Iowa Considering Mandated E-Prescribing

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Iowa is the latest state to consider legislation that would require electronic prescribing. The Iowa Board of Pharmacy suggested Senate Study Bill 30741 which would require all prescriptions to be sent electronically. Like several other states with similar enacted and proposed legislation, lawmakers in Iowa hope to curb the opioid epidemic with this bill.

Executive director of the Iowa Board of Pharmacy, Andrew Funk, informed senators that currently 65% of Iowa prescriptions for non-addictive drugs are sent electronically, but only 9% of prescriptions for addictive drugs are electronic. This leaves a lot of room for fraudulent prescriptions.

Iowa Senator Tom Greene, a former pharmacist, is all too familiar with forged paper prescriptions. "A patient presented me with a prescription for sleeping medication-a controlled substance," said Greene. "And the doctor had ordered ten tablets. Well, the patient changed the one-zero to a four-zero. There are cases like that out there, and again electronic prescribing and the electronic transmission of that information is very accurate." Lawmakers hope that in addition to preventing phony prescriptions, it would also help with mistakes caused by handwritten prescriptions. Prescriptions sent electronically eliminate the possibilities for patients to alter them, as well as remove the potential for pharmacists to misinterpret illegible prescriptions.

The bill allows for providers to ask for temporary exemptions if they aren’t able to meet the requirements in time, but any prescriber without an exemption would be subject to $250 fines per violation of the law, up to $5,000 per year. There are also exemptions for prescriptions for patients in nursing homes, long-term care facilities, or jail, as well as veterinary prescriptions. In addition, the bill states the requirements do not apply to compound prescriptions containing two or more components and prescriptions requiring “information that makes electronic submission impractical, such as complicated or lengthy directions for use or attachments.”

As the bill is written now, it would begin July 1, 2019. Some lobbyists, however, feel that this is too soon especially for rural hospitals and physicians. They are pushing for the date to moved to July 1, 2020. Senator Greene and two other senators on the subcommittee were said to informally agree to a compromise of January 1, 2020.

One of the great things about our stand-alone web-based e-Prescribing products is that there is not a lot of setup needed. As long as a prescriber has a device that can access the internet (computer, tablet, or phone), they can send their prescriptions electronically. While sending controlled substances electronically does require a 2nd device to electronically sign the prescription, it is as simple as using a phone or key fob.  Most prescribers can get setup and start e-Prescribing with MDToolbox in just a matter of minutes. There is no need to stress about putting complex systems in place or wait until the deadline. To see how quick and easy it is, sign up for a free trial or request a demo here.

 

1.  https://www.legis.iowa.gov/legislation/BillBook?ba=SSB3074

Arizona to Require E-Prescribing to Fight Opioid Abuse

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Last week, Arizona Governor Doug Ducey called a special legislative session to pass the Arizona Opioid Epidemic Act1. In record speed, the Arizona Legislature voted unanimously to approve it and Ducey signed it into law on Friday.

The act is aimed at combating the opioid epidemic in Arizona, where in just the last 6 months there have been more than 800 opioid-related deaths. The focus of the act is to reduce opioid misuse, promote safe prescribing and dispensing, and improve access to treatment.

As stated in the Governor’s news release outlining the act, the policy includes:

  • Identifying gaps in and improving access to treatment, including for uninsured or underinsured Arizonans, with a new $10 million investment;
  • Expanding access to the overdose reversal drug Naloxone for law enforcement or corrections officers currently not authorized to administer it;
  • Holding bad actors accountable by ending pill mills, increasing oversight mechanisms, and enacting criminal penalties for manufacturers who defraud the public about their products;
  • Enhancing continuing medical education for all professions that prescribe or dispense opioids;
  • Enacting a Good Samaritan law to allow people to call 911 for a potential opioid overdose;
  • Cracking down on forged prescriptions by requiring e-prescribing;
  • Requiring all pharmacists to check the Controlled Substances Prescription Monitoring Program prior to dispensing an opioid or benzodiazepine;
  • And limiting the first-fill of an opioid prescription to five days for all opioid naïve patients and limiting dosage levels to align with federal prescribing guidelines. These proposals contain important exemptions to protect chronic pain suffers, cancer, trauma or burn patients, hospice or end-of-life patients, and those receiving medication assisted treatment for substance use disorder.

