pharmacy can't supply the full quantity | Pharmacist | Within 72 hours. If the remainder isn't supplied in 72 hours, the pharmacist notifies the prescriber, and no more may be dispensed without a new prescription. | 21 CFR 1306.13(a) |
| Patient or prescriber request (CARA 2016) | Patient or prescriber | Remaining portions filled no later than 30 days after the date written; total may not exceed the quantity prescribed | 21 U.S.C. § 829(f); Utah § 58-17b-610.7(3) |
| Long-term care facility patient or terminally ill patient | Pharmacist, documenting the patient's status | Partial fills allowed for up to 60 days from the issue date; total may not exceed the quantity prescribed; note "terminally ill" or "LTCF patient" | 21 CFR 1306.13(b); Utah § 58-17b-610.7(2) |
Utah recording rule (R156-17b-610.7): for each partial fill, record by prescription number the date, quantity supplied, and quantity remaining. Utah also allows partial filling of prescriptions for terminal patients in licensed hospices, home health agencies, or nursing homes when the patient may not need the full amount (R156-17b-612(6)).
A partial fill at the patient's request is a tool for opioid stewardship. For example, a patient who wants only three days of a post-operative opioid can receive a partial fill and return for more if needed within the window.
Emergency oral Schedule II prescriptions
Federal rule (21 CFR 1306.11(d))
In an emergency, a pharmacist may dispense a Schedule II drug on the prescriber's oral authorization if:
- the quantity is limited to what is needed for the emergency period;
- the pharmacist immediately reduces the order to writing with all required information except the prescriber's signature;
- the pharmacist makes a reasonable, good-faith effort to verify the prescriber if the prescriber is unknown; and
- the prescriber delivers a written (or electronic) prescription within 7 days, marked "Authorization for Emergency Dispensing" with the date of the oral order. The pharmacist attaches it to the oral record and notifies DEA if it is not received.
Utah rule (R156-37-605)
- Prescriber side: in an emergency situation (defined in R156-37-102(3)), a prescriber may give an oral CII order if the quantity is no more than 72 hours; the prescriber has examined the patient within the past 30 days, or the patient is under the prescriber's continuing care for a chronic disease, or the prescriber is covering for another practitioner and knows the patient's condition; and a written prescription is delivered within seven business days.
- Pharmacist side: a pharmacist may fill the oral CII order if the amount does not exceed a 72-hour supply and the pharmacist reasonably believes, or makes a reasonable effort to determine, that the prescriber is licensed to prescribe the drug.
- An emergency oral CII order is exempt from Utah's EPCS mandate (R156-37-609(3)(a)(iii)), and § 58-37-304(3)(c) allows emergency oral dispensing when the order is promptly reduced to writing.
Utah's 72-hour cap is stricter than the federal "emergency period," and the federal 7-day cover-prescription deadline is stricter than Utah's seven business days. Apply the stricter rule in each case.
Methadone emergency medical orders in hospitals (§ 58-37-307)
A qualified practitioner (DEA-registered to issue an emergency medical order and working at a general acute hospital) may issue an emergency medical order to a qualified pharmacy (a Class A or B pharmacy on the hospital's premises) to dispense up to a 72-hour supply of methadone. The purpose is to relieve acute withdrawal while arranging referral for substance use disorder treatment, in accordance with 21 CFR 1306.07 and DEA guidance.
Other federal Schedule II points
- Faxed CII prescriptions may serve as the original only for home infusion narcotics, long-term care residents, and hospice patients (Section 4.2).
- An unfilled electronic CII prescription may be transferred once between pharmacies for initial filling (DEA 2023 rule; § 58-37-302(3)).
- Changes to a CII prescription follow DOPL's July 2024 clarification (Section 4.2).
Scenarios
- Short on stock. A pharmacy has only 40 of 60 oxycodone tablets. It dispenses 40, notes the quantity, and must supply the remaining 20 within 72 hours. Otherwise it notifies the prescriber, and the remainder is void.
- Patient wants fewer. A post-surgical patient asks for 10 of 30 hydrocodone tablets. The pharmacy may partially fill at the patient's request and dispense the rest within 30 days of the date written, recording each partial fill.
- After-hours emergency. A hospice physician calls in morphine for a patient the physician saw last week. The pharmacist may dispense up to a 72-hour supply, reduce the order to writing, and must receive the written "Authorization for Emergency Dispensing" prescription within 7 days.
A pharmacy can supply only 40 tablets of a 60-tablet oxycodone prescription because of a stock shortage. The patient did not ask for a partial fill. What does federal law require?
Void the prescription immediately after the partial fill
Supply the remainder any time within 30 days of the date written
Supply the remainder within 60 days, because partial fills are always allowed for 60 days
Supply the remaining 20 within 72 hours; if that can't be done, notify the prescriber, and no further quantity may be supplied without a new prescription
A Utah patient asks the pharmacist to dispense only 10 of 30 prescribed hydrocodone/acetaminophen tablets. What does Utah law allow?
No partial fill, because only long-term care patients may receive partial Schedule II fills
A partial fill at the patient's request, with remaining portions dispensed within 30 days of the date written, and each partial fill recorded by prescription number with date, quantity supplied, and quantity remaining
A partial fill with the remainder valid for 6 months
A partial fill only if the prescriber approves in writing first
A physician calls a Utah pharmacy with an emergency oral order for morphine for a patient she examined 10 days ago. Under R156-37-605 and federal law, what may the pharmacist dispense?
No more than a 72-hour supply, reducing the order to writing and receiving the prescriber's written "Authorization for Emergency Dispensing" prescription within 7 days
Up to a 30-day supply, because the prescriber examined the patient recently
Any quantity, as long as a cover prescription arrives within 30 days
Nothing, because Schedule II drugs may never be ordered orally
For a patient in a long-term care facility, how long may a Schedule II prescription be partially filled under federal rules?
For up to 6 months
Indefinitely, while the patient remains in the facility
For up to 60 days from the issue date, as long as the total dispensed does not exceed the quantity prescribed
For up to 72 hours only
Sections you finish are checked off in the contents.