MAY 2023 STATUS UPDATE:    On May 9, 2023 the DEA has announced a temporary extension of the Public Health Emergency ruling that allowed electronic prescribing of controlled substances via telemedicine encounters.  The flexibilities allowed during the COVID-19 pandemic were set to expire on May 11, 2023.   With this new extension, telemedicine healthcare providers can continue to see their patients and prescribe medications without first needing an in person encounter for most medications. The extension has been set for 6 additional months while the DEA reviews feedback they received on their February proposed ruling for new regulations with telemedicine prescribing post-pandemic.

For more information see the DEA press release at:

https://www.dea.gov/press-releases/2023/05/09/dea-samhsa-extend-covid-19-telemedicine-flexibilities-prescribing

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ORIGINAL POST April 2023:

On April 11, the Biden Administration signed a bill ending the pandemic emergency. After three years, the federal public health emergency (PHE) will expire May 11, 2023.

Three years ago when the emergency was declared, several rules that affected healthcare were changed.  One of the biggest ones in e-prescribing was the Ryan Haight Act which stated Controlled Substances could not be prescribed via telemedicine.  With the new PHE emergency declared, this rule was temporarily paused, controlled substances could now be prescribed via telemedicine without an in person encounter prior to.

The Drug Enforcement Administration (DEA) has proposed a new ruling (Ryan Haight Act Amendment) which would allow limited controlled substance prescribing via telemedicine only visits but it is only proposed – it has not passed yet.  If this ruling does not pass, on May 11, 2023 telemedicine only encounters/visits no longer can prescribe controlled substances again. If it does pass then it is likely a limited set of controlled substances will be able to be prescribed via telemedicine.

Details on the Proposed Ruling:

In late February, the DEA announced a set of proposed rules that would both include and roll back some of the flexibilities allowed during the pandemic for the prescribing of controlled substances via telemedicine. Prior to the PHE, in most cases prescribing of controlled substances via telemedicine was not allowed. A prior in person visit was required for schedule 2-5 prescribing.

The proposed new rule which is currently being voted on would restrict Schedule 2 drugs via telemedicine again.    However, for many Schedule 3-5 drugs, patients would be able to receive an initial 30-day prescription via telehealth. But after the initial fill, patients will need an in-person visit to get a refill.  The proposed rule was open for comments during March and many medical associations and providers have commented they think it should be longer than 30 days, some even saying 6 months or a years worth before needing an in person visit.  The main push is because of Schedule 3-5 drugs that treat controlled substance addiction.  Many believe giving patients easier access to medicines that treat substance abuse is helping fight the addiction problem in the U.S.

The proposed ruling also contain several other new rules including the requirements for “record keeping” (prescribers would need to be able to produce a list of all patients and medications prescribed via telemedicine on demand if requested by DEA investigation) as well as all prescriptions prescribed by telemedicine would need to include a note that the prescription was prescribed by a telemedicine encounter.

MDToolbox already has the ability to produce reports as well as the ability to include the required note (pharmacy note field) as well as other small enhancements are being considered as we await the final ruling.   Another update will be published after the DEA final ruling announcement.   To start e-prescribing via telemedicine contact us today to get your free 30 day no-obligation trial.    https://mdtoolbox.com/eprescribing-free-trial.aspx

Illinois Governor JB Pritzker has recently signed the State’s electronic prescribing mandate into law. Illinois House Bill 3596 mandates healthcare providers to electronically prescribe all controlled substance medications with an effective date of January 1^st, 2023.

The Illinois mandate contains the most concise language seen from any state mandate thus far, totaling just over 200 words. The mandate allows for providers who prescribe less than 25 prescriptions in a calendar year an exception for complying with the law. Currently, there are no penalties for non-compliance listed in Illinois.  The Act states that violations shall not be grounds for disciplinary actions.  The bill states that the Department of Financial and Professional Regulation will establish rules and requirements around implementing further exemptions.

