Why Ketamine Must Be E-Prescribed
Ketamine is classified as a Schedule III controlled substance under the federal Controlled Substances Act. This applies to ketamine in any compounded dosage form, including troches, rapid dissolve tablets, and nasal sprays, and to combination preparations such as the ketamine/lidocaine nasal spray. The full prescription is treated as a Schedule III controlled substance regardless of the dosage form.
Two layers of law require electronic prescribing. Federally, the Centers for Medicare & Medicaid Services (CMS) requires all Schedule II–V controlled substance prescriptions covered under Medicare Part D to be transmitted electronically. At the state level, effective January 2, 2020, Rhode Island law (RI Law §21-28-3.18) requires prescribers to sign and transmit electronic prescriptions in schedules II–V. Because of these mandates, Bayview Pharmacy accepts compounded ketamine prescriptions by EPCS only.
E-Prescribe (EPCS)
Search for Bayview Pharmacy, Warwick, RI in your EPCS-enabled EHR. Select Ketamine (bulk) powder as the controlled-substance drug, then enter the concentration, dosage form, quantity, day supply, refills, ICD-10 diagnosis, and complete directions before signing with your two-factor credential.
View E-prescribe InstructionsCall for Help
Prescribers or authorized office staff may call Bayview Pharmacy for formulation guidance, concentration selection, EPCS troubleshooting, or refill coordination. The prescription itself must still arrive electronically.
Call 401-284-4505No Fax or Phone Orders
Because ketamine is a Schedule III controlled substance and Rhode Island law requires electronic prescribing of controlled substances, faxed and phoned-in ketamine prescriptions cannot be accepted or used as a workaround.
Not Set Up for EPCS?Clinical Safety & Monitoring
Compounded ketamine is prescribed off-label, most often for treatment-resistant depression, within a prescriber-supervised treatment plan. The FDA has cautioned about the risks of compounded ketamine for psychiatric use, including at-home use without a healthcare provider present to monitor for sedation and dissociation. The points below summarize the safety and monitoring considerations for prescribers.
Ketamine is prescribed within a supervised treatment plan.
Compounded ketamine is used off-label, most often for treatment-resistant depression, and is not FDA-approved. The FDA has cautioned about the risks of compounded ketamine for psychiatric use, including a specific alert on compounded ketamine nasal spray and a warning about at-home use without a healthcare provider present to monitor for sedation and dissociation. These notes are provided for prescriber reference; the prescriber determines whether treatment is appropriate and sets the dose, setting, and monitoring plan.
Compounded ketamine is prescribed as part of a structured plan that may include medical and psychiatric screening, individualized dosing, monitoring, and follow-up.
Counsel patients to remain seated while a dose takes effect and to avoid driving, operating machinery, or activities requiring full alertness until effects have completely worn off. Monitor for sedation and dissociation.
The prescriber determines where each dose is taken and whether another person or healthcare professional should be present, especially for at-home use.
Use additional caution or reconsider in patients with uncontrolled hypertension, certain cardiovascular conditions, a history of substance misuse, certain psychiatric conditions, or bladder problems. Review pregnancy and breastfeeding status and the full medication list.
Do not prescribe under the brand name Ketalar® for compounded ketamine. Select Ketamine (bulk) powder as the controlled-substance drug.
Patients experiencing a mental health crisis or thoughts of self-harm can call or text 988 for the Suicide & Crisis Lifeline or seek emergency care.
EPCS Requirements: One-Time Setup
Before a prescriber can e-prescribe any controlled substance, DEA regulations (21 CFR Part 1311) require a one-time EPCS enrollment. If you already e-prescribe controlled substances, skip to the e-prescribing instructions below. Setup typically takes a few days, driven mostly by identity proofing. If your EHR does not support EPCS, standalone EPCS-certified e-prescribing platforms are available. Call Bayview Pharmacy for suggestions that work well with compound prescriptions.
Five steps to get EPCS-enabled.
EPCS enrollment is required by the DEA before any controlled substance can be e-prescribed. Each step is completed through your EHR vendor, and your office only does this once per prescriber.
All major EHRs support EPCS, but it usually must be activated per prescriber. Ask your vendor to enable the EPCS module.
Verify your identity through your vendor's process (commonly ID.me or Experian). Have government-issued ID ready.
Register two of the following: a password/PIN, a hard token or authenticator app, or a biometric. You will use this credential to sign every controlled substance prescription.
A second individual in the practice (often the administrator) must grant your account EPCS permissions. Solo prescribers should ask their vendor about the approved process.
