APRN and PA Prescribing

Q. What is the maximum quantity of a CII that may be prescribed for acute pain by an APRN? Please note per KRS 314.011(8),the only Schedule II controlled substance used to treat pain that an APRN may prescribe for greater than a 3 day supply is any hydrocodone combination product. For all other Schedule II controlled substances used to treat pain, KRS 314.011(8) limits the quantity to a 3 day supply with no exceptions.

A. KRS 218A:205, limits the prescribing of a Schedule II controlled substance used to treat acute pain by all practitioners who are allowed to prescribe Schedule II controlled substances to a 3 day supply. KRS 314.011(8) limits all Schedule II controlled substances withthe exception of hydrocodone combination products (and ADD/ADHD medication in specific circumstances) to a 3 day supply. The exceptions for an APRN to prescribe greater than a 3 day supply of HYDROCODONE COMBINATION PRODUCTS ONLY are: 
    1. In the professional judgment of the APRN, more than a 3 day supply is needed.  The need must be documented . For the purposes of pharmacy dispensing, the medical necessity for the hydrocodone combination product as documented by the APRN in the patient’s medical record and the prescription for more than a 3 day supply for the hydrocodone combination product are presumed to be valid.
    2. Treating chronic pain.
    3. Treating cancer pain.
    4. Treating a patient at end of life or in Hospice.
    5. Treatment of pain after major surgery or significant trauma as defined by the licensing Board and the Office of Drug Control Policy.
    6. Administered directly to the patient in an inpatient setting.dministered directly to the patient in an inpatient setting.
    7. Scenarios authorized by the licensing board. 
    8. Please note, APRNs must still follow prescribing limits set forth in KRS 314.011.

Q. What controlled substances may an APRN prescribe? 

    A.  CII – 3 day supply, KRS 314.011(8) with exceptions:

    ADD/ADHD if certified in mental health 30 days, KRS 314.011(8) and hydrocodone combination products 30 days. KRS 218A.020(3)

         CIII – 30 day supply no refills. KRS 314.011(8)

         CIV – V – 6 month supply, KRS 314.011(8), with exceptions:

              Diazepam (Valium) C IV

              Clonazepam (Klonopin) C IV

              Alprazolam (Xanax) C IV

              Lorazepam (Ativan) C IV

              Carisoprodol (Soma) C IV

    All limited to 30 day supply with no refills. 201 KAR 20:059


Q. What controlled substances may a PA prescribe?

A. CII - PA's may not prescribe CII's.
    CIII- 30 day supply no refills, KRS 311.858(5)(c)
 
   CIV-V - 6 month supply, KRS 311.858(5)(d) with exceptions: Benzodiazepines C IV and Carisoprodol (Soma) C IV. All limited to 30 day supply with no refills. KRS 311.858(5)(e)


 Q. What controlled substances may an out of state APRN or PA prescribe? 

A.  APRN and PA controlled substance prescribing varies from state to state. Kentucky pharmacists should only dispense a controlled substance prescription for an out of state APRN  and PA up to the authority they would have if it were a Kentucky APRN or PA. 


Q. May an APRN prescribe buprenorphine?

A. The 2016 Comprehensive Addiction and Recovery Act (CARA) extended the prescribing of buprenorphine in office-based settings to APRNs, who may obtain a DATA waiver number (an X DEA) to treat up to 30 patients after completing 24 hours of required training. An APRN may prescribe transdermal (Butrans) and buccal film (Belbuca) or buprenorphine in the form of brands and generics of buprenorphine single entity products and buprenorphine/naloxone combination products for an off label use (such as pain). 201 KAR 20:065


 Q. What is the maximum quantity of a CII that may be prescribed by various practitioners?

    1. MD/DO: Other than the 3 day limit for acute pain and the exemptions listed above, there is no maximum quantity in state or federal law

    2. DMD/DDS: Other than the 3 day limit for acute pain and the exemptions listed above, there is no maximum quantity in state or federal law; however, it should be only of a sufficient amount to treat the patient. KRS 313.035(6)

    3. DVM: Other than the 3 day limit for acute pain and the exemptions listed above, there is no maximum quantity in state or federal law. 201 KAR 16:110

    4. DPM: Other than the 3 day limit for acute pain and the exemptions listed above, there is no maximum quantity in state or federal law. 201 KAR 25:090

    5. APRN: Other than the 3 day limit for acute pain and the exemptions listed above for hydrocodone combination products ONLY, APRNs are limited to a  3 day supply with exceptions for ADD/ADHD drug if certified in mental health for up to 30 days, KRS 314.011(8) and hydrocodone combination products for up to 30 days. KRS 218A.020(3)

    6. OD: limited to a 72 hour supply of hydrocodone combination products, KRS 218A.020(3) but may not prescribe any other CII. KRS 320.240(13)

    7. PA's may not prescribe CII's.