Prescriptions
HRS §329-38
in effect329-38. Prescriptions
(a) No controlled substance in schedule II may be dispensed without a written prescription of a practitioner, except:
(1) In the case of an emergency situation, a
pharmacist may dispense a controlled substance listed in schedule II upon
receiving oral authorization from a prescribing practitioner; provided that:
(A) The quantity prescribed and dispensed is
limited to the amount adequate to treat the patient during the emergency period
(dispensing beyond the emergency period shall be pursuant to a written
prescription signed by the prescribing practitioner);
(B) If the prescribing practitioner is not
known to the pharmacist, the pharmacist shall make a reasonable effort to
determine that the oral authorization came from a registered practitioner,
which may include a callback to the prescribing practitioner using the phone
number in the telephone directory or other good faith efforts to identify the
prescriber; and
(C) Within seven days after authorizing an
emergency oral prescription, the prescribing practitioner shall cause a written
prescription for the emergency quantity prescribed to be delivered to the
dispensing pharmacist. In addition to conforming to the requirements of this
subsection, the prescription shall have written on its face "Authorization
for Emergency Dispensing". The written prescription may be delivered to
the pharmacist in person or by mail, and if by mail, the prescription shall be postmarked
within the seven-day period. Upon receipt, the dispensing pharmacist shall
attach this prescription to the oral emergency prescription, which had earlier
been reduced to writing. The pharmacist shall notify the administrator if the
prescribing practitioner fails to deliver a written prescription to the
pharmacy within the allotted time. Failure of the pharmacist to do so shall
void the authority conferred by this paragraph to dispense without a written
prescription of a prescribing individual practitioner. Any practitioner who
fails to deliver a written prescription within the seven-day period shall be in
violation of section 329-41(a)(1);
(2) No schedule II narcotic controlled substance may
be prescribed or dispensed for more than a thirty-day supply, except where such
substances come in a single unit dose package that exceeds the thirty-day limit
or where a terminally ill patient is certified by a physician to exceed the
thirty-day limit;
(3) When dispensed directly by a practitioner, other
than a pharmacist, to the ultimate user. The practitioner in dispensing a
controlled substance in schedule II shall affix to the package a label showing:
(A) The date of dispensing;
(B) The name, strength, and quantity of the
drug dispensed;
(C) The dispensing practitioner's name and
address;
(D) The name of the patient;
(E) The "use by" date for the drug,
which shall be:
(i) The expiration date on the manufacturer's
or principal labeler's container; or
(ii) One year from the date the drug is
dispensed, whichever is earlier; and
(F) Directions for use, and cautionary
statements, if any, contained in the prescription or as required by law.
A complete and accurate record of all
schedule II controlled substances ordered, administered, prescribed, and
dispensed shall be maintained for five years. Prescriptions and records of
dispensing shall otherwise be retained in conformance with the requirements of
section 329-36. No prescription for a controlled substance in schedule II may
be refilled; or
(4) In the case of an electronic prescription, a
pharmacist may dispense a controlled substance listed in schedule II upon
receiving an electronic prescription.
(b) A schedule II controlled substance
prescription shall:
(1) Be filled within seven days following the date
the prescription was issued to the patient; and
(2) Be supplied to a patient only if the prescription
has been filled and held by the pharmacy for not more than seven days; provided
that a prescription issued to a qualified patient pursuant to chapter 327L
shall be supplied to the patient if the prescription has been filled and held
by the pharmacy for not more than thirty days.
(c) Initial concurrent prescriptions for
opioids and benzodiazepines shall not be for longer than seven consecutive days
unless the prescription is issued for a qualified patient pursuant to chapter
327L or a supply of longer than seven days is determined to be medically
necessary for the treatment of:
(1) Pain experienced while the patient is in
post-operative care;
(2) Chronic pain and pain management;
(3) Substance abuse or opioid or opiate dependence;
(4) Cancer;
(5) Pain experienced while the patient is in
palliative care; or
(6) Pain experienced while the patient is in hospice
care;
provided that if a prescribing practitioner issues a
concurrent prescription for more than a seven-day supply of an opioid and
benzodiazepine, the practitioner shall document in the patient's medical record
the condition for which the practitioner issued the prescription and that an
alternative to the opioid and benzodiazepine was not appropriate treatment for
the condition.
