What Nurse Practitioners Need to Know About New Hydrocodone Rules

Last month, a new ruling from the DEA regarding hydrocodone went into effect. So, this month, when your patients present for refills of their pain medications, they will likely have questions. In some states, the new regulations may even impact nurse practitioner’s ability to prescribe these medications.

With more than 135 million prescriptions written in 2012, hydrocodone is the most prescribed drug in the United States. To put this in perspective, the only two medications to top 100 million prescriptions written annually are levothyroxine at 100 million prescriptions, and hydrocodone.  

For more than 10 years, the idea of increasing restrictions in regards to hydrocodone-containing products like Vicodin has been considered. The purpose? To reduce recreational use of these addictive medications. Traditionally, lower potency (less than 15mg) hydrocodone pills in combination with another drug such as acetaminophen, have been placed in the Schedule III category. As of October 6, 2014, hydrocodone-containing products have been bumped to the more restrictive Schedule II designation.

Say goodbye to hydrocodone refills

According to new regulations, refills for hydrocodone are not permitted for prescriptions written after October 6, 2014. For prescriptions written before the new guidelines took effect, the DEA will continue to allow refills through April 30, 2015. Many pharmacies, however, will no longer be able to process refills for hydrocodone-containing medications as their computer systems have changed. Some states have also said they will not honor refills for hydrocodone regardless of when the prescription was written. So, most patients will need to see a healthcare provider to have their pain medications prescribed according to new rules.

Don’t try to call in prescriptions for hydrocodone-containing products

As a Schedule II drug, prescriptions for hydrocodone must now be written or sent directly to the pharmacy as an eScript. They may not be faxed or called in. eScripts may only be used in states permitting Schedule II substances to be prescribed electronically.

There is one exception to this rule. In case of emergency, providers may call in a limited quantity of hydrocodone containing meds to cover the emergency period only. Prescribers must follow this up by submitting a written prescription to the pharmacy within seven days. Pharmacies are obligated to report providers who fail to comply to the DEA.

Some nurse practitioners may no longer be permitted to prescribe hydrocodone-containing meds

The new Schedule II designation for hydrocodone could cause problems for nurse practitioners in some states. In areas where NPs are not allowed to prescribe Schedule II drugs, for example, Georgia, Alabama, and Oklahoma, this means they will no longer be permitted to prescribe hydrocodone-containing medications.

You can beat the system…in some states

Healthcare providers are permitted to write multiple prescriptions for hydrocodone containing medications for a single patient. For example, in a single visit, the provider could hand the patient three, separate prescriptions each for a 30 day supply of medication. In this case, only up to a 90 day supply may be prescribed. The earliest date each prescription can be filled must be indicated on each script.


How will the rescheduling of hydrocodone-containing medications affect you and your patients?


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