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!

South Carolina Governor Henry McMaster recently signed HB3728 into law.  This was a bipartisan bill that was amended a few times during the legislative process.  This Act mandates South Carolina healthcare providers to electronically prescribe all controlled substance medications with an effective date of January 1^st, 2021.

Other subsections of the Act include:

• The Act requires healthcare facilities and first responders who have diagnosed an opioid overdose to submit data to the state PMP (Prescription Monitoring Program) for each instance that an opioid antidote was administered to a patient.  This data will then be analyzed by the Bureau of Drug Control.

• The State PMP must be consulted when prescribing a Schedule II controlled substance and must be documented in the patient’s chart that the PMP was consulted.

• The Act makes dispensers immune from civil and criminal liability from the State Board of Pharmacy over dispensing prescriptions that potentially violate the laws established in the Act.  If a prescription is sent to the pharmacy in a non-electronic format, this section puts the responsibility on the prescriber to ensure that a valid exceptional circumstance (detailed in the bill) was utilized.

South Carolina is currently above the national average for opioid-related overdose deaths, with 15.5 deaths per 100,000 people in 2017 while the national average was 14.6 deaths.  Prescription opioid overdose rates rose steadily from 1999 to 2013, then more than doubled between 2013 and 2014.  Opioid overdose rates have remained stable since 2014.  Heroin and synthetic opioid deaths have risen since 2013, with synthetic opioids skyrocketing higher than the national average.  Synthetic opioid deaths are almost ten times what they were in 2013.  In 2015, South Carolina had one of the highest rates of opioid prescribing in the US, 109 prescriptions for every 100 people.  This number was reduced drastically in 2017 to 79.3 prescriptions but is still well above the national average of 58.7.[1] 

In 2015, South Carolina passed the South Carolina Overdose Prevention Act which raised public awareness for the severity of the opioid epidemic in South Carolina and outlined legislation for the administration of opioid antidotes during an overdose.  The law provided immunity from legal prosecution for any medical providers, caregivers, or pharmacists involved in dispensing or administering an opioid antidote.  South Carolina then established the Law Enforcement Officer Naloxone (LEON) program which focused on training and education for law enforcement first responders to identify and treat opioid drug overdoses.  In 2018, South Carolina passed S918 which established a report card for prescribers.  The report card pulls data about controlled substances that the practitioner has prescribed and compares their statistics to other prescribers.

South Carolina currently has a 21.4% prescriber enablement for electronic prescribing of controlled substances, which is well below the national average of 35.4%.  Pharmacy enablement for EPCS is 95.8% which is just 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!

South Carolina now aligns with several other states mandating electronic prescribing.  MDToolbox looks forward to working with providers throughout South Carolina 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/opioid-summaries-by-state/south-carolina-opioid-summary

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