APRN and PA Prescribing

Q. What is the maximum quantity of a CII that may be prescribed for acute pain?

A. KRS 218A:205, limits the prescribing of a Schedule II controlled substance used to treat acute pain to a 3 day supply. The exceptions are: 
    1. In the professional judgment of the practitioner, more than a 3 day supply is needed.  The need must be documented . For the purposes of pharmacy dispensing, the medical necessity for a Schedule II controlled substance as documented by the practitioner in the patient’s medical record and the prescription for more than a 3 day supply for that controlled substance 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. Part of a narcotic treatment program.
    6. Treatment of pain after major surgery or significant trauma as defined by the licensing Board and the Office of Drug Control Policy.
    7. Dispensed or administered directly to the patient in an inpatient setting.
    8. Scenarios authorized by the licensing board. 
    9. APRNs must still follow prescribing limits set forth in KRS 314.011.
    10. PA's may not prescribe CII's.

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

    1. Other than the 3 day limit for acute pain and the exemptions listed above, MD/DO There is no maximum quantity in state or federal law
    2. Other than the 3 day limit for acute pain and the exemptions listed above, DMD/DDS 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. Other than the 3 day limit for acute pain and the exemptions listed above, DVM There is no maximum quantity in state or federal law. 201 KAR 16:110
    4. Other than the 3 day limit for acute pain and the exemptions listed above, DPM There is no maximum quantity in state or federal law. 201 KAR 25:090
    5. Other than the 3 day limit for acute pain and the exemptions listed above, APRN 3 day supply with exceptions for ADD/ADHD drug if certified in mental health 30 days, KRS 314.011(8) and hydrocodone combination products 30 days. KRS 218A.020(3)
    6. Other than the 3 day limit for acute pain and the exemptions listed above, OD 72 hour supply of hydrocodone combination products, KRS 218A.020(3) but no other CII. KRS 320.240(13)
    7. PA's may not prescribe CII's.


 Q. What controlled substances can 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 can 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 can 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. Can 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