Controlled substance prescriptions: schedules, refills, partial fills and transfers
PTCB topic: Controlled substance prescriptions and DEA schedules
- Schedule II prescriptions are never refilled.
- Schedule III-IV: up to 5 refills within 6 months of issue.
- Patient-requested Schedule II partial fill: finish within 30 days of writing.
- Pharmacy short on Schedule II stock: fill the balance within 72 hours.
- Schedule III-V refills transfer once, pharmacist to pharmacist.
Key facts
- Schedule II examples: oxycodone, morphine, fentanyl, hydrocodone (including hydrocodone with acetaminophen), methylphenidate, amphetamine, lisdexamfetamine.
- Schedule III: codeine combinations with no more than 90 mg codeine per dosage unit, buprenorphine, ketamine, anabolic steroids such as testosterone. Schedule IV: alprazolam, lorazepam, zolpidem, tramadol, carisoprodol. Schedule V: codeine cough preparations (no more than 200 mg/100 mL), pregabalin, lacosamide.
- Schedule III and IV: no fill or refill more than 6 months after the date issued, and no more than 5 refills.
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- Schedule II partial fill requested by the patient or prescriber: remaining portions within 30 days of the date written.
- Schedule II partial fill because the pharmacy is short: balance within 72 hours, or notify the prescriber.
- Emergency oral Schedule II order: the prescriber delivers a written prescription within 7 days.
- An unfilled electronic Schedule II-V prescription may be transferred once for its first fill, electronically, pharmacist to pharmacist.
Quick check1 question · 2 more at the end
Under federal law, what is the refill limit for a prescription for a Schedule III or IV controlled substance?
Correct answer: C.
For Schedule III and IV controlled substances, federal law allows up to 5 refills and no fill or refill more than 6 months after the date the prescription was issued, whichever limit comes first. Schedule II prescriptions cannot be refilled at all. Federal regulations set no refill limit for Schedule V; it may be refilled as authorized by the prescriber (state law may be stricter).
A Refills are prohibited for Schedule II prescriptions, not for Schedule III or IV.
B Federal law caps Schedule III and IV prescriptions at 5 refills and 6 months, not 11 refills in a year.
C Correct: 21 CFR 1306.22(a) allows no more than 5 refills and no filling more than 6 months after the date of issue.
D The 6-month window starts on the date the prescription was issued, not the first fill, and it is 6 months, not a year.
Full lesson
Each part starts with its main idea. Open a part when you want the details.
The short answer: Under federal law, Schedule II prescriptions cannot be refilled. Schedule III and IV prescriptions allow up to 5 refills within 6 months of the date issued. A patient-requested Schedule II partial fill must be completed within 30 days of the date written; a stock shortage allows 72 hours. Refill transfers for Schedules III-V happen once, pharmacist to pharmacist.
1 How are controlled substances scheduled?DEA places each controlled substance in one of five schedules based on medical use, abuse potential and dependence risk. 1 min
DEA places each controlled substance in one of five schedules based on medical use, abuse potential and dependence risk. The full list is in 21 CFR 1308.11-1308.15; the schedule decides every prescription rule below.
| Schedule | Meaning | Common examples |
|---|---|---|
| I | No accepted medical use, high abuse potential | Heroin, LSD, MDMA ("Ecstasy") |
| II | High abuse potential, severe dependence | Oxycodone, morphine, fentanyl, hydrocodone/acetaminophen, methylphenidate, amphetamine |
| III | Less than II | Acetaminophen with codeine (no more than 90 mg codeine per unit), buprenorphine, ketamine, testosterone |
| IV | Less than III | Alprazolam, lorazepam, zolpidem, tramadol, carisoprodol |
| V | Lowest | Codeine cough syrups (no more than 200 mg/100 mL), pregabalin, lacosamide |
2 What makes a controlled substance prescription valid?A valid prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of practice. 1 min
A valid prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of practice. It must be dated and signed on the day issued. It must show the patient's full name and address, and the drug name, strength, dosage form, quantity and directions. It must also show the prescriber's name, address and DEA number.