[(d)]
The transfer of original prescription information for a controlled substance
listed in schedule III, IV, or V for the purpose of dispensing is permissible
between pharmacies on a one time basis only. However, pharmacies
electronically sharing a real-time, online database may transfer up to the
maximum refills permitted by law and the prescriber's authorization. Transfers
are subject to the following requirements:
(1) The transfer shall be communicated directly
between two licensed pharmacists, and the transferring pharmacist shall:
(A) Write or otherwise place the word
"VOID" on the face of the invalidated prescription;
(B) Record on the reverse of the invalidated
prescription the name, address, and Drug Enforcement Administration
registration number of the pharmacy to which it was transferred and the name of
the pharmacist receiving the prescription information; and
(C) Record the date of the transfer and the
name of the pharmacist transferring the information;
(2) The pharmacist receiving the transferred
prescription information shall reduce to writing the following:
(A) Write or otherwise place the word
"transfer" on the face of the transferred prescription;
(B) Record all information required to be on
a prescription, including:
(i) The date of issuance of original
prescription;
(ii) The original number of refills authorized
on original prescription;
(iii) The date of original dispensing;
(iv) The number of valid refills remaining and
dates and locations of previous refills;
(v) The pharmacy's name, address, Drug
Enforcement Administration registration number, and original prescription
number from which the prescription information was transferred;
(vi) The name of the transferor pharmacist; and
(vii) The pharmacy's name, address, and Drug
Enforcement Administration registration number, along with the prescription
number from which the prescription was originally filled;
(3) Both the original and transferred prescription shall
be maintained for a period of five years from the date of last refill; and
(4) Any pharmacy electronically accessing a
prescription record shall satisfy all information requirements of a manual mode
prescription transferal.
Failure to comply with this subsection shall
void the authority of the pharmacy to transfer prescriptions or receive a
transferred prescription to or from another pharmacy.
[(e)] A pharmacy and an authorized central
fill pharmacy may share information for initial and refill prescriptions of
schedule III, IV, or V controlled substances. The following requirements shall
apply:
(1) A pharmacy may electronically transmit, including
by facsimile, prescriptions for controlled substances listed in schedule III,
IV, or V to a central fill pharmacy. The pharmacy transmitting the
prescription information shall:
(A) Ensure that all information required to
be on a prescription pursuant to subsection [(h)] is transmitted to the central
fill pharmacy either on the face of the prescription or electronically; and
(B) Keep a record of receipt of the filled
prescription, including the date of receipt, the method of delivery (private,
common, or contract carrier) and the identity of the pharmacy employee
accepting delivery; and
(2) The central fill pharmacy receiving the
transmitted prescription shall:
(A) Keep for five years a copy of a
prescription received by facsimile or an electronic record of all the
information transmitted by the pharmacy, including the name, address, and Drug
Enforcement Administration registration number of the pharmacy transmitting the
prescription;
(B) Keep a record of the date of receipt of
the transmitted prescription, the name of the licensed pharmacists filling the
prescription, and the dates the prescription was filled or is refilled; and
(C) Keep a record of the date the filled
prescription was shipped to the pharmacy.