Your DEA number must be current and transmits with every EPCS prescription. Mid-level prescribers should confirm any required supervising or collaborating prescriber information is configured.
E-prescribing
Prescribers send compounded ketamine prescriptions electronically through their EPCS-enabled EHR. Ketamine will not appear as a finished product, so the order should be entered by selecting Ketamine (bulk) powder as the active drug. Selecting the bulk powder ensures the order is treated as a controlled substance, which is required for the EPCS signature to validate. Do not use the brand name Ketalar®.
In your EHR, search for:
Bayview Pharmacy
Warwick, RI — NCPDP: 4106882
In the instructions, directions, or notes field, include the concentration of the preparation, the dosage form, an exact strength, the quantity (federal law prohibits more than 100 dosage units), day supply, refills (maximum 5), an ICD-10 diagnosis code, and complete directions/SIG. Ranged formulations, such as ketamine 10–300 mg rapid dissolve tablets, must be prescribed at an exact strength.
What to Include When E-prescribing Ketamine Compounds
Select Ketamine (bulk) powder as the active drug. It must be selected as a controlled substance so the EPCS signature validates. Do not use the brand name Ketalar®.
Troche, rapid dissolve tablet, or nasal spray. State the form clearly so the pharmacy prepares the intended preparation.
Give the exact per-unit strength (for example, Ketamine HCl 100 mg troche) or the nasal spray concentration (for example, Ketamine 50 mg/mL). Ranged formulations must be prescribed at an exact strength.
Number of dosage units for troches and tablets, or total volume/bottles for nasal spray. Federal law prohibits dispensing more than 100 dosage units.
Required for controlled substances. Make sure it matches the quantity and SIG.
Maximum 5 refills within 6 months of the issue date. PRN refills are not valid for controlled substances.
Include an ICD-10 diagnosis code with every ketamine prescription.
Include dose per administration, administration site or route, and frequency (for example, dissolve one troche between cheek and gum once daily).
Include any patient-specific clarification, supervised-dosing or monitoring instructions, or counseling notes.
Formulations
For dosage form comparisons, safety information, and patient counseling details, see the ketamine troche, rapid dissolve tablet, and nasal spray formulation pages. The most commonly prescribed ketamine preparations and their strength ranges are listed below.
Bayview's most commonly prescribed ketamine formulations.
Ketamine is compounded in three customized dosage forms. Because ketamine is prescribed as a single active ingredient, there is no shorthand code to enter — select Ketamine (bulk) powder as the drug, then state the dosage form, exact strength or concentration, quantity, directions, refills, and an ICD-10 diagnosis so the prescription can be verified before compounding.
Ketamine HCl 10–200 mg
Ketamine HCl 10–300 mg
Ketamine 10 / 50 / 100 mg/mL
Ketamine Troche +
Ketamine HCl ____ mg (10–200 mg) Troche — prescribe an exact strength.
Suggested: Dissolve one troche between cheek and gum once daily.
Ketamine Rapid Dissolve Tablet +
Ketamine HCl ____ mg (10–300 mg) Rapid Dissolve Tablet — prescribe an exact strength.
Suggested: Place 1 tablet under the tongue and allow to dissolve for 1–2 minutes before swallowing.
Ketamine Nasal Spray +
Ketamine 10 mg/mL Nasal Spray
Ketamine 50 mg/mL Nasal Spray
Ketamine 100 mg/mL Nasal Spray
Ketamine 25 mg/mL / Lidocaine HCl 4% Nasal Spray
Suggested: Inhale 1 spray in each nostril every 4–6 hours as needed.
EHR Ordering Tips
Because each EHR handles compounded controlled substances differently, the exact screen names may vary. In every system, select Ketamine (bulk) powder as the drug so the order is treated as a controlled substance, and enter the concentration, dosage form, and exact strength in the medication or notes field. The prescription is signed with the prescriber's two-factor EPCS credential before it transmits.
To help Bayview Pharmacy process the prescription quickly, include the concentration, dosage form, exact strength, quantity, an ICD-10 diagnosis, and complete directions.
Select your EHR below for practical tips on entering compounded ketamine prescriptions. Screen names vary by practice setup, but the same prescription elements should be included in every system: select Ketamine (bulk) powder as the drug, state the concentration and dosage form, include an ICD-10 diagnosis, keep the quantity to no more than 100 dosage units, and sign with your two-factor EPCS credential.
Epic / Hyperspace +
- Open the patient chart and start a new outpatient medication order.
- Search for and select Ketamine (bulk) powder so the order is treated as a controlled substance.
- Select Bayview Pharmacy, Warwick, RI as the destination pharmacy.
