Federal vs. State Law: The Top 10 Conflicts Every MPJE Candidate Must Master to Avoid Failing the Pharmacy Law Exam

Federal vs. State Law: The Top 10 Conflicts Every MPJE Candidate Must Master to Avoid Failing the Pharmacy Law Exam

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Every MPJE candidate knows the rule of thumb: when federal and state pharmacy laws conflict, follow the stricter law—unless federal law preempts the field. But exam questions rarely make it that simple. They hinge on precise details: deadlines, refill limits, what counts as a valid prescription, who can prescribe, and what pharmacies can dispense or compound. Below are the 10 conflict zones that most often trip candidates. For each, you’ll see what the laws say, why they differ, and what to choose on test day.

1) The master rule: stricter law vs federal preemption

Why this matters: It decides which law you apply when federal and state rules clash.

How it works:

  • Stricter standard usually controls. States can go above federal minimums in areas like controlled substance scheduling, counseling, and labeling.
  • Federal preemption means the federal rule wins when Congress intends to occupy the field or when the two laws directly conflict. Examples: marijuana remains Schedule I under federal law; 503A compounding rules control federal drug approval and misbranding concepts; Ryan Haight telemedicine rules set federal prerequisites to prescribe controlled substances.

MPJE move: If both can be followed, pick the stricter requirement. If the state “allows” what federal law forbids (e.g., pharmacies dispensing marijuana), you must follow federal law.

2) Medical/recreational marijuana and CBD: state permission vs federal prohibition

The conflict: Many states authorize medical or adult-use cannabis. Under the federal Controlled Substances Act (CSA), marijuana (cannabis) is Schedule I. Pharmacies cannot dispense Schedule I substances.

What this means:

  • Pharmacies cannot dispense marijuana despite state programs. Dispensaries operate under state law, not federal pharmacy law.
  • Hemp-derived CBD with less than 0.3% delta-9 THC is not a controlled substance federally, but FDA still regulates it as a drug if therapeutic claims are made. States often add stricter age, labeling, or testing rules.

MPJE move: If a question puts marijuana behind your counter with a “state card,” the answer is no. For CBD, follow any stricter state rule on sale and labeling.

3) C-II partial fills and prescription expirations

The conflict: Federal law sets frameworks that states frequently tighten.

Federal basics:

  • Expiration: No explicit federal expiration for C-II prescriptions (but no refills allowed). States often impose 21–30 day limits.
  • Partial fills: Allowed if the pharmacy cannot supply full quantity, with the balance within 72 hours. For long-term care facility (LTCF) or terminally ill patients, partial filling is allowed for a longer period (often up to 60 days under federal rules). Federal law also permits patient- or prescriber-requested partial fills within tight time frames (commonly up to 30 days from issuance), subject to state allowance and recordkeeping.

State twists: Many states require faster completion of partial fills, impose shorter validity windows (e.g., 7 or 14 days), or limit quantities.

MPJE move: Apply the strictest clock. If the state says 30-day expiration for C-II prescriptions, that controls. If the state shortens the 72-hour completion window, use the shorter timeline.

4) Emergency oral C-II prescriptions

The conflict: Federal law allows an emergency oral C-II order in limited cases; states often shorten deadlines and tighten quantity.

Federal basics:

  • Quantity: Only the amount needed for the emergency period.
  • Follow-up: Prescriber must deliver a valid follow-up prescription (covering the emergency quantity) to the pharmacy within 7 days. It must be marked to link to the oral order.

State twists: Some states require the follow-up within 72 hours or 3 business days, or require electronic follow-up instead of paper, or define “emergency” more narrowly.

MPJE move: Choose the strictest timing and the smallest necessary amount. If the follow-up is late, report per state rules; do not dispense more.

5) E-prescribing mandates vs EPCS technology rules

The conflict: Federal law allows electronic prescribing of controlled substances (EPCS) if the system meets DEA security rules. States may mandate e-prescribing for certain or all prescriptions and include different exceptions.

Federal basics:

  • EPCS has specific identity proofing and two-factor authentication requirements for prescribers; pharmacies need certified software and audit trails.

State twists:

  • Many states require e-prescribing for Schedule II–V drugs, sometimes for all prescriptions, and list exceptions (e.g., system downtime, veterinary, out-of-state, hospice).
  • Some states require e-prescribing but still accept paper for a short transition period or in defined circumstances.

MPJE move: If the state mandates e-prescribing, follow it unless a listed exception applies. Federal EPCS rules are technology standards; state mandates are practice rules—both must be satisfied.