[(f)] No controlled substance in schedule III,
IV, or V may be dispensed without a written, facsimile of a written, oral prescription
of a practitioner, or receipt of an electronic prescription, except when a
controlled substance is dispensed directly by a practitioner, other than a
pharmacist, to an ultimate user. The practitioner, in dispensing a controlled
substance in schedule III, IV, or V, shall affix to the package a label
showing:
(1) The date of dispensing;
(2) The name, strength, and quantity issued of the
drug;
(3) The dispensing practitioner's name and business
address;
(4) The name of the patient;
(5) The "use by" date for the drug, which
shall be:
(A) The expiration date on the manufacturer's
or principal labeler's container; or
(B) One year from the date the drug is
dispensed, whichever is earlier;
(6) Directions for use; and
(7) Cautionary statements, if any, contained in the
prescription or as required by law.
A complete and accurate record of all schedule III,
IV, and V controlled substances administered, prescribed, and dispensed shall
be maintained for five years. Prescriptions and records of dispensing shall be
retained in conformance with the requirements of section 329-36 unless
otherwise provided by law. Prescriptions may not be filled or refilled more
than three months after the date of the prescription or be refilled more than
two times after the date of the prescription, unless the prescription is renewed
by the practitioner.
[(g)] The effectiveness of a prescription for
the purposes of this section shall be determined as follows:
(1) A prescription for a controlled substance shall
be issued for a legitimate medical purpose by an individual practitioner acting
in the usual course of the practitioner's professional practice. The
responsibility for the proper prescribing and dispensing of controlled
substances shall be upon the prescribing practitioner, but a corresponding
responsibility shall rest with the pharmacist who fills the prescription. An
order purporting to be a prescription issued not in the usual course of
professional treatment or for legitimate and authorized research shall not be
deemed a prescription within the meaning and intent of this section, and the
person who knowingly fills such a purported prescription, as well as the person
who issues the prescription, shall be subject to the penalties provided for
violations of this chapter;
(2) A prescription may not be issued to allow an
individual practitioner to obtain controlled substances for supplying the
individual practitioner for the purpose of general dispensing to patients;
(3) A prescription may not be issued for the
dispensing of narcotic drugs listed in any schedule for the purpose of
"detoxification treatment" or "maintenance treatment"
except as follows:
(A) The administering or dispensing directly
(but not prescribing) of narcotic drugs listed in any schedule to a narcotic
drug-dependent person for "detoxification treatment" or
"maintenance treatment" shall be deemed to be "in the course of
a practitioner's professional practice or research" so long as the
practitioner is registered separately with the department and the federal Drug
Enforcement Administration as required by section 329-32(e) and complies with title
21 Code of Federal Regulations section 823(g) and any other federal or state
regulatory standards relating to treatment qualification, security, records,
and unsupervised use of drugs; and
(B) Nothing in this section shall prohibit a
physician or authorized hospital staff from administering or dispensing, but
not prescribing, narcotic drugs in a hospital to maintain or detoxify a person
as an incidental adjunct to medical or surgical treatment of conditions other
than addiction;
(4) An individual practitioner shall not prescribe or
dispense a substance included in schedule II, III, IV, or V for that individual
practitioner's personal use, except in a medical emergency; and
(5) A pharmacist shall not dispense a substance
included in schedule II, III, IV, or V for the pharmacist's personal use.
[(h)] Prescriptions for controlled substances
shall be issued only as follows:
(1) All prescriptions for controlled substances shall
originate from within the State and be dated as of, and signed on, the day when
the prescriptions were issued and shall contain:
(A) The first and last name and address of
the patient; and
(B) The drug name, strength, dosage form,
quantity prescribed, and directions for use. Where a prescription is for gamma
hydroxybutyric acid, methadone, or buprenorphine, the practitioner shall record
as part of the directions for use, the medical need of the patient for the
prescription.
