Medication Prescribing InformationTable of ContentsClinical Standards of Prac0ce: S0mulant Dosages...................................................................1TL;DR:..............................................................................................................................................1References.......................................................................................................................................2Mul0ple Post-Dated Scripts Can Be Wri>en Up to90-day Supply............................................5Quan0ty Limits: No law/rule limits maximum supply; Medicaid pays for 30 days or 100 days if maintenance medica0on for chronic condi0on (Dr’s discre0on to define chronic)...................5Early Refills: Medicaid refills CII currently aTer 50% of prior rx 0me has lapsed by default, or prior to 50% if necessary by phone request;at 85% prior to COVID19, 1x/life0me/drug if lost; immediately if rx is a “dose increase”.....................................................................................6OTC Drugs Paid For: Aspirin and various others labeled “OTC” in the PDL...............................7Paper Scripts Can Be Wri>en for CII Drugs..............................................................................7Pharmacist Authority: CAN dispense alterna0ve dose; CAN dispense a subs0tute (non-psychotropic) drug; CAN dispense emergency refill w/o an rx.................................................7Clinical Standards of Prac0ce: S0mulant DosagesTL;DR:American Academy of Sleep Medicine (formerly American Sleep Disorders Associa5on), Standards of Prac5ce Commi;ee, 1994, 2000, 2007, 2021:•Pa5ents have a wide varia5on in response to s5mulants... therefore, full therapeu5c response in adult pa5ents with narcolepsy can usually be obtained with daily medica5on doses below the recommended maximal doses of:... dextroamphetamine sulfate, 100 mg"Understanding Unapproved Use of Approved Drugs "Off Label", United States Federal Drug Administra;on, 02/05/2018The approved drug labeling for healthcare providers gives key informa5on about the drug that includes:

12-280-125. Substitution of prescribed drugs and biological products authorized - when - conditions.(1) (a) A pharmacist filling a prescription order for a specific drug by brand or proprietary name may substitute an equivalent drug product if the substituted drug product is the same generic drug type and, in the pharmacist’s professional judgment, the substituted drug product is therapeutically equivalent, is interchangeable with the prescribed drug, and is permitted to be moved in interstate commerce. A pharmacist making a substitution shall assume the same responsibility for selecting the dispensed drug product as he or she would incur in filling a prescription for a drug product prescribed by a generic name; except that the pharmacist is charged with notice and knowledge of the FDA list of approved drug substances and manufacturers that is published periodically.

12-280-125.3. Pharmacists’ authority - minor prescription adaptions.(1) Except as provided in subsection (3) of this section, a pharmacist who is acting in good faith and is using professional judgment and exercising reasonable care may make the following minor adaptions to an order if the pharmacist has the informed consent of the patient for whom the prescription was provided:(a) A change in the prescribed dosage form or directions for use of the prescription drug if the change achieves the intent of the prescribing practitioner;(b) A change in the prescribed quantity of the prescription drug if the prescribed quantity is not a package size commercially available from the manufacturer;(c) An extension of the quantity of a maintenance drug for the limited quantity necessary to achieve medication refill synchronization for the patient; and(d) Completion of missing information on the order if there is sufficient evidence to support the change.(2) A pharmacist who adapts an order in accordance with subsection (1) of this section shall document the adaption and the justification for the change in the patient’s pharmacy record with the original prescription and shall notify the prescribing practitioner of the adaption.(3) A pharmacist shall not adapt an order if the prescribing practitioner has written “do not adapt” on the prescription or has otherwise communicated to the pharmacist that the prescription must not be adapted.

