7.2 Emergency Refills, Combined Refills & Insulin Continuity
Key Takeaways
A Utah pharmacist or intern may make an emergency refill of a non-controlled drug the patient is currently using if the prescriber is not promptly available, no emergency refill of that prescription has been given before at that pharmacy, and it is in the patient's interest (Utah Code § 58-17b-608).
If the prescription is on file and expired within the past 30 days or has no refills left, an emergency refill may exceed three days but not the lesser of a 30-day supply or the last quantity dispensed.
A pharmacist may combine refills of a non-controlled legend drug up to a 100-day supply unless the prescription says "dispense quantity written" (Utah Code § 58-17b-608.1).
For an "exhausted" insulin prescription (expired within six months, or no refills left), a Utah pharmacist may dispense up to a 60-day supply once per prescription (Utah Code § 58-17b-608.2).
After an insulin emergency refill, the pharmacist must tell the prescriber the amount and type of insulin dispensed within 30 days.
7.2 Emergency Refills, Combined Refills & Insulin Continuity
Blueprint item 3.4 covers "exceptions to dispensing or refilling prescriptions." Utah has several, each with its own conditions.
The emergency refill statute (§ 58-17b-608)
If a prescription cannot otherwise be refilled, a pharmacist or pharmacy intern may refill it in an emergency, without the prescriber's authorization, if all of these are true:
- the drug is not a controlled substance;
- the patient is currently using the drug;
- the prescriber is not available promptly to authorize the refill;
- the pharmacist or intern (or another at the same pharmacy) has not already given an emergency refill for this prescription under this section;
- refilling is in the interest of the patient's health;
- in the pharmacist's or intern's professional judgment, it should be refilled;
- it is dispensed according to the prescriber's instructions on the prescription (except for the quantity limit below); and
- no more is dispensed than is necessary to address the emergency.
How much may be dispensed
If the prescription is on file at the dispensing pharmacy, the pharmacist or intern may dispense more than a three-day supply only if:
- the prescription expired within the past 30 days, or it has no refills remaining; and
- the amount does not exceed the lesser of a 30-day supply or the quantity last dispensed at that pharmacy (as a fill or refill).
R156-17b-612(14) restates this for drugs "currently using and on file." The pharmacist must inform the prescriber of the emergency refill as soon as practicable (§ 58-17b-608(3)).
The emergency refill rule (R156-17b-612(11))
DOPL's rule describes a pharmacist or DMP refilling, in professional judgment, "a drug, other than a Schedule II controlled substance," without authorization, when:
- the quantity does not exceed a 72-hour supply (unless the drug comes only in a larger package);
- not refilling might interrupt therapy or cause suffering;
- a disaster prevents contacting the prescriber, or the pharmacist cannot reach the prescriber after a documented reasonable effort;
- if the prescription was filled at another pharmacy, the patient has the label or other documentation, and the pharmacist cannot reach that pharmacy to transfer refills, or there are none left; and
- the pharmacist tells the patient the refill is being given without authorization and that future refills need authorization, informs the prescriber at the earliest reasonable time, keeps a record with the prescription information, and labels the container under § 58-17b-602.
Important
The statute limits pharmacist emergency refills to non-controlled drugs, and federal rules allow controlled-substance refills only as the prescriber authorizes. On the exam, a pharmacist may not independently give an emergency supply of a controlled substance such as clonazepam or zolpidem. For a Schedule II emergency, the only path is the prescriber's oral emergency order (Section 9.2).
Combining refills (§ 58-17b-608.1)
If a legend-drug prescription authorizes refills, a pharmacist or intern may dispense one or more refills at once if:
- the drug is not a controlled substance;
- the prescription does not say "Dispense quantity written" (or similar);
- the total dispensed does not exceed a 100-day supply; and
- the pharmacist or intern judges it appropriate.
Eye drops: a refill of a liquid legend drug administered to the eye may be dispensed once enough time has passed that the patient should have used 70% of the dosage units as directed.