- Enter the concentration, dosage form, and exact strength in the medication or notes field. Do not use the brand name Ketalar®.
- Complete the SIG, quantity (no more than 100 dosage units), day supply, refills, and ICD-10 diagnosis.
- Epic will prompt for your two-factor EPCS credential at signing. Complete the token, authenticator, or biometric prompt to transmit.
Ketamine HCl 100 mg Troche. Dissolve one troche between cheek and gum once daily. ICD-10: ____.
Dispense ____ troches (max 100 dosage units). Day supply: ____. Refills: ____ (max 5).
eClinicalWorks +
- Open the patient chart and go to the medication or eRx workflow.
- Select Ketamine (bulk) powder as the drug (must be a controlled substance).
- Select Bayview Pharmacy, Warwick, RI as the pharmacy.
- In the directions/notes field, enter the concentration, dosage form, and exact strength.
- Complete directions, quantity (max 100 dosage units), day supply, refills, and ICD-10 diagnosis.
- Sign with your two-factor EPCS credential when prompted to transmit.
Ketamine HCl 150 mg Rapid Dissolve Tablet. Place 1 tablet under the tongue and allow to dissolve for 1–2 minutes before swallowing. ICD-10: ____.
Quantity: ____ tablets (max 100). Day supply: ____. Refills: ____ (max 5).
athenahealth +
- Open the patient chart and start a new prescription.
- Search for and select Ketamine (bulk) powder as the controlled-substance drug.
- Search for Bayview Pharmacy, Warwick, RI.
- Enter the concentration, dosage form, and exact strength in the medication name or prescription notes field.
- Include quantity (max 100 dosage units), day supply, refills, complete SIG, and ICD-10 diagnosis.
- Athena will require your EPCS token or authenticator at signing before the prescription transmits.
Ketamine 50 mg/mL Nasal Spray. Inhale 1 spray in each nostril every 4–6 hours as needed. ICD-10: ____.
Dispense ____ mL (max 100 dosage units). Day supply: ____. Refills: ____ (max 5).
AdvancedMD +
- Open the patient chart and select the e-prescribing workflow.
- Select Ketamine (bulk) powder as the drug (controlled substance).
- Choose Bayview Pharmacy, Warwick, RI as the pharmacy.
- Enter the concentration, dosage form, and exact strength in the medication or notes field.
- Complete SIG, quantity (max 100 dosage units), day supply, refills, and ICD-10, then sign with your two-factor EPCS credential.
Ketamine HCl 200 mg Troche. Dissolve one troche between cheek and gum once daily. ICD-10: ____.
Dispense ____ troches (max 100). Day supply: ____. Refills: ____ (max 5).
Tebra / Kareo +
- Open the patient chart and create a new prescription.
- Select Ketamine (bulk) powder as the drug (controlled substance).
- Select Bayview Pharmacy, Warwick, RI.
- Enter the concentration, dosage form, and exact strength in the directions or notes field.
- Include quantity (max 100 dosage units), day supply, refills, SIG, and ICD-10, then complete the EPCS two-factor prompt at signing.
Ketamine 25 mg/mL / Lidocaine HCl 4% Nasal Spray. Inhale 1 spray in each nostril every 4–6 hours as needed. Dispense ____ mL (max 100). Day supply: ____. Refills: ____. ICD-10: ____.
DrChrono +
- Open the patient chart and go to the Send eRx workflow.
- Select Ketamine (bulk) powder as the controlled-substance drug.
- Select Bayview Pharmacy, Warwick, RI.
- Enter the concentration, dosage form, and exact strength.
- Enter SIG, quantity (max 100 dosage units), day supply, refills, and ICD-10, then sign with your EPCS credential to transmit.
Ketamine HCl 300 mg Rapid Dissolve Tablet. Place 1 tablet under the tongue and allow to dissolve for 1–2 minutes before swallowing. ICD-10: ____.
Dispense ____ tablets (max 100). Day supply: ____. Refills: ____ (max 5).
NextGen +
- Open the patient chart and start a new medication prescription.
- Select Ketamine (bulk) powder as the drug (controlled substance).
- Select Bayview Pharmacy, Warwick, RI.
- Enter the concentration, dosage form, and exact strength in the medication or notes field.
- Add quantity (max 100 dosage units), day supply, refills, SIG, and ICD-10, then complete the two-factor EPCS prompt at signing.
Ketamine 100 mg/mL Nasal Spray. Inhale 1 spray in each nostril every 4–6 hours as needed. ICD-10: ____.
Dispense ____ mL (max 100 dosage units). Day supply: ____. Refills: ____ (max 5).
