Managing a Prescription for a Controlled Substance

Mar 1, 2023


Alto Pharmacy

Some prescription medications used to treat chronic conditions or manage pain also carry the potential for dependence and misuse. These medications fall into a different category than most and are classified as controlled substances.

The distinction between controlled and non-controlled substances is an important one, as controlled substances are more heavily regulated than other prescription medications. There are limits on refills, and additional steps may also be required to get your prescription. Specific restrictions depend on factors such as your insurance plan’s benefits and the laws in your state. For example, many insurance providers limit the quantity of a controlled medication that they will cover over a given period of time.

Read on to learn how to manage your prescription for a controlled substance.

What are controlled substances?

Controlled substances are regulated under federal law. The category includes both prescription medications and illegal drugs.

These substances are further categorized into five schedules, based on factors including their medical use, safety, and potential for misuse or dependency, with Schedule I substances being the most regulated.

  • Schedule I substances have no currently accepted medical use and are defined by the U.S. Drug Enforcement Administration (DEA) as having a high potential for misuse. Substances categorized into this schedule include heroin, ecstasy, and marijuana.

  • Schedule II substances are defined by the DEA as having a high potential for misuse and severe psychological or physical dependence. Substances categorized into this schedule include both illegal drugs such as cocaine and methamphetamine as well as prescription medications such as meperidine (Demerol®), oxycodone (OxyContin®), fentanyl, Dexedrine®, Adderall®, and Ritalin®.

  • Schedule III substances are defined by the DEA as having a moderate to low potential for physical and psychological dependence. Substances categorized into this schedule include some codeine-containing products, like Tylenol® with codeine; ketamine; anabolic steroids; and testosterone.

  • Schedule IV substances are defined by the DEA as having a low potential for misuse and a low risk of dependence. Substances categorized into this schedule include alprazolam (Xanax®), diazepam (Valium®), lorazepam (Ativan®), zolpidem (Ambien®), and Tramadol (ConZip®, Ultram®).

  • Schedule V substances are defined by the DEA as having an even lower potential for misuse than Schedule IV substances. Substances categorized into this schedule contain limited quantities of certain narcotics, including Robitussin AC®, Lomotil®, Motofen®, Lyrica®, and Parepectolin®.

Restrictions on controlled substances

Under federal law, there is a 30-day limit on the supply of any controlled substance. Additional federal restrictions on filling or refilling controlled substances vary by schedule. Some states may have additional restrictions or requirements for filling a controlled substance prescription. Here’s a brief overview.

Schedule II

  • No refills are allowed for schedule II substances. A new prescription from your healthcare provider is required for every fill.

  • Some states require a hand-written prescription with a provider’s signature.

  • Some states have expiration dates for Schedule II prescriptions, but there isn’t a federal law.

Schedule III, IV, and V

  • You are allowed to refill a prescription for these medications with a provider’s authorization.

  • If your provider has authorized refills, you are typically allowed up to five refills in six months. After five refills, a new prescription is required.

  • A prescription for a Schedule III, IV, or V medication expires after six months. After six months, a new prescription is required regardless of how many refills are left.

Tips for safe use of a controlled medication

If you are prescribed a controlled substance, it is especially important to keep track of your medication supply and take your medication only as directed. Never adjust the frequency or dose of your medication without consulting your provider. Make sure that anyone who prescribes a medication for you is aware of any other medications you take.

Be aware that some providers ask patients to sign a written agreement to ensure safe use of controlled substances like pain medication. These agreements may require that you only fill your prescription at one pharmacy and don’t take controlled substances prescribed by another provider.

Filling a prescription for a controlled substance at Alto

Given the additional regulations of controlled substances, these medications are currently not eligible for auto refills or medication bundling at Alto. Your convenience and safety is our priority, and we hope to expand these services to include controlled substances in the future.

Delivery of these medications requires a signature from you or an authorized signer. To add an authorized signer to your Alto account, head to Account > Delivery Addresses > Edit Address > Delivery Instructions in the Alto app.

In states where a written prescription is required to fill a controlled medication, these prescriptions cannot be transferred to Alto from another pharmacy.

The pharmacy care you deserve

Our team can answer any questions you have about your prescriptions. We also offer free, same-day delivery and medication management tools like reminders and auto refills to make it as simple as possible to stay on track with your treatment.

To learn more, reach out any time through secure in-app messaging or by phone at 1-800-874-5881.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

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