Illinois Figures & Statistics

Illinois is currently above the national average for opioid-related overdose deaths, with roughly 17 deaths per 100,000 people when comparing the population of the State in 2018 to the number of overdoses provided. Prescription opioid overdose deaths continued to gradually rise until rising more sharply in 2015, then began to fall after 2017.[1] Illinois has passed legislation attempting to tackle their Opioid dependence issues.  Laws passed in 2010 and 2015 made Opioid Reversal drugs progressively easier to obtain and increased training initiatives involving law enforcement, schools and emergency responders.  In 2017 the State allocated federal funds for education and addiction treatment throughout the state including establishing an Opioid Crisis hot-line that is accessible 24 hours per day.  Illinois currently requires prescribers to consult the State PMP database when prescribing.

Illinois has a 50.4% prescriber enablement for electronic prescribing of controlled substances, well below the national average of 67.1%. Pharmacy enablement in Illinois for EPCS is 96.6%, just above the national average of 96.1%[2] MDToolbox encourages providers not to wait until the last minute to setup electronic prescribing.

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 Illinois 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/drug-topics/opioids/opioid-summaries-by-state/illinois-opioid-involved-deaths-related-harms

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

The State of Missouri has passed legislation establishing their State PMP (prescription drug monitoring program) to track controlled substances that have been prescribed to patients throughout the State in an effort to curb Opioid overdoses.  Missouri is the final state in the US to establish a PMP.  St. Louis County, along with 75 additional Jurisdictions had previously established its own PMP which now covers 85% of the State population but is not sanctioned by the State.  This County-run PMP also recently signed an agreement to share data with 18 other States.[1]  The St. Louis County PMP will now likely be absorbed into the State program once it becomes active.

Legislation to establish a State-wide PMP had been presented annually since 2005, but stalled or was dismissed at various stages of the legislative processes.  Senator Holly Rehder has filed Missouri’s PMP legislation for nine consecutive years.[2]

Missouri Senate Bill 63 is the 2021 legislation that has become law establishing the PMP.  The Act was signed into law by Missouri Governor Mike Parson on June 8^th, 2021.  Governor Parson said. “SB 63 will help provide necessary information to health care professionals and empower them to make decisions that better serve their patients and assist in fighting the opioid epidemic in Missouri.” The Act establishes the Joint Oversight Task Force for Prescription Drug Monitoring which will supervise and regulate the collection and use of patient dispensation information.  The task force is to contractually enter an agreement with a vendor to operate the program.  The St. Louis County PMP currently utilizes Appriss Health as their vendor.  The Task Force will also enforce fines that the legislation establishes for dispensers that fail to report controlled substance dispensings.

The legislation goes on to set specifications for data that must be included in the PMP entries by dispensers within 24 hours of dispensing the medication.  Beginning January 1^st, 2023, the State is expected to begin phasing in real-time reporting to the PMP, with a mandate for real-time reporting required by January 1^st, 2024.

MDToolbox makes checking most State PMP databases convenient with our PMP Integration. This allows prescribers to pull a patient specific PMP report directly from the prescription writer, drastically reducing the steps required to check the database.  Prescribers save time by not having to navigate to another website, login, search for a patient and pull up the report. See our recent blog post on the benefits of integrating your State’s PMP.

While some studies have not found a clinically significant reduction in Opioid prescribing rates due directly to PMP usage, certain specific PMP features have been shown to reduce Opioid related Emergency Department visits.  According to a study produced by the Healthcare Cost and Utilization Project[3], States that have implemented mandatory PMP usage have shown a 6% reduction in the growth of ED visits for Opioid overdoses over States that did not require PMP usage.  Studies such as this demonstrate that with proper utilization, PMPs can be a powerful tool for reducing Opioid Overdoses.

MDToolbox applauds the State of Missouri for passing legislation to create their PMP and join the rest of the country in further attempting to remedy the Opioid Crisis.  We continually encouraging providers to take full advantage of the time and stress saving technologies we provide including Electronic Prescribing of Controlled Substances (EPCS), Electronic Prior Authorization (e-PA) and Real-time Price Transparency as they are important tools to use in fighting the devastating opioid epidemic and making electronic prescribing as convenient as possible for prescribers. Contact us for more information on about electronic prescribing and setting up a PMP Integration.

