§ 18 — Issuance of prescription by practitioner or physician

Massachusetts § 18

• Jurisdiction: Massachusetts
• Part I: ADMINISTRATION OF THE GOVERNMENT
• Title XV: REGULATION OF TRADE
• Ch. 94C: CONTROLLED SUBSTANCES ACT

Text

Section 18. (a) A prescription for a controlled substance may be issued only by a practitioner who is:(1) authorized to prescribe controlled substances; and(2) registered pursuant to the provisions of this chapter.(b) An oral prescription issued by a practitioner may be communicated to a pharmacist by an expressly authorized employee or agent of the practitioner.(c) A prescription for a controlled substance contained in schedules III to VI, inclusive, as defined in section three may also be issued by an authorized practitioner who is duly licensed and authorized to engage in prescriptive practice and duly registered in the state wherein he resides, if required, and duly registered under federal law to write prescriptions. It is the duty of the registered pharmacist who is filling a prescription under this paragraph to determine, in accordance with professional standards and personal judgment, that such prescription is authentic and valid; provided, however, that if the substance is in schedules III to V, inclusive, the registered pharmacist shall verify the prescription by telephone or other means. A pharmacist shall not fill a prescription for which said verification cannot be obtained. The pharmacist shall not be held liable for refusing to fill a prescription for which said verification cannot be obtained, provided that documented good faith efforts were made to determine the authenticity and validity of the prescription. This paragraph shall be valid only for the purpose of authorizing the filling of prescriptions, issued within the preceding thirty days, and shall not authorize said practitioner to process, administer or dispense controlled substances as provided in section nine or to practice within the commonwealth. In the case of any oral prescription for a schedule III through V substance, the pharmacist shall record that he has requested that the practitioner deliver or mail to the dispensing pharmacy a written prescription for the controlled substance within seven days or such shorter period required by Federal law. Any prescription issued under this paragraph shall be issued in the manner prescribed in section twenty-two and all relevant provisions of this chapter shall apply to such practitioner and prescription. Nothing contained in this section shall be deemed to authorize any mail order pharmacies.(d) A prescription for a nonnarcotic substance contained in Schedule II of section three may also be issued by a practitioner who is licensed and authorized to engage in prescriptive practice and registered in another state where he resides or practices, if required, and registered under federal law to write prescriptions. A registered pharmacist filling a prescription under the provisions of this paragraph shall determine, in accordance with professional standards and personal judgment, that such prescription is authentic and valid; and shall verify such prescription by telephone or other means. A pharmacist shall not fill a prescription for which said verification cannot be obtained. A pharmacist shall not be held liable for refusing to fill such prescription for which said verification cannot be obtained; provided, however, that documented good faith efforts were made to determine the authenticity and validity of such prescription. This paragraph is only for the purpose of authorizing the filling of prescriptions within the commonwealth, issued within the preceding five days, and shall not authorize such practitioner to possess, administer or dispense controlled substances as provided in section nine, or to practice within the commonwealth. Any prescription issued under the provisions of this paragraph shall be issued in the manner prescribed in section twenty-two and all relevant provisions of this chapter shall apply to such practitioner and prescription. In the case of any prescription for a Schedule II substance filled under the provisions of this paragraph, a pharmacist filling such prescription shall within thirty days after the filling of such prescription deliver to the department a copy of each such Schedule II prescription; provided, however, that such copy shall not include the name and address of the patient for whom the prescription is issued and that such copy and the information contained thereon shall not be deemed to be public record within the meaning of section seven of chapter four and shall be subject to the restrictions set forth in section two of chapter sixty-six A. Nothing contained in this section shall be deemed to authorize any mail order pharmacies.(d1/2) Except as provided in section 18A, a prescription for a narcotic substance contained in Schedule II of section 3 may also be issued by a practitioner who is licensed and authorized to engage in prescriptive practice and registered in Maine or in a state contiguous with the commonwealth wherein such practitioner resides or practices, if required, and registered under federal law to write prescriptions. A registered pharmacist filling a prescription under this subsection shall determine, in accordance with professional standards and personal judgment, that such prescription is authentic and valid and shall verify the prescription by telephonic or other means. A pharmacist shall not fill a prescription for which a verification cannot be obtained. A pharmacist shall not be liable for refusing to fill a prescription for which a verification cannot be obtained provided that documented good faith efforts were made to determine the authenticity and validity of such prescription. This subsection shall only apply to authorizations for the filling of prescriptions within the commonwealth, issued within the preceding 5 days, and shall not authorize such practitioner to possess, administer or dispense controlled substances under section 9 or to practice within the commonwealth. A prescription issued under this subsection shall be issued in the manner provided in section 22 and all relevant provisions of this chapter shall apply to any such practitioner and any such prescription. In the case of a prescription for a Schedule II substance filled pursuant to this subsection, a pharmacist shall, within 30 days after filling such prescription, deliver to the department a copy of each such Schedule II prescription; provided, however, that such copy shall not include the name and address of the patient for whom the prescription was issued; and provided further, that such copy and the information contained therein shall not be a public record within the meaning of section 7 of chapter 4 and shall be subject to the restrictions set forth in section 2 of chapter 66A. Nothing in this section shall authorize a mail-order pharmacy.Nothing in this subsection shall be interpreted to prohibit a retail pharmacy operating within the commonwealth from filling prescriptions for a narcotic substance contained in schedule II of section 3 to residents of states other than Maine and the states contiguous with the commonwealth, provided, however, that:(1) the pharmacy shall be licensed for retail by the commonwealth and, if applicable, registered with the appropriate regulatory authorities in the state from which the prescription is received and the United States Drug Enforcement Administration, as applicable, for the