6) C-III to C-V refills and transfers

The conflict: Federal law sets a ceiling; states sometimes tighten further.

Federal basics:

  • Refills: Up to 5 refills within 6 months of issuance for C-III and C-IV. C-V refills are not capped by federal law, but many states mirror the 5-in-6 rule for all C-III–V.
  • Transfers: One-time transfer for C-III–V between two pharmacies, unless pharmacies share a real-time online database; then refills may be transferred up to the maximum permitted by law and prescriber authorization. Non-controls can be transferred as many times as needed while valid.

State twists: Some states limit C-V refills, ban database-based multiple transfers, or classify certain drugs (e.g., benzodiazepines, codeine combos) more strictly than federal schedules.

MPJE move: Use the stricter rule on both refills and transfers. Always verify the drug’s state schedule before applying federal limits.

7) Compounding for “office use,” 503A vs 503B

The conflict: State laws sometimes “allow” office-use compounding by 503A pharmacies. Federal law treats most of that as manufacturing unless done by a 503B outsourcing facility.

Federal basics:

  • 503A pharmacies compound only pursuant to patient-specific prescriptions (with limited anticipatory compounding based on history).
  • No routine office-use distribution by 503A. Compounding “for office use” is generally viewed as distribution of unapproved drugs without patient prescriptions.
  • 503B outsourcing facilities may compound in bulk for office use but must meet current good manufacturing practice and other federal requirements.

State twists: Some states authorize limited office-use under state license. That does not override the federal Food, Drug, and Cosmetic Act.

MPJE move: If the question is about a 503A pharmacy filling a standing office-use request, the safe answer is no unless the item is patient-specific or the entity is a 503B facility. Federal law controls here.

8) Counseling, DUR, and labeling: OBRA ’90 vs state requirements

The conflict: OBRA ’90 requires prospective DUR and an offer to counsel for Medicaid patients. States usually extend these duties to all patients and expand what must be on the label.

Federal basics:

  • Prospective DUR for Medicaid prescriptions.
  • Offer to counsel Medicaid patients; content is flexible and patient-specific.
  • Basic federal label elements plus, for C-II–IV, the federal transfer warning: “Caution: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed.”

State twists:

  • Mandatory counseling (not just an offer) for new prescriptions, dose changes, high-risk drugs, or all patients.
  • Expanded label elements: beyond-use date, drug name and strength, physical description, prescriber name, purpose if requested, “Do not flush” or other cautions, or larger font.
  • Some states require the transfer warning on C-V as well.

MPJE move: Apply the strictest counseling and labeling rules in the state. If a label element is required by either law, include it.

9) Pseudoephedrine, ephedrine, and phenylpropanolamine: sales limits and tracking

The conflict: Federal Combat Methamphetamine Epidemic Act (CMEA) sets minimums; states often tighten.

Federal basics:

  • Daily limit 3.6 grams base; 30-day limit 9 grams (7.5 grams for mail-order).
  • Product placement behind-the-counter, photo ID, and logbook with purchaser signature and information.
  • Some exemptions for single-dose packages of certain dosage forms below set thresholds.

State twists:

  • Lower daily or monthly limits, mandatory real-time tracking systems, or making the products prescription-only.
  • Age restrictions and stricter ID requirements.

MPJE move: Use the tighter limit, the more robust ID requirement, and the stricter record format. If the state requires an electronic system, you must use it even though federal law allows paper logs.

10) PDMP duties, HIPAA, and mandatory checks

The conflict: HIPAA protects patient information. State PDMP laws require pharmacies to report controlled substance dispensing and often require pharmacists to check the PDMP before dispensing.

Why this is not a true conflict: HIPAA permits disclosures required by law and for public health and oversight activities. PDMP reporting and queries mandated by state law fit within HIPAA’s permitted uses.

State twists: States set who must check (pharmacist vs technician), when to check (e.g., every new C-II–IV, first fill only, or when red flags exist), reporting deadlines (e.g., next business day or within 24 hours), and delegate rules.

MPJE move: Follow state PDMP mandates even if HIPAA is mentioned in the question. Document checks per state rules. If the state requires a check, dispensing without it is a violation regardless of clinical judgment.

11) Mid-level prescribers, scope, and DEA authority

The conflict: DEA issues registrations and controls prescribing of controlled substances. States define scope of practice for nurse practitioners (NPs/APRNs), physician assistants (PAs), and others—including whether they may prescribe controlled substances, which schedules, and any quantity/day limits.