ModMed +
- Open the patient chart and start an e-prescription.
- Select Ketamine (bulk) powder as the controlled-substance drug.
- Choose Bayview Pharmacy, Warwick, RI.
- Enter the concentration, dosage form, and exact strength.
- Include directions, quantity (max 100 dosage units), day supply, refills, and ICD-10, then sign with your EPCS credential.
Ketamine HCl 50 mg Troche. Dissolve one troche between cheek and gum once daily. ICD-10: ____.
Dispense ____ troches (max 100). Day supply: ____. Refills: ____ (max 5).
Practice Fusion +
- Open the patient chart and select the prescription/eRx workflow.
- Select Ketamine (bulk) powder as the drug (controlled substance).
- Choose Bayview Pharmacy, Warwick, RI.
- Enter the concentration, dosage form, and exact strength in the medication or notes field.
- Include full SIG, quantity (max 100 dosage units), day supply, refills, and ICD-10, then complete the EPCS two-factor prompt to transmit.
Ketamine HCl 100 mg Rapid Dissolve Tablet. Place 1 tablet under the tongue and allow to dissolve for 1–2 minutes before swallowing. ICD-10: ____.
Dispense ____ tablets (max 100). Day supply: ____. Refills: ____ (max 5).
Veradigm / Allscripts +
- Open the patient chart and create a new prescription.
- Select Ketamine (bulk) powder as the controlled-substance drug.
- Select Bayview Pharmacy, Warwick, RI.
- Enter the concentration, dosage form, and exact strength in the medication or notes field.
- Include quantity (max 100 dosage units), day supply, refills, complete directions, and ICD-10, then sign with your two-factor EPCS credential.
Ketamine 10 mg/mL Nasal Spray. Inhale 1 spray in each nostril every 4–6 hours as needed. ICD-10: ____.
Dispense ____ mL (max 100 dosage units). Day supply: ____. Refills: ____ (max 5).
E-prescribe Examples
Use the examples below as formatting guides when entering ketamine compounds in an EHR.
Drug selected: Ketamine (bulk) powder
Preparation: Ketamine HCl ____ mg (10–200 mg) Troche
Quantity: ____ troches (max 100 dosage units)
Day supply: ____
Refills: ____ (max 5)
ICD-10: ____
Directions: Dissolve one troche between cheek and gum once daily.
Drug selected: Ketamine (bulk) powder
Preparation: Ketamine HCl ____ mg (10–300 mg) Rapid Dissolve Tablet
Quantity: ____ tablets (max 100 dosage units)
Day supply: ____
Refills: ____ (max 5)
ICD-10: ____
Directions: Place 1 tablet under the tongue and allow to dissolve for 1–2 minutes before swallowing.
Drug selected: Ketamine (bulk) powder
Preparation: Ketamine ____ mg/mL (10, 50, or 100 mg/mL) Nasal Spray
Quantity: ____ mL (max 100 dosage units)
Day supply: ____
Refills: ____ (max 5)
ICD-10: ____
Directions: Inhale 1 spray in each nostril every 4–6 hours as needed.
Drug selected: Ketamine (bulk) powder
Preparation: Ketamine 25 mg/mL / Lidocaine HCl 4% Nasal Spray
Quantity: ____ mL (max 100 dosage units)
Day supply: ____
Refills: ____ (max 5)
ICD-10: ____
Directions: Inhale 1 spray in each nostril every 4–6 hours as needed.
Drug selected: Ketamine (bulk) powder
Preparation: Ketamine HCl ____ [dosage form] at a custom strength within the available range
Quantity: ____ (max 100 dosage units)
Day supply: ____
Refills: ____ (max 5)
ICD-10: ____
Directions: Complete directions including dose per administration, site/route, and frequency.
Concentration: ____
Dosage form: Troche / Rapid dissolve tablet / Nasal spray
Directions: ____
ICD-10: ____
Quantity: ____ (max 100 dosage units)
Refills: ____ (max 5)
Custom Formulation Cost Notice
The troche, rapid dissolve tablet, and nasal spray concentrations listed on this page are Bayview Pharmacy's most commonly prepared ketamine options. Prescriptions for custom strengths, non-listed concentrations, or unusual combinations may require additional review and may have an increased cost.
To help avoid delays or unexpected pricing changes, prescribe within the listed ranges when possible, and always include the dosage form, exact strength or concentration, quantity, directions, ICD-10 diagnosis, and refill information.
Schedule III Prescription Rules
Because ketamine is a Schedule III controlled substance, a few prescription rules apply that do not apply to Bayview's non-controlled compounds.
Rules that apply to every ketamine prescription.