[1] https://pdmp-stlcogis.hub.arcgis.com/

[2] https://themissouritimes.com/missouri-legislature-gives-final-approval-to-statewide-pdmp-bill/

[3] https://hcup-us.ahrq.gov/reports/PDMPsAndOpioidHospitalizations.pdf

Nebraska Governor Pete Ricketts and New Hampshire Governor Chris Sununu have both recently signed their State’s electronic prescribing mandates into law. Nebraska Legislature Bill 583 mandates healthcare providers to electronically prescribe all controlled substance medications with an effective date of January 1^st, 2022. New Hampshire House Bill 143 also mandates providers to electronically prescribe all controlled substances with an effective date of January 1^st, 2022.

The Nebraska mandate allows for exceptions to the law including situations that involve State emergencies and patients that reside in long-term care facilities for instance.  The Act also states that dentists will also need to comply with the mandate but not until January 1^st, 2024.  Currently, there are no penalties for non-compliance listed in Nebraska.  The Act states that violations shall not be grounds for disciplinary actions.  The bill goes into extensive detail regarding pharmacy and dispenser requirements including allowing partial filling of certain schedules of medications.

The New Hampshire mandate is somewhat standard in comparison to legislation that other States have enacted.  The mandate contains the usual exemptions such as technological failure, circumstances where the provider dispenses the medication in-office, and for compounded medications.  The mandate also establishes a one-year waiver system for providers but does not contain specific details.  HB143 also changes regulations regarding licensing requirements for Social Workers and Mental Healthcare providers.

Nebraska Figures and Statistics

Nebraska is very limiting in the data they provide for State overdose statistics.  It appears they are currently below the national average for opioid-related overdose deaths, with roughly 7 deaths per 100,000 people when comparing the population of the State in 2018 to the number of overdoses provided. The national average is 14.6 deaths. Prescription opioid overdose deaths continued to gradually rise until 2013, then remained stable until another spike in 2017.  Rates of deaths involving opioids appears to have been similar since 2009.[1]  Nebraska passed legislation in 2018 attempting to tackle their opioid dependence issues.  LB931 established guidelines for prescribing both opioids, limiting prescription durations for minors and requiring patient education. LB731 requires prescribers to complete continuing education regarding prescribing opioids.  Nebraska does not currently require prescribers to consult the State PMP database.

Nebraska currently has a 67% prescriber enablement for electronic prescribing of controlled substances, right at the national average of 67.1%. Pharmacy enablement in Nebraska for EPCS is 98.0%, above the national average of 96.1%.[2]

New Hampshire Figures and Statistics

New Hampshire currently has the third worst opioid-overdose rate in the country with 33.1 deaths per 100,000 people.  Again, the national average is just 14.6 deaths per 100,000 people. Prescription opioid overdose deaths gradually rose until 2014, then began a gradual decline until returning to rates not seen since 2001.  Synthetic opioid use however, skyrocketed at the end of 2013.[3]  The New Hampshire Controlled Drug Act became effective in 2009 and set a limit on Schedule II and Schedule III controlled substances that can be prescribed.  HB1423 was passed in 2016 and required State medical boards to submit guidelines for prescribing controlled substances.  In 2015, New Hampshire launched the “Anyone, Anytime” campaign which greatly increased public access for Naloxone.[4]  New Hampshire currently requires prescribers to consult the State PMP database.

New Hampshire currently has a 61.8% prescriber enablement for electronic prescribing of controlled substances, below the national average of 67.1%. Pharmacy enablement in New Hampshire for EPCS is 98.8%, above the national average of 96.1%.[2] MDToolbox encourages providers not to wait until the last minute to setup electronic prescribing!

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 Nebraska and New Hampshire 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/drug-topics/opioids/opioid-summaries-by-state/nebraska-opioid-involved-deaths-related-harms

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

[3]https://www.drugabuse.gov/drug-topics/opioids/opioid-summaries-by-state/new-hampshire-opioid-involved-deaths-related-harms

[4]https://oig.hhs.gov/oas/reports/region1/11801501_Factsheet.pdf

Surescripts has released their 2020 National Progress Report which details the current state of electronic prescribing in the United States. Surescripts is a health information network hub that digitally connects healthcare providers to pharmacies and PBMs/insurance companies. Surescripts is privately owned by the National Association of Chain Drug Stores (NACDS), National Community Pharmacists Association (NCPA), CVS Health and Express Scripts.