Dispensing an Emergency Supply of a Chronic Maintenance Drug Without a Prescription

Early RefillsPharmacies are able to override early refills at the point-of-sale (POS) after 50% of medication day supply has lapsed sincelast fill for reasons related to COVID-19. Use DUE response codes with reason for service code ‘ER’ at the POS to receive apaid claim. This override is not available for use by mail order pharmacies.If a member requires a refill before 50% of the day supply has lapsed, a POS override is not available. Please contact theMagellan Help Desk at 1-800-424-5725 for a one-time refill authorization

Lost/Stolen/Damaged/Vacation Prescriptions The Department does not pay for early refills when needed for a vacation supply. The Health First Colorado program will cover lost, stolen, or damaged medications once per lifetime for each member. Pharmacies must call for overrides for lost, stolen, or damaged prescriptions. If a member calls the call center, the member will be directed to have the pharmacy call for the override. Stolen prescriptions will no longer require a copy of the police report to be submitted to the Department before approval will be granted. The replacement request and verification must be submitted to the Department within 60 days of the last refill of the medication.

Refill Too Soon Policy For DEA Schedule 2 through 5 drugs, 85 percent of the days' supply of the last fill must lapse before a drug can be filled again. For non-scheduled drugs, 75 percent of the days' supply of the last fill must lapse before a drug can be filled again. A 7.5 percent tolerance is allowed between fills for Synagis. If the appropriate numbers of days have not lapsed, the claim will be denied as a refill-too-soon unless there has been a change in the dosing. For non-mail order transactions, there is a maximum 20-day accumulation allowed every rolling 180 days. If a Medicaid member enters or leaves a nursing facility, the member may require a refill-too-soon override in order to receive his or her drugs. A PAR must be submitted by contacting the Pharmacy Benefit Manager Support Center.

Health First Colorado Pharmacy Benefits Frequently Asked Questions Are over-the-counter (OTC) medications covered?Insulin and aspirin are covered without a prior authorization. All other over-the-counter (OTC) medications require a prior authorization before approval unless an OTC is a preferred product on the Preferred Drug List (PDL).

Can I get my medication early?Early refills are covered when there is an increase in dosage or if a client is going into or leaving a nursing home. Clients may receive up to a 100 day supply of maintenance medications and up to a 30 day supply of non-maintenance medications. If you run out of medication, contact your doctor and discuss adjusting your prescription to your current needs.

Please note that DEA does not assign a numerical limit to the amount of schedule II controlledsubstance to be prescribed. Instead, DEA recognizes that these are medical decisions within theprescribing practitioner’s sound medical discretion, as guided by any limitations imposed by thestate medical board and state law

8.800.14 PRESCRIPTION QUANTITIES8.800.14.A For chronic conditions requiring maintenance drugs, the maximum dispensing quantities for new and refill prescriptions shall be a 100-day supply. For all other drugs, the maximum dispensing quantities for new and refill prescriptions shall be a 30-day supply. The Department may set or change minimum or maximum dispensing quantities of certain drugs

Preferred Drug List (PDL)

practitioner must signand date the multiple prescriptions as of the date issued, (21 CFR 1306.05(a)); and, write on eachseparate prescription the earliest date on which the prescription can be filled (21 CFR1306.12(b)(ii)).

ursuant to 21CFR 1306.12(b) “an individual practitioner may issue multiple prescriptions authorizing the patientto receive a total of up to a 90-day supply of a schedule II controlled substance, subject to specificconditions are met

This does not prohibit thepractitioner from issuing one prescription for a 90-day supply if allowed by state law and regulationthat otherwise comport with 21 CFR 1306.04(a)

U. S. Department of JusticeDrug Enforcement Administration

The prescriber reasonably determines that the patient would be unable to obtain controlled substances prescribed electronically in a timely manner and that the delay would adversely affect the patient’s medical condition.

12-30-111. Electronic prescribing of controlled substances - exceptions - rules - definitions

Electronic prescribing of controlled substances: What physicians and practices need to know

"Similarly on the justice front, we now work with a Legal Aid funded lawyer. If I see that someone has legal concerns of any sort — and these can be very broad from domestic violence issues to family issues to criminal issues — I can refer them straight over to that member of our team."