The e-Prescribing requirement will begin January 1, 2019 and mandates schedule II controlled substances must be sent electronically. There is some concern that those in rural areas do not have the necessary technology for e-Prescribing. Therefore, the act gives those providers additional time and outlines that e-Prescribing will not be mandated until July 1, 2019 for counties with less than 150,000. It also allows for the Board of Pharmacy to grant waivers to prescribers with a lack of broadband Internet access or other hardships.

At MDToolbox, we urge providers not to wait until the mandate and to e-Prescribe all prescriptions. In addition to preventing forged prescriptions and helping combat opioid abuse, e-Prescribing provides many other benefits for providers and patients. Contact us to get started with a free trial today.

 

1.       Arizona Opioid Epidemic Act Policy Primer https://azgovernor.gov/sites/default/files/related-docs/arizona_opioid_epidemic_act_policy_primer.pdf

National E-Prescribing of Controlled Substances Bill Proposed to Fight Opioid Abuse

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Congressman Markwayne Mullin (R-OK) and Congresswoman Katherine Clark (D-MA) recently introduced legislation that would mandate Electronic Prescribing of Controlled Substances (EPCS) under Medicare Part D. The “Every Prescription Conveyed Securely Act”, H.R. 35281, was introduced into the House of Representatives.

It states that a prescription for a covered part D drug under a prescription drug plan for schedule II – V controlled substances must be transmitted electronically. If the bill passes, it would apply to coverage of drugs prescribed on or after January 1, 2020.

The aim of the legislation is to combat the national opioid epidemic. E-Prescribing does this by providing safer and more secure prescriptions. Electronic prescriptions can’t be forged or stolen like paper prescriptions. It also allows prescribers to easily track prescriptions and prevents patients from doctor shopping.

“Opioids claim nearly a hundred lives a day, and parents across the country worry they will be next to get the call their child has overdosed,” said Clark.  “Modernizing public health practices to include electronic prescriptions will curb the over-prescribing of opioids, eliminate the costs and inefficiencies of paperwork, and strengthen communication between doctors and patients.  Congress should come together to pass this commonsense solution to prevent overdoses and save lives.”

Mullen stated, “We need to ensure that patients are receiving opioids only when absolutely necessary and take precautionary measures to prohibit them from falling into the wrong hands.  Our bill, the EPCS Act, aims to close a dangerous loophole that has been fueling the problem of excessively prescribed opioids. By requiring all doctors and pharmacists to use an online database when prescribing these highly addictive drugs, we allow e-prescriptions to control, track, and monitor these highly addictive painkillers on a new level. This bill prevents patients from doctor shopping and prevents fraudulent, handwritten paper prescriptions.”

We have seen several states including New York, Maine, Connecticut, Virginia, and North Carolina take a similar approach to combat opioid abuse by mandating e-Prescribing of controlled substances at the state level, but this would be the first bill passed at the national level. This is definitely a step in the right direction of fighting the national opioid epidemic and we are hopeful that Congress will recognize the benefits e-Prescribing can bring. We also urge prescribers and health IT vendors alike not to wait for such bills to be enacted and to start taking advantage of the benefits of EPCS now. Contact us for more information about EPCS for prescribers and integrating EPCS for vendors at info@mdtoolbox.com.