The report began by sharing some harsh statistics for how 2020 affected some practices.  During the first peak of the pandemic, ambulatory care visits dropped by 60%.  By the end of the year, 8% of US practices had permanently closed.  As we saw with a few clients, the pandemic helped push some providers into retirement.  The graph below shows how the pandemic has influenced the number of active prescribers per month, a drop in active providers in April with the first wave of COVID-19 and then a steady rise through the end of the year.  The number of active electronic prescribers broken 1 million for the first time in part due to the rise in popularity (and necessity) of telemedicine and the need to have prescriptions sent electronically.

 Active Prescribers by Month – Surescripts 2020 National Progress Report

Surescripts processed 1.91 BILLION prescriptions in 2020, here are some selections of statistics from the report:

Rate of e-Prescribing – Surescripts 2020 National Progress Report

Rate of e-prescribing – Surescripts 2020 National Progress Report

Non-controlled substance e-prescribing rates rose three percent, while EPCS rose a remarkable 20% in 2020!  This number likely rose dramatically not only due to the pandemic, but also the seven states that mandated electronic prescribing in 2020.  As states continue to mandate e-prescribing of controlled substances, this number will continually rise.  Currently, 37 states have enacted or pended legislation for electronic prescribing mandates.

E-Prescribing Utilization Among Prescibers – Surescripts 2020 National Progress Report

Prescriber utilization of e-prescribing has steadily risen every year, hitting 84% in 2020.  Nearly all pharmacies in the US are utilizing e-prescribing. Our EPCS page has a table displaying pharmacies enabled for EPCS in every state. While the numbers of pharmacies slightly trend down; likely from smaller pharmacies closing, the percentage of those enabled for EPCS continue to rise.

Rate of e-prescribing by State – Surescripts 2020 National Progress Report

The above graph compares EPCS enablement throughout the 2020 calendar year in some States with current mandates (NY, VA, MN, NC), some states with mandates that are pending (CO, CA, MD), and a few states with no current mandate (HI, OH, NE, OR).  Nebraska, Ohio, and Oregon (which do not have a current mandate) surpassed several states with pending and current mandates.  Prior to 2020, Hawaii was the state with the lowest prescriber EPCS enablement. Their massive jump at the end of 2020 from 7.6% to 36.2%, surpassing Alabama which is currently the state with the lowest prescriber enablement.  Surescripts attributed this sudden rise with the fact that several major health networks in Hawaii switched to electronic prescribing.

Check out our State map page for a look at the current status of electronic prescribing mandates for the entire country. Bookmarking our blog is another great way to keep up with these changes in legislation.

Rate of RTPB – Surescripts 2020 National Progress Report

The report also details an increase in the number of real-time prescription benefit checks. Real-time prescription benefit allows prescribers to check the patient cost for medications at the patient’s pharmacy in real-time, saving patients an average of $50 for a standard family practice visit. This advanced feature has been included with MDToolbox since 2018.

The increase in usage of Electronic Prescribing throughout the US means better protections for both prescribers and patients. For a prescriber it means there is less chance of fraud and abuse through prescribing, for a patient it means greater convenience by not having to keep track of paper prescriptions, better security for their personal information, and seeing a prescriber that can save them money on prescription drugs. We look forward to working with providers throughout the US 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://surescripts.com/news-center/national-progress-report-2020

Most prescribers and dispensers use a prescription drug monitoring program (PMP, also referred to as PDMP) each time they write or dispense a prescription as part of the industry’s efforts to stem the opioid crisis.  PMPs are electronic databases utilized in almost every state in the US, outside of Missouri. Each time a patient picks up a controlled substance prescription, pharmacies across the state log the prescription into the State database. Providers then refer to the database before prescribing to ensure other providers have not already recently prescribed similar medications for that specific patient. Effectively, PMPs help prescribers and dispensers keep track of patients at high risk of becoming opioid-dependent as well as assist in tracking patients that utilize potentially fraudulent or inappropriate prescriptions.

From 1999 to 2018, almost one quarter of a million Americans lost their lives due to prescription Opioid overdoses.[1] In recent years, the annual number of prescription opioid overdoses have begun to fall, but initial findings from State agencies over the past year show some of the largest increases of overdose deaths in history. This sudden increase appears to be in part due to the changes in healthcare and clinic shut-downs stemming from COVID-19.