Federal basics:

  • To prescribe controlled substances, a practitioner must be authorized by the state and have a DEA registration (or be exempt, such as certain federal practitioners under specific conditions).

State twists:

  • Some states prohibit certain mid-levels from prescribing C-II, limit quantities or days’ supply (e.g., 5–30 days), or require supervising physician involvement or specific collaboration agreements.

MPJE move: Both must be true: state authority and DEA registration. If state law is more restrictive, follow it. A DEA number alone never expands state scope.

12) Mailing and delivery of prescriptions, especially controlled substances

The conflict: Federal postal regulations permit pharmacies to mail controlled substances under specific packaging and labeling rules. States may add restrictions on mailing or require certain delivery procedures.

Federal basics:

  • Controlled substances may be mailed by registered entities if they are not outwardly dangerous and are packaged to prevent damage or identification of contents.

State twists:

  • Some states require patient consent for mail, restrict mailing across state lines, or set extra requirements for controlled substances (e.g., adult signature, no delivery to certain sites).

MPJE move: Follow state-imposed mailing limits and any stricter packaging or signature rules. If a state bans mailing certain controlled substances, do not mail them even though federal rules allow it.

Rapid-fire scenarios and how to choose the right rule

  • Out-of-state C-II prescription, paper format, no e-prescribing: If the state requires EPCS and no exception applies, do not fill. Federal allows paper, but the state mandate controls.
  • Emergency oral C-II for a 10-day supply: Federal requires only the amount needed for the emergency period. Ten days is likely excessive; dispense the minimal necessary and demand the follow-up within the state’s stricter timeline.
  • Patient asks for partial fill of a new C-II: Federal law allows partial fill in many cases with tight time limits; states may restrict. If state allows, document and complete within the strictest applicable window.
  • NP writes for a C-II outside their state authority: Even with a DEA number, the prescription is invalid. State scope controls.
  • Physician orders compounded cream “for office use” from a 503A pharmacy: Decline unless it’s patient-specific. Direct them to a 503B outsourcing facility for office-use supply.
  • PDMP required check not performed due to workload: That is a violation if state law mandates the check. HIPAA is not a barrier to checking; it is permitted.
  • Filling a benzodiazepine in a state that schedules it as C-II: Apply the stricter state schedule: no refills, use C-II rules.
  • Label missing beyond-use date where state requires it: That is noncompliant even if federal law is silent. Add all state-required label elements.
  • Patient wants to buy 4.0 grams of pseudoephedrine today: Federal daily max is 3.6 grams. Deny or reduce the sale. If the state’s daily limit is even lower, apply the lower amount.

How to think through any federal vs state question on the MPJE

  • Identify the domain: CSA (controlleds), FDCA/503A–B (compounding), HIPAA/PDMP, OBRA ’90 (counseling/DUR), or practice acts (scope, e-prescribing).
  • Ask two questions: 1) Can both rules be followed? 2) Did Congress preempt the field? If both can be followed, use the stricter rule. If the state “allows” what federal forbids (marijuana, 503A office-use), federal prevails.
  • Watch for clocks and counts: Days to complete partial fill, days to receive C-II emergency follow-up, refills and transfer limits, PDMP reporting timelines.
  • Confirm the drug’s schedule under state law: The state may place it in a stricter schedule, changing everything downstream.
  • Document, document, document: MPJE answers assume good records: who authorized, quantities, dates, counseling, PDMP checks, and system downtimes for exceptions.

Key takeaways you can use on test day

  • Stricter law wins unless federal law directly forbids the activity. Then federal wins.
  • Marijuana is off-limits to pharmacies under federal law, regardless of state programs.
  • C-II rules are state-tightened: expect shorter expirations, shorter partial-fill windows, and stricter emergency follow-up deadlines.
  • E-prescribing mandates are state-driven, but EPCS technology standards are federal. You must meet both.
  • For C-III–V: use the stricter refill and transfer rule and confirm the state schedule.
  • 503A vs 503B matters: 503A is patient-specific. Office-use belongs to 503B.
  • OBRA ’90 is the floor: states usually require counseling for everyone and more label elements.
  • PSE limits: state limits often undercut federal limits—follow the lower number.
  • PDMP vs HIPAA is not a conflict: state-mandated PDMP actions are HIPAA-permitted.
  • DEA number is not a golden ticket: mid-level scope is defined by state law first.

Master these conflict zones, and the MPJE turns from a guessing game into a checklist. On the job, the same approach protects patients and your license: find the governing domain, compare federal and state rules, and apply the stricter standard unless federal law forbids the activity outright.

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