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      RS 40:978     

  

§978. Prescriptions

            A. Except when dispensed or administered directly by a medical practitioner or administered by a person authorized to administer by such practitioner, other than a pharmacist, to an ultimate user, no controlled dangerous substance included in Schedule II, which is a prescription drug as determined under the Louisiana Revised Statutes of 1950, may be dispensed or administered without either the written prescription of a practitioner, or an electronic prescription order as provided by federal law or regulation, except that in emergency situations, as prescribed by the board by regulation, such drug may be dispensed or administered upon oral prescription reduced promptly to writing and filed by the pharmacist. Prescriptions shall be retained in conformity with the requirements of R.S. 40:976. No prescription for a Schedule II substance may be refilled nor may such prescription be filled more than ninety days after the date of the prescription. The pharmacist filling a prescription for a Schedule II substance may, upon request of the patient, dispense the prescribed substance in an amount less than the full quantity prescribed in accordance with 21 U.S.C. 829.

            B. Except when dispensed or administered directly by a practitioner or administered by a person authorized to administer by such practitioner, other than a pharmacist, to an ultimate user, no controlled dangerous substance included in Schedule III and IV which is a prescription drug as determined under the Louisiana Revised Statutes may be dispensed or administered without either a written prescription, an oral prescription, or an electronic prescription order as provided by federal law or regulation. Such prescription may not be filled or refilled more than six months after the date thereof or refilled more than five times after the date of the prescription, unless renewed by the practitioner.

            C. No controlled dangerous substance included in Schedule V may be distributed, administered or dispensed other than for a medical purpose by prescription of a licensed practitioner or as otherwise permitted by the provisions of this Part. However, nothing contained in this Subsection shall prohibit a practitioner from delegating the authority to administer controlled dangerous substances in Schedule V to a person authorized by such practitioner.

            D. Notwithstanding the requirements of this Section, a prescription for a controlled substance listed in Schedule II, III, IV, or V may be generated, signed, transmitted, and received in electronic form, but only in conformance with the federal rules established by the United States Drug Enforcement Administration at 21 CFR 1311.

            E.(1) The pharmacist shall not dispense more than a ten-day supply at a dosage not to exceed the United States Food and Drug Administration's approved labeling for the medication if the prescriber for such medication is not licensed by the state of Louisiana, and the medication is an opioid derivative Schedule II or an opioid derivative Schedule III controlled dangerous substance. The dispensing pharmacist shall notify the prescriber of the supply dispensed and the cancellation of the remainder of the prescription.

            (2) Within sixty days of the dispensing of a medication pursuant to Paragraph (1) of this Subsection, such a medication shall not be dispensed again for the individual by a prescriber not licensed by the state of Louisiana.

            (3) The provisions of this Subsection shall not apply if either of the following apply:

            (a) The prescription monitoring information from the state of the prescriber may be viewed by the dispensing pharmacist.

            (b) The prescriber includes on the prescription a diagnosis of cancer or terminal illness.

            F.(1) A prescriber or his delegate shall access and review the patient's record in the prescription monitoring program established in R.S. 40:1001 et seq. prior to initially prescribing any opioid to a patient, and shall access the prescription monitoring program and review the patient's record at least every ninety days if the patient's course of treatment continues for more than ninety days. The requirement established in this Subsection shall not apply in the following instances:

            (a) The drug is prescribed or administered to a hospice patient or to any other patient who has been diagnosed as terminally ill.

            (b) The drug is prescribed or administered for the treatment of cancer-related chronic or intractable pain.

            (c) The drug is ordered or administered to a patient being treated in a hospital.

            (d) The prescription monitoring program is inaccessible or not functioning properly due to an internal or external electronic issue. However, the prescriber or his delegate shall check the prescription monitoring program once electronic accessibility has been restored and note the cause for the delay in the patient's chart.

            (e) No more than a single seven-day supply of the drug is prescribed or administered to a patient.

            (2) The provisions of this Subsection shall be enforced by the health profession licensing board that regulates the prescriber. Each health profession licensing board that regulates prescribers shall promulgate rules and regulations in accordance with the Administrative Procedure Act to comply with the mandate in this Subsection. If a health profession licensing board becomes aware of a prescriber's first failure to comply with this Subsection, as verified by the data of the prescription monitoring program, the board shall notify the prescriber of the relevant statutory requirements and inform the prescriber of the need to correct or amend his prescribing practices to comply with the provisions of this Subsection. If a health profession licensing board becomes aware of a second or subsequent failure to comply with this Subsection, as verified by the data of the prescription monitoring program, the board shall treat the notification as a complaint against the licensee, but shall not consider such notice as evidence of deviation from standard of care.

            (3) The provisions of this Subsection shall not apply to individuals licensed by the Louisiana Board of Veterinary Medicine.

            G.(1)(a) Except as provided in Paragraph (2) of this Subsection, when issuing a first-time opioid prescription for outpatient use to an adult patient with an acute condition, a medical practitioner shall not issue a prescription for more than a seven-day supply.

            (b) Except as provided in Paragraph (2) of this Subsection, a medical practitioner shall not issue a prescription for an opioid to a minor for more than a seven-day supply at any time and shall discuss with a parent, tutor, or guardian of the minor the risks associated with opioid use and the reasons why the prescription is necessary.

            (2) If, in the professional medical judgment of a medical practitioner, more than a seven-day supply of an opioid is required to treat the adult or minor patient's acute medical condition or is necessary for the treatment of chronic pain management, pain associated with a cancer diagnosis, or for palliative care, the practitioner may issue a prescription for the quantity needed to treat the patient's acute medical condition or pain. The condition triggering the prescription of an opioid for more than a seven-day supply shall be documented in the patient's medical record and the practitioner shall indicate that a nonopioid alternative was not appropriate to address the medical condition.

            (3) This Subsection shall not apply to medications designed for the treatment of substance abuse or opioid dependence.

            H.(1) Prior to issuing a prescription for an opioid, a medical practitioner shall do both of the following:

            (a) Consult with the patient regarding the quantity of the opioid and the patient's option to fill the prescription in a lesser quantity.

            (b) Inform the patient of the risks associated with the opioid prescribed.

            (2)(a) A pharmacist filling a prescription for an opioid may dispense the prescribed substance in an amount less than the recommended full quantity indicated on the prescription if requested by the patient and the prescription complies with the provisions of this Section. The patient may request that the pharmacist fill an additional amount not to exceed the remaining prescribed quantity in accordance with 21 U.S.C. 829.

            (b) If the dispensed amount is less than the recommended full quantity, the pharmacist or a designee shall ensure that the actual dispensed amount is accurately recorded in the prescription monitoring program. The pharmacist or a designee shall also, within seven days, make a notation in the interoperable electronic health record of the patient if the pharmacist has access to the record.

            (c) Nothing in this Subsection shall be interpreted to conflict with or supersede any other requirement established in this Section for a prescription of a controlled dangerous substance or any requirements or conditions for drug substitutions established by law.

            Added by Acts 1972, No. 634, §1. Amended by Acts 1975, No. 667, §1; Acts 1978, No. 786, §5, eff. July 17, 1978; Acts 2011, No. 155, §1; Acts 2014, No. 865, §1; Acts 2015, No. 189, §1, eff. June 23, 2015; Acts 2016, No. 192, §1, eff. May 26, 2016; Acts 2017, No. 76, §1, eff. June 12, 2017; Acts 2017, No. 82, §1; Acts 2018, No. 32, §1; Acts 2018, No. 206, §4; Acts 2018, No. 219, §2; Acts 2018, No. 405, §1.



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