Products included in the Triplicate Prescription Program* This is a reference list provided for convenience. While all generic medication names appear, only sample brand names are provided and it should not be viewed as an all-inclusive listing of all trade names of drugs included in the Triplicate Prescription Program. BUPRENORPHINE METHADONE BuTrans, Suboxone** Metadol, Methadose - May only be prescribed by physicians Prescription regulations summary chart who hold an approval to prescribe methadone from their BUTALBITAL PREPARATIONS provincial regulatory body*** Summary of federal and provincial laws governing prescription drug ordering, Fiorinal, Fiorinal C ¼ & C ½, Pronal, Ratio-Tecnal, records, prescription requirements, and refills Ratio-Tecnal C ¼ & C ½, Trianal, Trianal C ½ METHYLPHENIDATE Biphentin®, Foquest®, and Concerta® brands are excluded Revised 2019 BUTORPHANOL from TPP prescr ip t i o n p a d req u ir e m e n t s (generic versions Butorphanol NS, PMS-Butorphanol, Torbutrol (Vet), of these products require a triplicate presc ription) Torbugesic (Vet) Apo-Methyphenidate, PHL-Methylphenidate, PMS- Prescription regulations DEXTROPROPOXYPHENE Methylphenidate, PMS-Methylphenidate ER, Ratio- None identified Methylphenidate, Ritalin, Ritalin SR, Sandoz- According to the Standards of Practice for Pharmacists and Pharmacy Technicians: Methylphenidate SR, Teva-Methylphenidate ER-C FENTANYL/SUFENTANIL/ALFENTANIL 6.4 Neither a pharmacist nor a pharmacy technician may dispense a drug or blood product under a Alfentanil Injection, Apo-Fentanyl Matrix, Co- MORPHINE prescription that was issued more than one year before the date the drug or blood product is to Fentanyl, Duragesic patches, Fentanyl Citrate Morphine Sulfate be dispensed. Injection, Fentora, Mylan-Fentanyl, PMS-Fentanyl Kadian, M-Eslon, Morphine HP & LP, MS Contin, MS-IR, MTX, Ran-Fentanyl, Sufentanil Citrate Injection Ratio-Morphine SR, Statex, PMS-Morphine Sulfate SR, USP, Sterimax, Teva-Fentanyl Sandoz-Morphine SR, Teva-Morphine SR 6.5 Neither a pharmacist nor a pharmacy technician may refill a prescription for (a) a benzodiazepine or other targeted substance, as defined in the regulations to the HYDROCODONE – DIHYDROCODEINONE Morphine Hydrochloride Controlled Drugs and Substances Act, for a period greater than 12 months after the Dalmacol, Dimetane Expectorant-DC, Hycodan, Doloral, Morphine Epidural, Ratio-Morphine prescription was first written, or Novahistex-DH, Novahistine-DH, PDH- (b) a Schedule 1 drug for a period greater than 18 months after the prescription was first Hydrocodone, Tussionex, Vasofrinic DH NORMETHADONE filled. Cophylac HYDROMORPHONE – DIHYDROMORPHINONE Prescriptions for drugs on the Prescription Drug List can be transferred to another pharmacy either by fax or Dilaudid, Dilaudid-HP, Hydromorph Contin, Jurnista, OXYCODONE over the phone by a pharmacist or pharmacy technician. The pharmacist or pharmacy technician receiving the PMS-Hydromorphone ACT-Oxycodone CR, Apo-Oxycodone CR, Endocet, Oxy-IR, transferred prescription must obtain all the information required in a prescription in addition to: OxyNEO, Percocet, Percocet-Demi, PMS-Oxycodone– the name and address of the transferring pharmacy; KETAMINE Acetaminophen, PMS-Oxycodone CR, Ratio-Oxycocet, Ketalar, Ketalean (Vet), Ketamine Hydrochloride Ratio-Oxycodan, Rivacocet, Sandoz- the name of the transferring pharmacist; Injection USP, Ketaset (Vet), Narktan (Vet) Oxycodone/acetaminophen, Supeudol, Targin the number of authorized refills remaining and, if applicable, the specified interval between refills; and the date of the first fill and last refill (or the date the prescription was written, if applicable). MEPERIDINE - PETHIDINE PENTAZOCINE Once the prescription is transferred out, the pharmacist or pharmacy technician who transferred the Demerol, Meperidine HCL injection Talwin prescription must inactivate the prescription at their pharmacy, ensuring it is not dispensed or transferred TAPENTADOL again. In addition, the following information must be documented: Nucynta ER, Nucynta IR the date of the transfer; the name and address of the pharmacy that received the prescription; the name of the pharmacist who received the prescription; the name of the pharmacist who transferred the prescription; and the name of the pharmacy technician who assisted the pharmacist with the transfer, if applicable. * For Veterinary considerations, please review Triplicate Prescription Program Guide: http://www.cpsa.ca/wp- content/uploads/2017/06/TPP-Guide.pdf **There are special considerations for physicians prescribing Buprenorphine for opioid dependency (Suboxone). Please review Suboxone Prescribing: http://www.cpsa.ca/wp-content/uploads/2017/03/Buprenorphine-Suboxone-Requirements-for-Dependence- flow-chart_web.png *** Confirm approval by contacting the College of Physicians & Surgeons of Alberta 780-423-4764 or 1-800-561-3899 or email [email protected] for Alberta prescriptions. Otherwise, contact the appropriate regulatory body in the prescription’s province or origin CLASSIFICATIONS DESCRIPTION PRESCRIPTION REFILLS FILING PURCHASE RECORD SALE ELECTRONIC PHONE REQUIREMENTS RECORD ORDERING ORDERING All single entity narcotic drugs. Written or faxed** A pharmacist or a Upon receiving, a YES YES NO N Narcotic drugs No refills or transfers permitted. All “re-orders” pharmacist must Except All narcotics for parenteral use. prescriptions signed and must be new written prescriptions. Part fills pharmacy technician who All preparations containing more than dated by an authorized engages in dispensing record: Propoxyphene Examples: Butrans*, Cesamet, allowed; for part fills, prescriber must indicate Codeine, Cophylac*, Demerol*, one narcotic drug or containing less prescriber. Verbal the total amount of medication, quantity for must ensure that their than two non-narcotic ingredients. prescriptions are not dispensing activities are 1. Drug name Dilaudid*, Dimetane Exp DC*, each part fill, and intervals between fills 2. Quantity received Duragesic*, Jurnista*, Ketalar*, permitted. recorded in a clear audit trail that identifies: 3. Date received Lomotil, Metadol*, Methadose*, 4. Name and address Morphine*, Novahistex DH*, a. all individuals who of the licensed Percocet*, Suboxone*, Talwin*, were involved in dealer, pharmacist, Targin*, Tussionex*, Tylenol #4, the processing of or hospital Tylenol with Codeine Elixir a prescription and dispensing of the Records/ invoices must Written, faxed** or verbal drug, and be readily available on NO YES YES N Verbal prescription narcotics Preparations that are not for parenteral No refills or transfers permitted. All “re-orders” prescriptions from an the premises and kept use and contain only one narcotic drug must be new prescriptions. Part fills allowed; for authorized prescriber. b. the role of each in a manner that Examples: Dimetane Expectorant-C, plus two or more additional medicinal part fills, prescriber must indicate the total individual. permits auditing. Calmylin ACE, Dimetapp-C Syrup, ingredients in a therapeutic dose. May amount of medication, quantity for each part fill, not contain diacetylmorphine (heroin), Verbal prescriptions must be and intervals between fills Robitussin AC, 292 Tablets, Tylenol direct from prescriber to A licensee must ensure #2, Tylenol #3, Fiorinal-C1/4, C1/2* hydrocodone*, methadone*, that written prescriptions, oxycodone*, or pentazocine*. pharmacist***. All verbal prescriptions must be transaction records, reduced to writing by the compounding records and pharmacist and indicate: repackaging records for YES YES NO C Controlled drugs – Part I Drugs listed in Part I of the Schedule to No refills allowed if original prescription is all drugs that have been Part G of the Food and Drug verbal. If written, the original prescription may 1. Name and address of dispensed, compounded Records must Examples: Adderall XR, Biphentin, Regulations. be repeated if the prescriber has indicated in patient or repackaged are: be readily Concerta, Dexedrine, Ritalin* writing the number of refills and the intervals available upon between refills. Transfers not permitted. a. filed 2. Name, initials and request. systematically; address of prescriber and NO YES YES Drugs listed in Part II and III of the 3. Name, quantity, and An original written or verbal prescription may C Controlled drugs – Part II & III b. retained for at Schedule to Part G of the Food and form of drug(s) only be refilled if the prescriber has authorized, least two years Drug Regulations. verbally or in writing, the number of refills and Examples: Anabolic Steroids, past the 4. Directions for use the intervals between refills. Transfers not Barbiturates (except Pentobarbital completion of permitted. and Secobarbital), Butorphanol*, drug therapy with 5. Name and initials of Nubain regard to the dispensing pharmacist prescription or for or pharmacy technician 42 months (3.5 NO YES YES C Drugs listed in the Schedule to the An original written or verbal prescription may years), from the T Benzodiazepines and other 6. Date Benzodiazepines and Other Targeted only be refilled if the prescriber has authorized, date of first fill, targeted substances Substances Regulations. verbally or in writing, the number of times it may whichever is the 7. Prescription number be refilled. Unfilled refills may be transferred – longest period. Examples: Apo-Oxazepam, Ativan, this applies only to drugs in this classification. Clorazepate, Flurazepam Frisium, 8. Number of refills (when Prescriptions