The pharmacist has a corresponding responsibility to fill only legitimate prescriptions.
- Schedule II: written (manually signed) or electronic. An oral order is allowed only in an emergency, for the emergency quantity, and the prescriber must deliver a written prescription within 7 days.
- Schedules III-V: written, electronic, faxed, or oral (reduced to writing by the pharmacist).
3 How do refills work?Schedule II prescriptions are never refilled, while Schedules III and IV get 5 refills within 6 months. 1 min
Schedule II prescriptions are never refilled, while Schedules III and IV get 5 refills within 6 months. The details:
- Schedule II: no refills. A prescriber may issue several prescriptions at once for up to a 90-day total supply, each later one marked with the earliest date it may be filled.
- Schedules III and IV: no fill or refill more than 6 months after the date issued, and no more than 5 refills, whichever comes first.
- Schedule V: federal regulations set no refill limit; refill as authorized by the prescriber (state law may be stricter).
Worked example: issued March 10 with 5 refills → the last possible fill date is September 10, even if refills remain.
4 What are the partial-fill rules for Schedule II?The deadline depends on who asked for the partial fill. 1 min
The deadline depends on who asked for the partial fill. Use this table:
| Reason for partial fill | Remaining quantity must be filled |
|---|---|
| Pharmacy cannot supply the full amount | Within 72 hours; otherwise notify the prescriber |
| Patient or prescriber asks for it | Within 30 days of the date written (72 hours for an emergency oral order) |
| Long-term care or terminally ill patient | Partial quantities allowed; prescription valid up to 60 days from issue |
The total dispensed can never exceed the amount prescribed. Schedule III-V partial fills are allowed too, within the 6-month window.
5 When can a prescription be transferred?Federal law allows two kinds of transfers, both communicated directly between two licensed pharmacists. 1 min
Federal law allows two kinds of transfers, both communicated directly between two licensed pharmacists. State law can be stricter.
- Refill transfer (Schedules III-V): one time only, unless the pharmacies share a real-time online database. The sending pharmacist voids the prescription and both record the details.
- First-fill transfer of an electronic prescription (Schedules II-V): at the patient's request, one time, kept in electronic form (never converted to fax). Unused Schedule III-V refills move with it.
6 What the technician does 1 min
- Checks the schedule, issue date, refill count and fill dates before processing.
- Flags expired refills, early fills and altered prescriptions for the pharmacist.
- Refers transfer calls, emergency orders and partial-fill requests to the pharmacist.
Common mistakes
The traps students fall into most. Read these before you practice.
Watch out: The 6-month window starts on the date the prescription was issued, not on the first fill or a refill.
Watch out: The 30-day partial-fill window runs from the date written, not from the first partial fill.
Watch out: Hydrocodone with acetaminophen is Schedule II, not Schedule III.
Watch out: Pregabalin is Schedule V, not Schedule IV.
Watch out: Transfers are communicated between two licensed pharmacists, not by a technician.
How to remember it
A short countdown holds the refill and partial-fill numbers in one line. Say "II: zero. III-IV: 5 and 6. Partial: 30, 72." It means no Schedule II refills and 5 refills in 6 months for III-IV. Requested Schedule II partials get 30 days, and a shortage gets 72 hours.
Self-check:
- A Schedule IV prescription issued January 15: what is the last date it may be refilled?
- A Schedule II prescription written May 2 is partially filled at the patient's request May 6. By what date must the rest be filled?
- Who may communicate a Schedule III refill transfer?
Show answers
- July 15.
- Schedule III and IV prescriptions cannot be filled more than 6 months after the date issued.
- January 15 + 6 months = July 15.
- This holds even if refills remain.
- June 1.
- A patient-requested partial fill must be completed within 30 days of the date written.
- Count from May 2, not from the May 6 partial fill.
- May 2 + 30 days = June 1.
- Two licensed pharmacists.
- Federal law says transfers are communicated directly between two licensed pharmacists.
- A technician does not communicate the transfer.