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!

Photo Credit: Tyler Bird

Washington Governor Jay Inslee recently signed SB5380 into law. This Act mandates Washington healthcare providers to electronically prescribe all controlled substances with an effective date of January 1^st, 2021.  This bill was created by request of the Governor and was one of several bills pushed through the House and Senate the day before Washington’s legislative session ended.

Other subsections of the Act include:

• Several sections of the bill state that prescribers of varying practice must inform patients of their right to refuse an opioid prescription.

• 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 are not required to verify if a controlled substance prescription received via written, oral, or fax falls within the state and federal laws.

• Effective January 1^st, 2021 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 as well.

• A large portion of the Act establishes regulations and oversight that governs opioid addiction treatment.  The Act establishes that substance use disorders are medical conditions and discusses various aspects of how law enforcement, the Department of Corrections, and school districts should act when dealing with substance abuse.

Washington has remained well above the national average for opioid-related overdose deaths since tracking began in 1999 but in 2015 was overtaken by the national average as US rates began to rise.  Prescription opioid overdose deaths have continued to gradually decrease since 2011, however heroin deaths have begun to rise.[1]  Washington State established and has been utilizing their PMP since 2012.  In 2017, Washington passed HB1427 which created 5 commissions and boards tasked with creating requirements and recommendations for WA prescribers to follow for curbing opioid misuse.  One requirement established is that prescribers must complete additional training for the prescribing of opioids.  The Agency Medical Director’s Group suggests using opioid misuse risk assessment tools with every new patient that is being considered for an opioid prescription.  These guides determine whether the patient should be prescribed opioids by assigning a score based on several history, illness, and risk questions.

Washington currently has an 18.2% provider enablement for electronic prescribing of controlled substances, which is significantly below the national average of 34.4%.  Pharmacy enablement for EPCS is 96.0% which is above the current national average for pharmacies of 95.3%.[2]  There will likely be a big push leading up to 2021 to secure electronic prescribing, MDToolbox encourages providers not to wait!

Washington now aligns with several other states mandating electronic prescribing.  MDToolbox looks forward to working with providers throughout Washington 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/washington-opioid-summary

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