Except for electronic prescriptions, controlled
substance prescriptions shall be no larger than eight and one-half inches by
eleven inches and no smaller than three inches by four inches. A practitioner
may sign a prescription in the same manner as the practitioner would sign a
check or legal document (e.g., J.H. Smith or John H. Smith) and shall use both
words and figures (e.g., alphabetically and numerically as indications of
quantity, such as five (5)), to indicate the amount of controlled substance to be
dispensed. Where an oral order or electronic prescription is not permitted,
prescriptions shall be written with ink or indelible pencil or typed, shall be
manually signed by the practitioner, and shall include the name, address,
telephone number, and registration number of the practitioner. The
prescriptions may be prepared by a secretary or agent for the signature of the
practitioner, but the prescribing practitioner shall be responsible in case the
prescription does not conform in all essential respects to this chapter and any
rules adopted pursuant to this chapter. In receiving an oral prescription from
a practitioner, a pharmacist shall promptly reduce the oral prescription to
writing, which shall include the following information: the drug name,
strength, dosage form, quantity prescribed in figures only, and directions for
use; the date the oral prescription was received; the full name, Drug
Enforcement Administration registration number, and oral code number of the
practitioner; and the name and address of the person for whom the controlled
substance was prescribed or the name of the owner of the animal for which the
controlled substance was prescribed.
A corresponding liability shall rest
upon a pharmacist who fills a prescription not prepared in the form prescribed
by this section. A pharmacist may add a patient's missing address or change a
patient's address on all controlled substance prescriptions after verifying the
patient's identification and noting the identification number on the back of
the prescription document on file. The pharmacist shall not make changes to
the patient's name, the controlled substance being prescribed, the quantity of the
prescription, the practitioner's Drug Enforcement Administration number, the
practitioner's name, the practitioner's electronic signature, or the
practitioner's signature;
(2) An intern, resident, or foreign-trained
physician, or a physician on the staff of a Department of Veterans Affairs
facility or other facility serving veterans, exempted from registration under
this chapter, shall include on all prescriptions issued by the physician:
(A) The registration number of the hospital
or other institution; and
(B) The special internal code number assigned
to the physician by the hospital or other institution in lieu of the
registration number of the practitioner required by this section.
The hospital or other institution shall forward a
copy of this special internal code number list to the department as often as
necessary to update the department with any additions or deletions. Failure to
comply with this paragraph shall result in the suspension of that facility's
privilege to fill controlled substance prescriptions at pharmacies outside of
the hospital or other institution. Each written prescription shall have the
name of the physician stamped, typed, or hand-printed on it, as well as the
signature of the physician;
(3) An official exempted from registration shall
include on all prescriptions issued by the official:
(A) The official's branch of service or
agency (e.g., "U.S. Army" or "Public Health Service"); and
(B) The official's service identification
number, in lieu of the registration number of the practitioner required by this
section. The service identification number for a Public Health Service
employee shall be the employee's social security or other government issued
identification number.
Each prescription shall have the name of the
officer stamped, typed, or handprinted on it, as well as the signature of the
officer; and
(4) A physician assistant registered to prescribe
controlled substances under the authorization of a supervising physician shall
include on all controlled substance prescriptions issued:
(A) The Drug Enforcement Administration
registration number of the supervising physician; and
(B) The Drug Enforcement Administration
registration number of the physician assistant.
Each written controlled substance
prescription issued shall include the printed, stamped, typed, or hand-printed
name, address, and phone number of both the supervising physician and physician
assistant, and shall be signed by the physician assistant.
[(i)] A prescription for controlled substances
may only be filled by a pharmacist acting in the usual course of the
pharmacist's professional practice and either registered individually or
employed in a registered pharmacy, central fill pharmacy, or registered
institutional practitioner. A central fill pharmacy authorized to fill
prescriptions on behalf of a pharmacy shall have a contractual relationship
with the pharmacy that provides for this activity or shall share a common owner
with the pharmacy. A central fill pharmacy shall not prepare prescriptions for
any controlled substance listed in schedule II.
