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!

Kansas Governor Laura Kelly recently signed HB2119 into law. This Act mandates Kansas healthcare providers to electronically prescribe all controlled substance medications that contain an opiate with an effective date of July 1^st, 2021.  The Kansas mandate details several circumstances where electronic prescribing is not required.  However, there are a couple of circumstances that are not typical or seen in mandates that other states have enacted:

• If the prescription is for a compounded controlled substance containing two or more components (one of which being an opiate) that make “electronic submission impractical”, electronic prescribing is not required. This provision is likely to help accommodate prescribers who are using software that does not support prescription orders for custom compounds.  At the time of writing this blog, many software systems only allow selecting orders from a list of drugs (MDToolbox e-Rx software however DOES accommodate custom compounds and would allow for this type of order to be electronically sent).

• If a prescriber issues 50 or fewer controlled substance prescriptions that contain an opiate per year, electronic prescribing is not required.

Other subsections of the 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.  The Act details penalties for practices that violate or misrepresent themselves when applying for waivers.

• The Act establishes penalties for any prescriber who violates “any lawful rules or regulations” set in place by the state which would include the EPCS mandate established by this Act.

• More than half of the Act amends previous legislation with new medical definitions for existing and future laws.

Kansas is currently well below the national average for opioid-related overdose deaths, with 5.1 deaths per 100,000 people in 2017 while the national average was 14.6 deaths.  Prescription opioid overdoses rose steadily from 2000 to 2007, then have consistently decreased from 2014 to 2017.  Heroin and synthetic opioid deaths have remained consistent despite the national average rising sharply in the last few years.[1]  Despite being one of the lowest states for opioid overdose deaths, Kansas prescribes more opioids than the national average.  Opioid prescriptions are 69.8 per 100 people while the national average is 58.7 per 100 people.[2]  Kansas was one of the first states to enact legislation for a prescription drug monitoring program (K-TRACS).  It went operational in 2010 but the state does not mandate it’s use for non-dispensing prescribers.  Funding issues threatened the K-TRACS program but support was reapproved by the Governor for 2018 and 2019.[3]

Kansas currently has an 18.6% prescriber enablement for electronic prescribing of controlled substances, which is significantly below the national average of 35.4%.  Pharmacy enablement for EPCS is 98.8% which is above the national average for pharmacy enablement of 95.4%.[4]  There will likely be a big push leading up to 2021 to secure electronic prescribing, MDToolbox encourages providers not to wait!

Kansas now aligns with several other states mandating electronic prescribing.  MDToolbox looks forward to working with providers throughout Kansas to ease the transition and help provide tools and resources in combating the opioid epidemic.  With MDToolbox providers have access to tools such as Electronic Prescribing of Controlled Substances (EPCS) and convenient on the go mobile e-prescribing.  Contact us for more information or to start your free 30 day free trial.

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

[2]https://opioid.amfar.org/KS

[3]http://www.kslegresearch.org/KLRD-web/Publications/BudgetBookFY19/2019BudgetAnalysisRpts/Biennial-Pharmacy.pdf

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