Auditors Targeting Ladder Schedule II Prescriptions

PAAS has been seeing an increase in audits for ‘laddered’ controlled substance prescriptions. A ladder prescription is a Schedule II controlled substance written as multiple prescriptions issued on the same date. This allows for fewer prescriber office visits where refills are not allowed by DEA regulations. They are commonly written for routine ADHD and pain medications.

The DEA has specific regulations for the issuance of multiple prescriptions for Schedule 2 controlled substances in 21 CFR §1306.12. The requirements include:

  • Each prescription must be for a legitimate medical purpose
  • Prescriptions may be for a total of up to a 90-day supply
  • Prescriptions must have written instructions indicating the earliest date each prescription may be filled
    • Except the first prescription if intended to be filled immediately
  • Prescriber determines that issuing multiple prescriptions does not increase risk of diversion or abuse
  • Prescriptions must comply with any additional state laws or regulations

PAAS Tips:

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  • Make sure that multiple prescriptions do not exceed a 90-day supply
    • Most common is 3 x 30-day supply prescriptions
    • 6 x 15-day supply may be allowed
    • Cannot do 4 x 30-day supply or 3 x 31-day supply
  • Ensure that all prescriptions have the same issue or written date
    • This must be the date that the prescriber signed or issued the prescriptions
  • Written date must be accurately entered into the prescription claim
    • Do not use the ‘Fill on’ date as the written date
    • Entering the wrong date can lead to Wrong Hard Copy or Invalid Written Date discrepancies. It may also result in a claim being filled past the normal expiration date
  • Ensure that at least the 2nd and 3rd prescriptions have the ‘Fill on’ or dispense date clearly indicated
    • Must be an actual date
    • ‘Fill 30 days after xx/xx/xx’ is NOT accepted
  • Ensure that all DEA required elements are present on the front face of the prescription
    • Patient name and address
    • Prescriber name, address, and DEA
  • Follow all state requirements for dispensing Schedule 2 controlled substances:
    • Prescription expiration after written
      • Varies from 7-90 days after written date
    • Supervising physician information for mid-level practitioners
      • May require supervisor’s name, address, phone, NPI, and/or DEA
    • What can be changed or clarified on a Schedule 2 prescription
      • DEA no longer allows changes to a Schedule 2 prescription unless specifically allowed by state regulations
      • Verify with your State Board of Pharmacy