[(j)] Partial filling of controlled substance
prescriptions shall be determined as follows:
(1) The partial filling of a prescription for a
controlled substance listed in schedule II is permissible if the pharmacist is
unable to supply the full quantity called for in a written, electronic
prescription, or emergency oral prescription and the pharmacist makes a
notation of the quantity supplied on the face of the written prescription (or
written record of the electronic prescription or emergency oral prescription). The
remaining portion of the prescription may be filled within seventy-two hours of
the first partial filling; provided that if the remaining portion is not or
cannot be filled within the seventy-two-hour period, the pharmacist shall
notify the prescribing individual practitioner. No further quantity shall be
supplied beyond seventy-two hours without a new prescription;
(2) The partial filling of a prescription for a
controlled substance listed in schedule III, IV, or V is permissible; provided
that:
(A) Each partial filling is recorded in the
same manner as a refilling;
(B) The total quantity dispensed in all
partial fillings does not exceed the total quantity prescribed;
(C) No dispensing occurs more than three
months after the date on which the prescription was issued; and
(D) The prescription is refilled no more than
two times after the initial date of the prescription, unless the prescription
is renewed by the practitioner; and
(3) A prescription for a schedule II controlled
substance issued for a patient in a long-term care facility or for a patient
with a medical diagnosis documenting a terminal illness may be filled in
partial quantities to include individual dosage units. If there is any
question whether a patient may be classified as having a terminal illness, the
pharmacist shall contact the practitioner prior to partially filling the
prescription. Both the pharmacist and the prescribing practitioner have a
corresponding responsibility to assure that the controlled substance is for a
terminally ill patient. The pharmacist shall record on the prescription
document on file whether the patient is "terminally ill" or a
"long-term care facility patient". For the purposes of this section,
"TI" means terminally ill and "LTCF" means long-term care
facility. A prescription that is partially filled and does not contain the
notation "TI" or "LTCF patient" shall be deemed to have
been filled in violation of this section. For each partial filling, the
dispensing pharmacist shall record on the back of the prescription (or on
another appropriate record, uniformly maintained, and readily retrievable) the
date of the partial filling, quantity dispensed, remaining quantity authorized
to be dispensed, and the identification of the dispensing pharmacist. The
total quantity of schedule II controlled substances dispensed in all partial
fillings shall not exceed the total quantity prescribed, nor shall a
prescription be partially filled more than three times after the initial date
of the prescription. Schedule II controlled substance prescriptions for
patients in a long-term care facility or patients with a medical diagnosis
documenting a terminal illness shall be valid for a period not to exceed thirty
days from the issue date unless sooner terminated by the discontinuance of
medication.
[(k)] A prescription for a schedule II
controlled substance may be transmitted by the practitioner or the
practitioner's agent to a pharmacy by facsimile equipment; provided that the
original written, signed prescription is presented to the pharmacist for review
prior to the actual dispensing of the controlled substance, except as noted in
subsections [(l), (m), and (n)]. The original prescription shall be maintained
in accordance with section 329-36. A prescription for a schedule III, IV, or V
controlled substance may be transmitted by the practitioner or the
practitioner's agent to a pharmacy by facsimile; provided that:
(1) The information shall be communicated only
between the prescribing practitioner or the prescriber's authorized agent and
the pharmacy of the patient's choice. The original prescription shall be
maintained by the practitioner in accordance with section 329-36;
(2) The information shall be communicated in a
retrievable, recognizable format acceptable to the intended recipient and shall
include the physician's oral code designation and the name of the recipient
pharmacy;
(3) No electronic system, software, or other
intervening mechanism or party shall alter the practitioner's prescription,
order entry, selection, or intended selection without the practitioner's
approval on a per prescription per order basis. Facsimile prescription
information shall not be altered by any system, software, or other intervening
mechanism or party prior to receipt by the intended pharmacy;
(4) The prescription information processing system
shall provide for confidentiality safeguards required by federal or state law;
and
(5) Prescribing practitioners and pharmacists shall
exercise prudent and professional judgment regarding the accuracy, validity,
and authenticity of any facsimile prescription information. The facsimile
shall serve as the original written prescription for purposes of this section
and shall be maintained in accordance with section 329-36.
