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!

Texas Governor Greg Abbott recently signed HB2174 into law, Nevada Governor Steve Sisolak has also signed AB310 into law.  Both Acts mandate Texas and Nevada healthcare providers to electronically prescribe all controlled substance medications with an effective date of January 1^st, 2021.

Both Acts contain provisions 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.  Reapplying for a waiver for subsequent years is also covered.

The Texas Act also establishes:

• The Act allows for partial filling of Schedule II prescriptions, but only for patients in long-term care facilities or for hospice patients with a medical diagnosis documenting a terminal illness.

• 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.

• The Act clarifies what specific information needs to be contained in both written and electronic prescriptions.

• Prescribers and pharmacists are required to complete two hours of continuing education on procedures of prescribing and monitoring controlled substances.  This education must be completed within one year of receiving a license to prescribe or dispense controlled substances.

• Prescribers are unable to write prescriptions that exceed a 10 day supply when being written for acute care.

The Nevada Act also establishes:

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

• More than half of the Act amends various pieces of Nevada code discussing potential penalties for medical staff.

Texas is currently well below the national average for opioid-related overdose deaths, with 5.1 deaths per 100,000 people while the national average is 14.6 deaths.  Prescription opioid overdose deaths peaked in 2006 and have remained mostly stable since.  Heroin deaths have gradually risen since 2000 and synthetic opioid deaths have remained stable until 2014, when they began to rise.  Texas also has a lower than average opioid prescription rate, this number has been decreasing since 2012[1]  Effective 9/1/19, pharmacists and prescribers will be required to consult the state PMP prior to dispensing or prescribing controlled substances.

Nevada is currently also below the national average for opioid-related overdose deaths, with 13.3 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 been reduced or remained stable.  Heroin deaths have gradually risen since 2011 and synthetic opioid deaths have slightly risen since 2015.[2]  Nevada passed SB459 in 2015 which mandated that Nevada prescribers check the state Prescription Drug Monitoring Program for controlled substance prescriptions.  AB474 was passed in 2017 which was considered “a comprehensive measure that addresses misuse, abuse, and diversion through enacting prescribing protocols at appropriate levels.”[3]

Texas currently has a 31.1% prescriber enablement for electronic prescribing of controlled substances while Nevada has nearly half the enablement of Texas.  Pharmacy enablement for both states is near the national average 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!

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 Texas and Nevada 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/texas-opioid-summary

[2]https://www.drugabuse.gov/opioid-summaries-by-state/nevada-opioid-summary

[3]https://oig.hhs.gov/oas/reports/region9/91801004_Factsheet.pdf

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