 

https://www.congress.gov/bill/115th-congress/house-bill/3528/text/ih?overview=closed&format=xml

Study Shows e-Prescriptions Aid in Best Practices for Opioid Prescribing

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 E-Prescriptions Safer than Hand Written

Implementing ways to fight the national opioid epidemic is at the forefront of many states’ legislative sessions.  As we’ve mentioned in several previous posts, a growing number of states are fighting the epidemic by requiring prescribers to electronically prescribe these controlled substances. A new study published by the Journal of Opioid Management shows that these lawmakers are on the right track. And it’s more than just increasing legibility and preventing prescription fraud.

Researchers from John Hopkins University analyzed 510 prescriptions for opioids looking for errors, discrepancies, and variations from ideal practice1. The study included both handwritten and electronically generated prescriptions filled at an outpatient pharmacy. An alarming 89% of handwritten prescriptions contained errors. What’s more is that 41% of those prescriptions were noncompliant with DEA rules. Overall, 92% of handwritten prescriptions failed to meet ideal practice standards, contained errors, or were noncompliant with DEA rules.

In contrast, none of the EHR computer-generated prescriptions contained errors and all of them were fully compliant with DEA rules. Electronic prescriptions are written using standard templates where most of the time the software will not even allow a prescriber to save the prescription without including necessary information such as the date, amount, and at least two patient identifiers. The software also aids in making sure any additional DEA rules and best practices are being followed.

The opioid epidemic needs to be tackled from several angles, including making sure the prescriptions that are being provided are accurate and safe for patients. Patient safety needs to be a top priority and prescribers need to make use of the tools available to aid them in following best practices and ensuring all DEA rules are abided by. Electronically prescribing has been shown time and time again to be a powerful resource. For more information on how to get started with e-Prescribing, contact us at info@mdtoolbox.com or 206-331-4420. 

 

  1.  An analysis of errors, discrepancies, and variation in opioid prescriptions for adult outpatients at a teaching hospital http://www.wmpllc.org/ojs-2.4.2/index.php/jom/article/view/556

North Carolina Joins Fight Against Opioid Abuse with Mandated e-Prescribing

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North Carolina e-Prescribing

North Carolina is the most recent state to pass a law requiring the use of e-Prescribing in an effort to combat opioid abuse. Governor Roy Cooper recently signed the Strengthen Opioid misuse Prevention (STOP) Act into law. The act requires that certain schedule II and schedule III controlled substances be electronically prescribed by January 1, 2020.

The act also sets a 5-day limit for initial prescriptions for acute pain and a 7-day limit for post-operative pain. It sets requirements for utilizing the North Carolina Controlled Substance Reporting System as well. The statewide reporting system tracks patients’ Schedule II-V controlled substance prescriptions so that prescribers can identify patients who may be misusing those controlled substances.

The opioid epidemic is hitting nationwide and North Carolina is no exception. There was a 73 percent increase in the number of opioid-related deaths from 2005 to 2015 in North Carolina with more than 13.000 opioid-related deaths during the period. 

North Carolina is the 5th state to pass such legislation. New York, Virginia, Maine and Connecticut have similar laws requiring e-Prescribing. Several other states have pending legislation as well. All of these states hope to fight the opioid epidemic by reducing the number of opioids available and preventing the addictions from even starting.

E-Prescribing is an important tool in the opioid battle and we are happy to see so many states recognizing that. We are sure more and more states will join in the fight with this tool, but we also hope that prescribers will recognize the benefits and not wait for state mandates to start utilizing it. If you are a prescriber ready to start employing e-Prescribing of controlled substances in your practice, contact us to get started right away. 

Connecticut Mandates e-Prescribing of Controlled Substances

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Connecticut just passed Public Act No. 17-1311 which mandates that prescribers must electronically prescribe controlled substances by January 1, 2018. The legislation was unanimously passed.

The law was originally proposed by Governor Dannel Malloy in an effort to combat opioid abuse and addiction. By requiring controlled substances prescriptions to be sent electronically, it allows the prescriptions to be tracked and prevents fraud from forged or stolen paper prescriptions.

The law also increases the ability of state agencies to share data on opioid abuse, as well as allows patients to insert a form in their medical records refusing to be prescribed opioids.

