During a review of 2015 and 2016 claims processing of DEA schedule II (CII) prescription drug claims, PerformRx noticed an increase in the number of schedule II (CII) drugs being incorrectly billed as refills at the point of sale (POS). While this may have been due to an error in entering and submitting prescription claim information to PerformRx, efforts need to continually be made to prevent these types of errors as they can signal potential fraud, waste or abuse incorrectly. Pursuant to 21 U.S.C. § 829(a), refills of medications with a DEA schedule II (CII) designation are prohibited at POS.

21 U.S.C. § 829(a): “Except when dispensed directly by a practitioner, other than a pharmacist, to an ultimate user, no controlled substance in schedule II, which is a prescription drug as determined under the Federal Food, Drug, and Cosmetic Act [21 U.S.C. 301 et seq.], may be dispensed without the written prescription of a practitioner, except that in emergency situations, as prescribed by the Secretary by regulation after consultation with the Attorney General, such drug may be dispensed upon oral prescription in accordance with section 503(b) of that Act [21 U.S.C. 353(b)]. Prescriptions shall be retained in conformity with the requirements of section 827 of this title. No prescription for a controlled substance in schedule II may be refilled [emphasis added].”

If you have any questions, please email us at Pharmacynetwork@performrx.com.