Jasen Bruce
Member
One question we receive a lot at the pharmacy is regarding how much testosterone can be dispensed at one time. Testosterone is a controlled substance in the US, specifically a schedule-3 controlled substance (in all but one State), and this includes any form of testosterone including injectable, transdermal, patches, pellets, and any compound or product containing testosterone as an ingredient.
New York has placed testosterone as a schedule-2 controlled substance, which is regulated even more so than a schedule-3. Schedule 2 drugs usually have the greatest risk of addiction/abuse, typically reserved for drugs like morphine. I am not sure of the logic that placed testosterone within this category in NY.
The amount of a controlled substance that can be dispensed to a patient at one time depends on how the drug is scheduled in addition to the laws of each state where the prescription is filled, the pharmacists discretion, and the type of medication.
MDs and DOs can dispense up to a 6 month supply of testosterone in every state since it's a non-narcotic (even New York). https://www.health.ny.gov/publications/1477/
However, many pharmacies still only allow a 3 month supply of testosterone to be dispensed at one time. It is at the discretion of the pharmacist and prescribing physician as to how much they will allow. Most pharmacies that I work with only allow a 6 month supply on a case by case basis (such as when a person is deploying overseas for longer than 3 months). Physicians need to document within the patient's chart as to why a 6 month supply is needed, and the pharmacist will usually confirm with the prescribing physician that a 6 month supply is needed at one time. Diagnosis or treatment code must also be written on the prescription when writing for the maximum amount allowed. This due diligence is standard protocol when dispensing controlled substances.
Most schedule 2 drugs can only be dispensed in 30 day supplies with no refills allowed. This means that the patient must obtain a new prescription at each refill. Although testosterone is a schedule 2 in NY, pharmacies may still dispense up to a 6 month supply of testosterone since it is not a narcotic drug.
Summary:
A practitioner may issue a prescription for up to a three month supply of a controlled substance, including chorionic gonadotropin, or up to a six-month supply of an anabolic steroid by writing on the face of the prescription either the diagnosis or code for the treatment of the following conditions:
Diagnosis
A- Panic Disorder
B- Attention Deficit Disorder
C- Chronic debilitating neurological conditions characterized as a movement disorder or exhibiting seizure, convulsive or spasm activity
D- Relief of pain in patients suffering from conditions or diseases known to be chronic or incurable
E- Narcolepsy
F- Hormone deficiency states in males; gynecologic conditions that are responsive with anabolic steroids or chorionic gonadotropin; metastatic breast cancer in women; anemia and angioedema
Insurance versus Cash Pay
All of the above applies to cash pay. Insurance brings in another set of rules since insurance companies only agree to pay for a specific amount. For example, many patients who use insurance to pay for their testosterone can only receive a 30 day supply. Any more than 30 days can result in having to pay out of pocket for the medication, which will be very high due to retail pharmacies charging high amounts for brand name and generic medications. They also must charge a high amount in this case so that they can receive maximum payment from the insurance companies (for example, if they bill insurance $200 for the medication, but only charge the patient $50 for the same amount, the insurance company will be more likely to pay the lower amount).
Regarding testosterone, cash pay is much easier since compounding pharmacies offer both injectable and transdermal testosterone preparations for very low prices, usually as low as a co-pay would be anyway. Plus, when paying cash you do not have to be limited to the amounts they allow. Compounding pharmacies use the same FDA approved drug ingredients as brand name manufactured drugs, the only difference is compounding pharmacies make the drug for the patient with the ability to customize strength, delivery form, and combinations.
New York has placed testosterone as a schedule-2 controlled substance, which is regulated even more so than a schedule-3. Schedule 2 drugs usually have the greatest risk of addiction/abuse, typically reserved for drugs like morphine. I am not sure of the logic that placed testosterone within this category in NY.
The amount of a controlled substance that can be dispensed to a patient at one time depends on how the drug is scheduled in addition to the laws of each state where the prescription is filled, the pharmacists discretion, and the type of medication.
MDs and DOs can dispense up to a 6 month supply of testosterone in every state since it's a non-narcotic (even New York). https://www.health.ny.gov/publications/1477/
However, many pharmacies still only allow a 3 month supply of testosterone to be dispensed at one time. It is at the discretion of the pharmacist and prescribing physician as to how much they will allow. Most pharmacies that I work with only allow a 6 month supply on a case by case basis (such as when a person is deploying overseas for longer than 3 months). Physicians need to document within the patient's chart as to why a 6 month supply is needed, and the pharmacist will usually confirm with the prescribing physician that a 6 month supply is needed at one time. Diagnosis or treatment code must also be written on the prescription when writing for the maximum amount allowed. This due diligence is standard protocol when dispensing controlled substances.
Most schedule 2 drugs can only be dispensed in 30 day supplies with no refills allowed. This means that the patient must obtain a new prescription at each refill. Although testosterone is a schedule 2 in NY, pharmacies may still dispense up to a 6 month supply of testosterone since it is not a narcotic drug.
Summary:
A practitioner may issue a prescription for up to a three month supply of a controlled substance, including chorionic gonadotropin, or up to a six-month supply of an anabolic steroid by writing on the face of the prescription either the diagnosis or code for the treatment of the following conditions:
Diagnosis
A- Panic Disorder
B- Attention Deficit Disorder
C- Chronic debilitating neurological conditions characterized as a movement disorder or exhibiting seizure, convulsive or spasm activity
D- Relief of pain in patients suffering from conditions or diseases known to be chronic or incurable
E- Narcolepsy
F- Hormone deficiency states in males; gynecologic conditions that are responsive with anabolic steroids or chorionic gonadotropin; metastatic breast cancer in women; anemia and angioedema
Insurance versus Cash Pay
All of the above applies to cash pay. Insurance brings in another set of rules since insurance companies only agree to pay for a specific amount. For example, many patients who use insurance to pay for their testosterone can only receive a 30 day supply. Any more than 30 days can result in having to pay out of pocket for the medication, which will be very high due to retail pharmacies charging high amounts for brand name and generic medications. They also must charge a high amount in this case so that they can receive maximum payment from the insurance companies (for example, if they bill insurance $200 for the medication, but only charge the patient $50 for the same amount, the insurance company will be more likely to pay the lower amount).
Regarding testosterone, cash pay is much easier since compounding pharmacies offer both injectable and transdermal testosterone preparations for very low prices, usually as low as a co-pay would be anyway. Plus, when paying cash you do not have to be limited to the amounts they allow. Compounding pharmacies use the same FDA approved drug ingredients as brand name manufactured drugs, the only difference is compounding pharmacies make the drug for the patient with the ability to customize strength, delivery form, and combinations.
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