Most state legislative sessions have come to a close for 2019.  There are a handful of states that have year-round legislative sessions (MA, MI, NJ, NY, OH, PA, WI), but the majority of 2019 state legislation being drafted has either passed or died.  We saw a record number of States this year that have passed electronic prescribing mandates.  As of the writing of this blog, 27 of the 50 states have an active or pending mandate! 

States that have passed a mandate in 2019 are listed below:

States requiring e-prescribing of all prescriptions:

• Delaware (1/1/21)

• Florida (7/1/21 or upon license renewal)

States requiring e-prescribing of controlled substances:

• Arkansas (1/1/21)

• Colorado (7/1/21 or 7/1/23 for solo practitioners)

• Indiana (1/1/21)

• Kansas (7/1/21)

• Kentucky (1/1/21)

• Missouri (1/1/21)

• Nevada (1/1/21)

• South Carolina (1/1/21)

• Texas (1/1/21)

• Washington (1/1/21)

• Wyoming (1/1/21)

Two states have enacted amendments to their previously passed mandates.  Tennessee has made several major changes to their mandate.  The amended Act expands the mandate to cover not only Schedule II drugs, but all controlled substances.  The effective date has also been postponed to January 1^st, 2020.  Arizona has also amended their mandate passed in 2018.  Arizona had initially set effective dates of January 1, 2019 for prescribers in counties with populations more than 150,000 and July 1, 2019 for prescribers in rural counties with less than 150,000 residents.  The amended mandate has an updated effective date of January 1^st, 2020 for all counties in the State.

The majority of states share language in their bills, however there are a few state mandates that contained unique provisions in the wording of their legislation.

• Missouri’s mandate states that electronic prescriptions of controlled substances can be substituted with a written prescription at the direct request of the patient, maintaining an avenue for written prescriptions.

• Florida’s mandate has a provision that allows for practices that exclusively use paper charts to not follow the state mandate requiring electronic prescribing.  In speaking with a prescriber in Florida, they were waiting for clarification on this provision before making any prescribing arrangements as the provision’s wording is not entirely clear as to what constitutes an electronic health record as is written in the Act.

• Washington’s mandate requires that medical entities with ten or more prescribers must use an EHR that is integrated with the state Prescription Monitoring Program (PMP) database.  The EHR must demonstrate both sending and receiving of PMP data.  A waiver process will be made available for this requirement.

• Colorado allows for practitioners who write less than 25 prescriptions for controlled substances per year to not have to adopt electronic prescribing.

Michigan currently has pending legislation for their mandate and is currently being deliberated in committee.  There is also an anticipated update to the Ryan Haight act as required per 2018’s SUPPORT Act regarding telemedicine.  The deadline established in the SUPPORT Act is October 24^th, 2019.  Watch our blog or check our social media accounts for any updates regarding either of these legislation changes.

If you reside in any of the states that have enacted mandates this year, MDToolbox encourages prescribers to do their research and adopt a solution early to ensure that they comply with state regulations.

Please see our website for other states that have either passed or have pending legislation that mandates electronic prescribing.  MDToolbox looks forward to providing tools and resources to assist providers throughout the United States to ease the transition and help our customers combat the opioid epidemic.  With MDToolbox, providers have access to tools such as Electronic Prescribing of Controlled Substances (EPCS) and convenient on the go e-prescribing with our mobile app!  We offer a free 30 day free trial, so Contact us for more information!

Florida and Delaware Governors Ron DeSantis and John Carney have both recently signed electronic prescribing mandates into law.  Florida HB831 mandates healthcare providers to electronically prescribe all medications with an effective date of either July 1^st, 2021, or upon license renewal (beginning January 1^st, 2020).  This bill was a bipartisan initiative that was amended several times in both the house and senate before being enacted.  Delaware HB115 mandates healthcare providers to electronically prescribe all medications with an effective date of January 1^st, 2021.

Other subsections of the Florida Act include:

• The Act makes changes to the required information included on written prescriptions.

• There are provisions in the Act for a waiver system with similar circumstances for approval as other states have enacted.  Some of these include economic hardship, technological limitations, and other circumstances determined by the board.

• The Act establishes that penalties may be issued if a prescriber fails to keep control over their prescription pads and authorized access to their electronic prescribing software.

• A large portion of the Act amends prior legislation that gives power to the “agency” that governs Florida health practitioners and practices.  There are several tasks detailed for the agency to complete pertaining to medications, pharmacies, and Medicaid.

Other subsections of the Delaware Act include:

• There are provisions in the Act for a waiver system with similar circumstances for approval as other states have enacted.  Some of these include economic hardship, technological limitations, and other circumstances determined by the board.

• Pharmacies and dispensers are not required to verify that a prescription presented to the pharmacy via other means than an electronic prescription is legally able to be filled.

Florida is currently above the national average for opioid-related overdose deaths, with 16.3 deaths per 100,000 people while the national average is 14.6 deaths.  Prescription opioid overdose deaths continued to gradually rise until 2011, then decreased until 2015.  Heroin, prescription Opioids, and synthetic opioid deaths have all risen drastically since then.[1]  Florida implemented their PMP in 2011 and also began restricting some controlled substances.  In 2017, Florida declared a state of emergency due to the Opioid epidemic and began writing additional legislation.  HB21 was a major change enacted in 2018 that required usage of the State Prescription Monitoring Program (PMP), required additional opioid training for prescribers, and placed limitations on the number of pills that can be prescribed.

Delaware is also currently above the national average for opioid-related overdose deaths, with 21.7 deaths per 100,000 people while the national average is 14.6 deaths.  Overdose deaths remained consistently above the national average from 2008 to 2016 and have risen drastically in 2016 and 2017 with 37.0 deaths per 100,000 people in 2017.[2]  Delaware enacted legislation that restricted opioid prescriptions to 7 days beginning in 2017.  Long-term opioid treatment is available, but only after certain criteria is met including regular queries of the State Prescription Drug Monitoring Program.

Florida currently has a 15.3% prescriber enablement for electronic prescribing of controlled substances; Delaware has a 20.3% prescriber enablement.  Both states are significantly below the national average of 35.4%.  Pharmacy enablement in Florida for EPCS is 92.9% which is the second lowest of any State in the US.  Delaware currently has a 99.5% pharmacy enablement, the national average is 95.4%.[3]  MDToolbox encourages providers not to wait until the last minute to setup electronic prescribing!

Please see our website for other states that have either passed or have pending legislation that mandates electronic prescribing.  MDToolbox looks forward to providing tools and resources to assist providers throughout Florida and Delaware to ease the transition and help our customers combat the opioid epidemic.  With MDToolbox, providers have access to tools such as Electronic Prescribing of Controlled Substances (EPCS) and convenient on the go e-prescribing with our mobile app!  We offer a free 30 day free trial, so Contact us for more information!

[1]https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state/florida-opioid-summary

[2]https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state/delaware-opioid-summary

[3]https://surescripts.com/enhance-prescribing/e-prescribing/e-prescribing-for-controlled-substances/