Insulin: exhausted prescriptions (§ 58-17b-608.2; R156-17b-612b)
An "exhausted prescription" is an insulin prescription the patient is currently using that either expired no earlier than six months before the request, or has not expired but has no refills.
| Rule | Detail |
|---|---|
| Combining refills | A pharmacist may combine insulin refills to dispense a 100-day supply, not exceeding the total authorized |
| Emergency supply | On an emergency basis, a refill of an exhausted prescription up to a 60-day supply under the prescriber's instructions, rounded to the nearest available package size |
| Frequency | No more than once per exhausted prescription |
| Before dispensing | Attempt to contact the prescriber to say the prescription has expired, and tell the patient the outcome of that attempt |
| After dispensing | Within 30 days, inform the prescriber of the amount and type of insulin dispensed |
| Documentation | Record the prescribing information, directions, the contact attempt, and the patient notice. Label the container "exhausted prescription." |
| Diabetes supplies | A pharmacist may dispense a therapeutic equivalent glucometer, test strips, lancets, syringes, needles, or other designated supplies |
Because § 58-17b-608.2 applies "notwithstanding" § 58-17b-608, the insulin rule has its own limits (60 days, once per exhausted prescription) that differ from the general 30-day emergency refill.
Other continuity-of-care provisions
- Hospital discharge: a hospital pharmacy may dispense up to a 72-hour supply to a patient discharged that day when the patient's usual Class A pharmacy is closed or cannot dispense (§ 58-17b-610.6; R156-17b-610.6).
- Emergency department: a prescriber may give up to a three-day emergency supply, a seven-day supply of STI prophylaxis, or a naloxone kit (R156-17b-610.5).
Scenario
On a Saturday a patient needs atorvastatin. The prescription on file at this pharmacy has no refills left, the prescriber can't be reached, and the patient last received a 30-day supply. The pharmacist may give a one-time emergency refill of up to 30 days (the lesser of 30 days and the last quantity), documents it, and notifies the prescriber as soon as practicable.
On a Saturday, a patient's atorvastatin prescription on file at the pharmacy has no refills remaining and the prescriber cannot be reached. The last fill was a 30-day supply. What is the most the pharmacist may dispense as an emergency refill?
A 30-day supply (the lesser of a 30-day supply or the quantity last dispensed), once for this prescription, with notice to the prescriber as soon as practicable
A 3-day supply only, because Utah never allows more than 72 hours
Nothing, because emergency refills require the prescriber's verbal approval
A 90-day supply, because atorvastatin is a maintenance drug
A patient with type 1 diabetes has an insulin glargine prescription that expired four months ago. The pharmacist tries to reach the prescriber without success. What does Utah Code § 58-17b-608.2 allow?
A one-time refill of up to a 60-day supply of the exhausted prescription, after telling the patient the outcome of the contact attempt and then informing the prescriber of the amount and type within 30 days
An unlimited supply as long as the patient signs a waiver
A 3-day supply only, because insulin is covered by the general emergency refill statute
Nothing, because the prescription has expired
A regular patient asks for an emergency 3-day supply of clonazepam 1 mg (Schedule IV) on a Sunday because the psychiatrist is unavailable. How should the Utah pharmacist respond?
Dispense a 30-day supply because the prescription expired within the last 30 days
Dispense a single dose from stock without documentation
Decline the pharmacist-initiated emergency refill, because Utah's emergency refill statute excludes controlled substances and federal rules require prescriber authorization for controlled-substance refills
Dispense a 72-hour supply under § 58-17b-608, because withdrawal is a serious risk
A prescription for losartan authorizes three refills of 30 tablets each and does not say "dispense quantity written." The patient asks for a 90-day supply. What does Utah law allow?
90 days only if the prescriber is called first
Only 30 days, because refills may never be combined
Up to a 180-day supply, because refills may always be combined
The pharmacist may combine refills to dispense 90 days, because Utah allows combining non-controlled legend-drug refills up to a 100-day supply
Sections you finish are checked off in the contents.