Are Your Prescription Pads Current? Pharmacies are Rejecting Prescriptions Due to Non-compliant Forms


CPMA has heard from members that pharmacies have rejected their prescriptions due either to forms that are out of date or are missing required elements. All prescriptions have been for controlled substances, which must be on tamper-resistant forms printed by California-approved printers and containing California specific pre-printed elements.

Doctors should immediately check that their tamper-resistant prescription forms have the following:

• Security features that include a latent, repetitive “void” pattern printed across the entire front of the prescription blank; a watermark showing “California Security Prescription” printed on the backside; a chemical void protection that prevents alteration by chemical washing; a feature printed in thermochromic ink; an area of opaque writing so that the writing disappears if the prescription is lightened; and a description of the security features included on each prescription form.

• Six quantity checkoff boxes for the prescriber to indicate the quantity by checking the applicable box where the following quantities shall appear: 1–24 25–49 50–74 75–100 101–150 151 and over

• In conjunction with the quantity boxes, a space or line to designate the units referenced in the quantity boxes when the drug is not in tablet or capsule form.

• Printed at the bottom, the statement “Prescription is void if the number of drugs prescribed is not noted.”

• The preprinted name, category of licensure, license

number, federal controlled substance registration number (DEA

number) and address of the prescribing Check boxes for the prescriber to indicate the number of refills ordered.

• A place to indicate the prescription’s date of origin.

• A check box indicating the prescriber’s order not to substitute.

• An identifying number assigned to the approved security printer by the Department of Justice.

• A check box by the name of each prescriber when a prescription form lists multiple prescribers.

Each batch of controlled substance prescription forms will have the lot number printed on the form and each form within that batch shall be numbered sequentially beginning with the numeral one.

CPMA members receive a 15% discount off prescription pads from state-approved printer RxSecurity