[(l)] A prescription prepared in accordance
with subsection [(h)] written for a narcotic listed in schedule II to be
compounded for the direct administration to a patient by parenteral,
intravenous, intramuscular, subcutaneous, or intraspinal infusion, but does not
extend to the dispensing of oral dosage units of controlled substances, may be
transmitted by the practitioner or the practitioner's agent to the pharmacy by
facsimile. The original prescription shall be maintained by the practitioner
in accordance with section 329-36. The pharmacist shall note on the face of
the facsimile prescription in red ink "Home Infusion/IV" and this
facsimile shall serve as the original written prescription for purposes of this
section and it shall be maintained in accordance with section 329-36.
[(m)] A prescription prepared in accordance
with subsection [(h)] written for a schedule II substance for a patient
enrolled in a hospice care program certified or paid for by medicare under
Title XVIII or a hospice program that is licensed by the State may be
transmitted by the practitioner or the practitioner's agent to the dispensing
pharmacy by facsimile. The original prescription shall be maintained by the
practitioner in accordance with section 329-36. The practitioner or
practitioner's agent shall note on the prescription that the patient is a
hospice patient. The pharmacist shall note on the face of the facsimile
prescription in red ink "HOSPICE" and this facsimile shall serve as
the original written prescription for purposes of this section and it shall be
maintained in accordance with section 329-36.
[(n)] A prescription prepared in accordance
with subsection [(h)] written for a schedule II controlled substance for a
resident of a state-licensed long-term care facility may be transmitted by the
practitioner or the practitioner's agent to the dispensing pharmacy by
facsimile. The original prescription shall be maintained by the practitioner
in accordance with section 329-36. The pharmacist shall note on the face of
the facsimile prescription in red ink "LTCF" and this facsimile shall
serve as the original written prescription for purposes of this section and it
shall be maintained in accordance with section 329-36.
[(o)] An electronic prescription for a
schedule II, III, IV, or V controlled substance may be electronically
transmitted by the practitioner to a pharmacy; provided that:
(1) The information shall be communicated only
between the prescribing practitioner and the pharmacy of the patient's choice. The
electronic prescription shall be maintained by the practitioner in accordance
with section 329-36;
(2) The information shall be communicated in a
retrievable, recognizable format acceptable to the intended recipient;
(3) No electronic system, software, or other
intervening mechanism or party shall alter the practitioner's prescription,
order entry, selection, or intended selection without the practitioner's
approval on a per-prescription, per-order basis. Transmitted prescription
information shall not be altered by any electronic system, software, or other
intervening mechanism or party prior to receipt by the intended pharmacy;
(4) The prescription information processing system
shall provide for confidentiality safeguards required by any applicable federal
or state law; and
(5) Prescribing practitioners and pharmacists shall
exercise prudent and professional judgment regarding the accuracy, validity,
and authenticity of any electronic prescription information.
[L 1972, c 10, pt
of §1; am L 1973, c 206, §1; am L 1979, c 194, §5; am L 1984, c 25, §2; am L
1986, c 214, §6; am L 1988, c 59, §4; am L 1991, c 159, §§10 to 12; am L 1996,
c 206, §2; am L 1997, c 280, §3; am L 1999, c 90, §2 and c 252, §4; am L 2002, c
165, §3; am L 2003, c 151, §8; am L 2006, c 69, §3; am L 2008, c 131, §3 and c
186, §4; am L 2009, c 117, §5; am L 2013, c 20, §3; am L 2016, c 218, §12; am L
2017, c 66, §§3, 6; am L 2018, c 18, §19 and c 152, §2; am L 2019, c 95, §2 and
c 256, §1; am L 2022, c 293, §6; am L 2024, c 178, §12]
Source: Hawaii State Legislature (capitol.hawaii.gov), via Internet Archive capturesURL: http://www.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRS0329/HRS_0329-0038.htmFetched: 11/10/2026