dispensing of controlled substances;(2) the prescription shall be filled by a pharmacist licensed and registered in the state from which the prescription originates, if the state of the prescription's origin requires such registration and licensing, and shall be written by a practitioner licensed and authorized to engage in prescriptive practice and registered in the same state or a contiguous state to where the prescription is to be delivered and registered under federal law to write prescriptions or shall be written by a nurse practitioner or physician assistant who is authorized by the state of the prescription's origin to write the prescription and is licensed and registered in the same state or a contiguous state to where the prescription is to be delivered and is registered under federal law to write prescriptions;(3) the prescription shall be received by the retail pharmacy via mail or commercial carrier or through an equivalent electronic means as may be authorized by federal law;(4) a registered pharmacist filling a prescription under this subsection shall determine, in accordance with professional standards and personal judgment, that such prescription is authentic, valid, legitimate and legal in the state from which it is received and shall verify the prescription by telephonic or other means; provided, however, that a pharmacist shall not fill a prescription for which verification cannot be obtained; and provided further, that any delivery of controlled substances to residents of another state shall be in full compliance with all laws and regulations of that state relative to the issuance and filling of prescriptions;(5) the pharmacy shall comply with all reporting requirements of the state to which the prescription is delivered including, but not limited to, enrollment in and adherence to the rules, regulations and requirements of the state's prescription monitoring program or any program equivalent thereto, where applicable; and(6) any substances delivered under this subsection shall be delivered via mail or by a commercial carrier to a verified address in the state of residence of the person for whom the prescription was written and shall not enter into the hands of any person in the commonwealth not directly associated by employment or subcontract with the United States Postal Service or commercial carrier selected for such purpose.Nothing in this subsection shall prohibit a retail pharmacy operating within the commonwealth from filling prescriptions for a narcotic substance contained in schedule II of section 3 of this chapter for patients admitted to a long-term care facility in Maine or a state contiguous with the commonwealth, provided; however, that:(i) the pharmacy is licensed for retail by the commonwealth and, if applicable, registered with the appropriate regulatory authorities in the state from which the prescription is received and the United States Drug Enforcement Administration, as applicable, for the dispensing of controlled substances; and(ii) the medications are delivered directly to the long-term care facility by a courier employed or contracted by the retail pharmacy.(d3/4) A pharmacist filling a prescription for a schedule II substance shall, if requested by the patient, dispense the prescribed substance in a lesser quantity than indicated on the prescription. The remaining portion may be filled upon patient request in accordance with federal law; provided, however, that only the same pharmacy that originally dispensed the lesser quantity shall dispense the remaining portion. Upon an initial partial dispensing of a prescription or a subsequent dispensing of a remaining portion, the pharmacist or the pharmacist's designee shall make a notation in the patient's record maintained by the pharmacy, which shall be accessible to the prescribing practitioner by request, indicating that the prescription was partially filled and the quantity dispensed. The initial partial dispensing of a prescription filled pursuant to subsection (d) or (d1/2) shall be filled not more than 5 days after the prescription issue date. The remaining portion filled pursuant to this subsection must be filled not later than 30 days after the prescription issue date.[ Subsection (e) effective until March 23, 2025. For text effective March 23, 2025, see below.](e) Practitioners who prescribe controlled substances, except veterinarians, shall be required, as a prerequisite to obtaining or renewing their professional licenses, to complete appropriate training relative to: (i) effective pain management; (ii) the risks of abuse and addiction associated with opioid medication; (iii) identification of patients at risk for substance use disorders; (iv) counseling patients about the side effects, addictive nature and proper storage and disposal of prescription medications; (v) appropriate prescription quantities for prescription medications that have an increased risk of abuse; and (vi) opioid antagonists, overdose prevention treatments and instances in which a patient may be advised on both the use of and ways to access opioid antagonists and overdose prevention treatments. The boards of registration for each professional license that requires this training shall develop the standards for appropriate training programs.[ Subsection (e) as amended by 2024, 285, Sec. 3 effective March 23, 2025. For text effective until March 23, 2025, see above.](e) Practitioners who prescribe controlled substances, except veterinarians, shall be required, as a prerequisite to obtaining or renewing their professional licenses, to complete appropriate training relative to: (i) effective pain management including, but not limited to: (A) appropriate, available non-opioid alternatives for the treatment of pain; (B) the advantages and disadvantages of the use of non-opioid treatment alternatives, considering a patient's risk of substance misuse; and (C) the options for referring or prescribing appropriate non-opioid treatment alternatives based on the practitioner's clinical judgment and following generally accepted clinical guidelines, taking into consideration the preference and consent of the patient and the educational information described in section 21; (ii) the risks of misuse and addiction associated with opioid medication; (iii) the identification of patients at risk for substance misuse; (iv) counseling patients about the side effects, risks, addictive nature and proper storage and disposal of prescription medications; (v) the appropriate prescription quantities for prescription medications that have an increased risk of misuse and addiction, including a patient's option to fill a prescription for a schedule II controlled substance in a lesser quantity than indicated on the prescription pursuant to subsection (d%74); and (vi) opioid antagonists, overdose prevention treatments and information to advise patients on both the use of and ways to access opioid antagonists and overdose prevention treatments. The boards of registration for each professional license that require this training shall, in consultation with the department, relevant stakeholders and experts in the treatment and management of acute and chronic pain, develop the standards for appropriate training programs. For the purposes of this section, non-opioid treatment alternatives shall include, but shall not be limited to, medications, restorative therapies, interventional procedures, behavioral health approaches and complementary and integrative treatments.