Most pharmacies appear ready, but it’s going to be a change for the majority of prescribers in the state. According to Surescripts’ EPCS State Readiness page2, 96.7% of pharmacies are enabled for e-Prescribing of controlled substances in Connecticut, but only 5% of prescribers are currently enabled. Surescripts National Progress Report also showed that in 2016 only 6% of controlled substances were prescribed electronically in Connecticut.

Connecticut is the fourth state to enact a mandate requiring electronic prescriptions for controlled substances (EPCS). Minnesota, New York, and Maine were the first three states to pass similar laws. Several other states are considering similar legislation as well.

We are pleased that many states have seen the benefits of EPCS and are taking action to combat the ever growing opioid crisis in our nation with this important tool. Find out more about EPCS and start e-Prescribing controlled substances today.

 

   1.  Public Act No. 17-131: An Act Preventing Prescription Opioid Diversion and Abuse. https://www.cga.ct.gov/2017/ACT/pa/2017PA-00131-R00HB-07052-PA.htm

   2.  Surescripts State Readiness and Local Search Tool http://surescripts.com/products-and-services/e-prescribing-of-controlled-substances

   3. Surescripts National Progress Report 2016 http://surescripts.com/news-center/national-progress-report-2016/#/EPCS-readiness-by-state

Maine e-Prescribing Deadline Fast Approaching

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Prescribers in Maine have less than 3 weeks until the mandate requiring all opioid prescriptions be sent electronically goes into effect. As of July 1st, 2017, licensed practitioners in Maine may no longer write paper prescriptions for opioid medications according to Public Law Chapter 4881.

As we wrote about earlier, the mandate was put in place in an effort to combat opiate abuse and heroin addiction. E-Prescribing prevents forged prescriptions, eliminates errors from illegible handwriting and misunderstood oral prescriptions, and helps prevent overprescribing of pain medications. It’s hoped that by limiting the pain pills, it will prevent people from even trying heroin to begin with.  

The Office of Substance Abuse and Mental Health Services in Maine produced a document “Electronic Prescribing in Maine: A Guide to Understanding E-Prescribing and its Benefits2,” which addresses some frequently asked questions about the mandate.  Among the FAQs, it’s stated that an electronic prescription will be required for any amount of opioid medication being prescribed, even those for fewer than 7 days. Sending a prescription via facsimile will also not meet the requirements. Opioid prescriptions must be sent electronically using software that meets all of the federal security requirements and has been approved by the DEA for EPCS.

The DEA requirements for EPCS include:

  • Using certified software that has gone through a 3rd Party Audit – software systems must show that they meet the DEA requirements for signing, transmitting, and processing controlled substances prescriptions
  • Identity proofing – all prescribers must prove they are who they say they are and have the proper credentials to prescribe controlled substances
  • 2-Factor Authentication – prescribers must use 2-factor authentication to sign controlled substance prescriptions electronically. This involves using 2 of the following: something you know (a password), something you have (most commonly a software or hardware token), or something you are (biometric information).

While the requirements can make it seem overwhelming, MDToolbox has simplified the process. Signing up for MDToolbox-Rx e-Prescribing with EPCS is a simple process with only a few steps that can be completed within minutes. Once signed up, utilizing the software is just as easy with an intuitive workflow.

Although it’s quick and easy to get started with MDToolbox, we do not recommend waiting any longer. If you prescribe opioids in Maine and still need e-Prescribing software to meet the mandate, contact us today at info@mdtoolbox.com or 206-331-4420! We are ready to answer any questions you have and help make your transition to EPCS as smooth as possible.

 

1.  https://legislature.maine.gov/legis/bills/bills_127th/chapters/PUBLIC488.asp

2. Electronic Prescribing in Maine, A Guide to Understanding E-Prescribing and its Benefits. http://www.maine.gov/dhhs/samhs/osa/data/pmp/Electronic-Prescribing.pdf