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!

 Missouri Governor Mike Parson recently signed SB275 into law. This Act mandates Missouri healthcare providers to electronically prescribe all controlled substance medications contained in Schedules II-IV with an effective date of January 1^st, 2021.  Missouri was very determined to pass an EPCS mandate, as they had at least 6 pieces of legislation pending that contained a mandate.  SB275 contains many elements of the additional pieces of legislation that were being debated.

Other subsections of the Act include:

• The Act states that electronic prescriptions of controlled substances can be substituted for a written prescription at the direct request from the patient.

• 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 penalties for practitioners who do now follow regulations established in this Act.

• The Act establishes the “Joint Committee on Substance Abuse Prevention and Treatment”, a new commission consisting of Senate, House, and governor-elected members to explore solutions and modify legislation for the state of Missouri pertaining to substance abuse.

• Regulations for the cost of Medication-Assisted Treatment (MAT) are established within the Act.

• Dentists are no longer allowed to prescribe extended-release opioids and any doses greater than 50 Morphine Milligram Equivalents per day.

• Several other state regulations are changed including: Drug trafficking offenses, practitioner credentialing procedures, nicotine replacement therapy, and collaborative practice arrangements between physicians and physician assistants.

Missouri is currently above the national average for opioid-related overdose deaths, with 16.5 deaths per 100,000 people while the national average is 14.6 deaths.  Prescription opioid overdose deaths continued to gradually rise until 2010, then have remained stable.  Heroin deaths have gradually risen since 2007 and synthetic opioid deaths have all risen drastically since 2014, up from ~100 to 618 in 2017.[1]  Missouri is the only state in the US to have not established a Prescription Drug Monitoring Program (PDMP).  However, St. Louis County, MO created their own PDMP for use within their county.  Jackson County, MO has partnered with St. Louis County to use their PDMP.  Prescribers across the state have joined the PDMP on a voluntary basis, tired of waiting for Missouri State Legislators to establish an official state-wide PMP.  There is currently no state legislation for establishing a PDMP.

Missouri currently has a 25% prescriber enablement for electronic prescribing of controlled substances, which is below the national average of 35.4%.  Pharmacy enablement for EPCS is 97.9% which is above the national average for pharmacy enablement is 95.4%.[2]  There will likely be a big push leading up to 2021 to secure electronic prescribing, MDToolbox encourages providers not to wait!

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 Missouri 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/opioid-summaries-by-state/missouri-opioid-summary

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