E-Prescribing: Forward-Dating Controlled Substance Prescriptions and Using Refills

Overview

Osmind's e-prescribing system (powered by DrFirst) handles controlled and non-controlled substances differently based on regulatory requirements. This article explains both workflows.

Non-Controlled Substances: Using the Refills Feature

For non-controlled medications, you can use the standard refills field when prescribing.

How to Add Refills

1. When creating a prescription in DrFirst, locate the Refills field.

2. Use the stepper controls to select the number of refills (e.g., 0, 1, 2, 3, etc.).

3. Select Substitution Permitted or Dispense as Written from the dropdown.

4. Complete the rest of the prescription details.

5. Sign and send the order.

Renewing Active Medications

For patients on stable medication regimens, you can quickly renew active non-controlled medications:

1. Navigate to the patient's Medications panel (e-Prescribe tab).

2. Locate the active medication you want to renew.

3. Click the Renew icon in the Actions column to pull in the existing prescription details.

   • To renew several medications at once, check the box next to each one, then click the Renew icon.

4. Adjust refills or other details as needed.

5. Sign and send.

Note: The refills field includes the initial dispensing plus any refills (e.g., "Fill + 2 refills" = 3 total dispensings).

Controlled Substances: Forward-Dating Prescriptions

For Schedule II controlled substances (such as stimulants), refills are not permitted under federal law (21 CFR 1306.12(a)) — each fill requires its own new prescription. To give a patient a supply of future fills without refills, DrFirst supports forward-dating multiple prescriptions using the Do Not Fill Before field.

Terminology note: DrFirst's field for this is called "Do Not Fill Before," not "Earliest Fill Date." Use this exact field name when referencing the product.

How Forward-Dating Works

Federal law (21 CFR 1306.12(b)(1)(ii)) allows a prescriber to issue multiple Schedule II prescriptions in a single visit, covering up to a 90-day total supply, as long as each prescription other than the first includes a Do Not Fill Before date. The pharmacy cannot fill a prescription before its designated date.

Important: Not all states permit use of the Do Not Fill Before field. Confirm your state's rules before using this workflow — some states restrict or prohibit forward-dating controlled substance prescriptions.

Osmind's standard practice is to send up to 3 separate prescriptions in a single prescribing session, for example:

• First prescription: Fills immediately (or the next day)

• Second prescription: Do Not Fill Before set to 25 days out

• Third prescription: Do Not Fill Before set to 50 days out

This 3-prescription, ~25-day cadence is an Osmind convention for common monthly stimulant regimens — not a DrFirst or DEA-imposed limit. The actual federal ceiling is the 90-day total supply per visit, so the number of prescriptions and spacing can be adjusted (e.g., fewer/longer-spaced prescriptions) as long as the total stays within 90 days and complies with state law.

Authentication: All prescriptions created in the same session can be signed and sent together — you only need to authenticate once (Signing Passphrase + one-time PIN) when sending the batch, even though multiple prescriptions are included.

Step-by-Step Workflow

First prescription:

1. Add all medication details (drug, strength, quantity, sig).

2. Leave "Do Not Fill Before" blank or set to today.

3. Leave "Refills" at 0 (refills are not permitted for Schedule II).

4. Save as pending.

Second prescription:

1. Add the same medication details.

2. Set "Do Not Fill Before" to 25 days out.

3. Leave "Refills" at 0.

4. Save as pending.

Third prescription:

1. Add the same medication details.

2. Set "Do Not Fill Before" to 50 days out.

3. Leave "Refills" at 0.

4. Save as pending.

Send all three together:

1. Check the box next to each pending prescription.

2. Enter your Signature Password.

3. Choose Send (or Send & Print).

4. Enter your EPCS passphrase and one-time PIN when prompted — this single authentication applies to all checked prescriptions in the batch.

Benefits

This workflow can significantly reduce patient calls for refills, since patients won't need to contact you each month for their stimulant prescriptions. All prescriptions are sent at once, but the pharmacy can only fill them on or after their designated dates.

Important Notes

• You cannot use the "Refills" field for Schedule II controlled substances — you must create completely separate prescription orders.

• This is a federal regulatory requirement for Schedule II medications like stimulants (21 CFR 1306.12(a)).

• Each prescription must be created as an individual order with its own "Do Not Fill Before" date.

• You cannot create a single prescription and add refills to it for controlled substances.

• Confirm your state allows forward-dating before using this workflow — state law can be more restrictive than federal law.

Quick Reference

For additional e-prescribing support, see our E-Prescribing articles or contact support at getsupport@osmind.org.