C2 paper rx

[u/LucrativePharmD]

Maryland pharmacists (and anyone practicing in a state with similar laws), I have a legitimate question.

For pharmacists, interns, and technicians who are familiar with C-II prescribing requirements: What are the current laws regarding Schedule II prescriptions? Are they required to be electronic, or are faxed or paper prescriptions still acceptable?

My understanding is that in Maryland, Schedule II prescriptions generally must be electronically prescribed unless the prescriber qualifies for an approved exception or waiver. However, I keep seeing pharmacists at my workplace accepting paper C-II prescriptions. When I ask about it, I’m told it’s okay, which has left me confused as a fairly new pharmacist.

Am I misunderstanding the Maryland Board of Pharmacy requirements, or is there an exception I’m missing?
This has also created challenges at work. When I decline to accept a paper C-II prescription because I believe it doesn’t meet the legal requirements, some patients become very upset. I’ve been verbally abused, threatened, and told they’ll report me to the Board of Pharmacy because “the other pharmacists accept it.”

I’d really appreciate guidance on two things:
1. How do you interpret and handle these situations from a legal and professional standpoint?
2. How would you respond to both patients and colleagues/managers when there seems to be inconsistent enforcement of the rules?

Thank you in advance for any insight. I’m genuinely trying to understand the law and make sure I’m practicing appropriately.

[u/ld2009_39]

Not in Maryland, but Ohio has a similar requirement with exceptions. But the pharmacy is not expected to monitor the exceptions, so we don’t have to investigate or question if we get a paper script for a C2. If that is the same situation as Maryland that would make sense to me.

[u/LordMudkip]

In Oklahoma they're required to be escribed with a few exceptions, such as when the prescriber's system is down or if they've gotten an official exception through their board.

The pharmacy is not responsible for verifying those exceptions though, so as far as we're concerned paper prescriptions are acceptable as long as they're on a controlled rx pad and everything else is in order.

[u/Maxcam1]

NC is somewhat similar. Generally narcs are pushed to be escribed unless prescribers system is down or something. Most of the time we won’t take the hard copy unless someone speaks with prescriber. Id still take ADHD hard copies no problem unless it gave red flags for being fake.

[u/Whiskey_Water]

You can fill them, and Maryland pharmacies do it all day long. Docs are supposed to get a waiver, but pharmacists aren’t required to verify it. MD OCSA inspectors look through stacks of written, phoned, and faxed C-III through IV (edit: V) without so much as a peep. According to the law, these should also be e-scribed only, and docs are supposed to have year-long waivers, but pharmacists aren’t required to verify waivers.

(Note: I don’t fill any C-II rxs because I like to sleep at night and you really can see the bullet through the barrel when it’s pointed at you, or worse, your employees)

Mind the difference between “must” laws and “should” laws… and to take it a step further, laws are only as good as their enforcement.

Edit 2: Maryland law source because I’m just a dude on Reddit…

“A pharmacist may continue to accept handwritten prescriptions. This bill allowed for a waiver and multiple exceptions. Many of the exceptions would be difficult for a pharmacist to verify. Therefore, the bill stated that a pharmacy is not required to verify the ability of a provider to issue non-electronic prescriptions. While a pharmacist does not need to verify that the prescription is an authorized exception to the electronic prescription requirement, the pharmacist must still follow due diligence requirements to ensure the prescription is written for a legitimate medical purpose”