Select Ketamine (bulk) powder as the active drug so it is treated as a controlled substance. The EPCS signature only validates when a controlled substance is selected.
Federal law prohibits dispensing more than 100 dosage units on a compounded ketamine prescription.
Maximum 5 refills within 6 months of the issue date, whichever comes first. PRN refills are not valid. After that, a new e-prescription is required.
The prescription cannot be filled or refilled more than 6 months after the date written.
Include an ICD-10 diagnosis code with every ketamine prescription.
Ranged formulations (for example, Ketamine HCl 10–300 mg tablets) must be prescribed at a specific strength or concentration.
The quantity, SIG, and day supply need to be internally consistent. Mismatches are the most common cause of clarification calls.
Bayview Pharmacy reports ketamine dispensings to the state prescription drug monitoring program as required by law.
Under Rhode Island law (RI Law §21-28-3.18), controlled substances in schedules II–V must be signed and transmitted electronically, removing the fax and phone options for ketamine.
Avoid Delays
Before sending the prescription, check for these common missing items.
Complete prescriptions allow Bayview Pharmacy to review, prepare, and coordinate the medication more efficiently. Missing details may require pharmacist clarification before compounding.
Drug not selected as Ketamine (bulk) powder, so the EPCS signature will not validate
Concentration or exact strength missing, or a range prescribed without a specific value
Dosage form not specified (troche, rapid dissolve tablet, or nasal spray)
ICD-10 diagnosis code not included
Quantity missing, or more than 100 dosage units authorized
Missing day supply, or day supply that does not match quantity and SIG
Refills written as PRN or more than 5 refills authorized
Brand name Ketalar® used instead of Ketamine (bulk) powder
Prescription printed or faxed instead of transmitted through EPCS
Ordering FAQ
Can a prescriber fax or call in a compounded ketamine prescription? +
No. Ketamine is a Schedule III controlled substance, and Rhode Island law (RI Law §21-28-3.18) requires controlled substances in schedules II–V to be signed and transmitted electronically. Ketamine prescriptions must be sent through an EPCS-enabled EHR. Office staff are welcome to call for formulation guidance, concentration selection, or e-prescribing help.
Why do I select "Ketamine (bulk) powder" instead of a finished product? +
Selecting Ketamine (bulk) powder ensures the order is treated as a controlled substance, which is required for the EPCS signature to validate. Enter the concentration, dosage form, exact strength, and directions in the instructions or notes field. Do not use the brand name Ketalar®.
Is there a limit on how much I can dispense? +
Yes. Federal law prohibits dispensing more than 100 dosage units on a compounded ketamine prescription. Make sure the quantity, day supply, and SIG are consistent.
Do I need to include an ICD-10 diagnosis code? +
Yes. Include an ICD-10 diagnosis code with every ketamine prescription, along with the concentration, dosage form, exact strength, quantity, day supply, refills, and complete directions so Bayview Pharmacy can verify the prescription before compounding.
What if my EHR is not set up for EPCS? +
EPCS activation is a one-time process: confirm your software is EPCS-certified, complete identity proofing, set up a two-factor credential, and have a second individual in the practice enable your EPCS permissions. If your EHR cannot support EPCS, standalone certified e-prescribing platforms are available. Call Bayview Pharmacy at 401-284-4505 for help getting set up.
How many refills can I authorize? +
Schedule III prescriptions may be refilled up to 5 times within 6 months of the issue date. PRN refills are not valid for controlled substances. After 5 refills or 6 months, whichever comes first, a new e-prescription is required.
Can I prescribe a custom strength or concentration? +
Yes. Custom strengths and concentrations may be prescribed within the available ranges when clinically appropriate for an individual patient. Custom or non-listed formulations may require additional pharmacist review and may have an increased cost.
What should the office do if the e-prescription fails to transmit? +
Call Bayview Pharmacy at 401-284-4505. The pharmacy team can confirm whether the prescription was received and help troubleshoot pharmacy selection or transmission issues. Do not fax a copy as a workaround; the prescription must arrive electronically.
Questions About E-Prescribing Ketamine?
Prescribers or authorized office staff may call Bayview Pharmacy directly for formulation guidance, concentration selection, EPCS setup and troubleshooting, or refill coordination. The prescription itself must be transmitted electronically. Formulation details, strengths, and patient information are on the ketamine troche, rapid dissolve tablet, and nasal spray formulation pages.
Call 401-284-4505Compounded ketamine is prepared pursuant to a valid prescription for an individual patient, is used off-label, and is not FDA-approved. The FDA has cautioned about the risks of compounded ketamine for psychiatric use.