Utilization of state PMPs is mandatory in most of the country. By law, a prescriber is required to login to the State’s database and do a check prior to writing a new controlled substance. See our State PMP Map for detailed information on which States require the State PMP be checked prior to prescribing controlled substances.

Empirical Data

A recently published study entitled “Association of Electronic Prescribing of Controlled Substances With Opioid Prescribing Rates”[2] detailed findings related to the electronic prescribing of controlled substances (EPCS) and mandatory PMP utilization and how it affects the rate of prescribing opioids.  The study states:

“…the interaction between EPCS use and mandatory PDMP checking was not statistically significant, such that in both states with and without mandatory PDMP checking, greater EPCS use was associated with a greater number of opioid prescriptions per 100 persons. Specifically, a 10 percentage point increase in EPCS use was associated with 2.4 more prescriptions per 100 persons in States without PDMP checking and 2.0 more prescriptions per 100 persons in States with PDMP checking. In the model predicting MME per 100 persons, the interaction between EPCS use and mandatory PDMP checking was statistically significant such that a 10 percentage point increase in EPCS use was associated with 4.4 more MME per 100 persons in States without mandatory PDMP checking and was not associated with greater MME in States with mandatory PDMP checking.”

While the study found a minor reduction in the number of prescriptions written in States with a PMP mandate, it was deemed not statistically significant. The study did find a statistically significant correlation between States requiring PMP checks and a reduction in the morphine milligram equivalent (MME) per person being reduced.  Essentially, patients were found to be prescribed less opioids in States that required providers to check the State PMP database.

MDToolbox makes checking most State PMP databases convenient with our PMP Integration. This allows prescribers to pull a patient specific PMP report directly from the prescription writer, drastically reducing the steps required to check the database.  Prescribers save time by not having to navigate to another website, login, search for a patient and pull up the report. According to informal feedback received from MDToolbox prescribers and their staff, burnout rate has been greatly reduced and efficiency has had a substantial increase for providers that have integrated their State PMP directly into their system versus providers who had not integrated the PMP and were required to access the State database separately.

The PMP-map page on our website details which States currently have active integrations and which States require PMP queries by prescribers.  Currently, half the State PMPs in the US have an active integration with us at no additional charge!  There are an additional 12 States that are not currently State-funded, so require an additional fee paid to the intermediary servicing the State databases. We are expecting more States to become active with their PMP integrations in the coming years, our map page will be updated as additional States approve the integration.

MDToolbox is continually encouraging providers to take full advantage of the time and stress saving technologies we provide including Electronic Prescribing of Controlled Substances (EPCS), Electronic Prior Authorization (e-PA) and Real-time Price Transparency as they are important tools to use in fighting the devastating opioid epidemic and making electronic prescribing as convenient as possible for prescribers. Putting federal mandates such as these in place is an important step toward fully utilizing the available technology to save lives.  Contact us for more information on setting up a PMP Integration.

[1] https://www.cdc.gov/drugoverdose/data/prescribing/overview.html

[2] https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774352

2021 will see a record number of states mandating electronic prescribing.  Although there was anticipation some states would postpone their mandate due to the public health crisis created by COVID-19, all States with enacted legislation for 2021 will still require electronic prescribing in 2021.  Washington State was the sole state to delay their mandate, which was delayed only a few months from 01/01/2021 to 09/30/2021.  This delay was announced in June of 2020.

States with mandates that took effect on January 1^st, 2021 include:

• kansas
• Delaware
• Indiana
• Kentucky
• Massachusetts
• Missouri
• Nevada
• South Carolina
• Tennessee
• Texas
• Wyoming

States with mandates that take effect later this year include:

• Colorado (07/01/2021)
• Kansas (07/01/2021)
• Michigan (10/01/2021)
• Washington (09/30/2021

At the time of this blog’s publication, 30 of the 50 states have an active or future (passed but not active) mandate! 

The majority of state legislation for mandates introduced last year shared language in their bills, there were very few unique sections to the bills that have been seen in past legislation.  Politicians seem to be standardizing legislation that has successfully passed in other states instead of writing unique mandates for their own state.  2020 presented unique circumstances that have and continue to disrupt many aspects of our lives. The year began as normal for the legislative season with several states introducing legislation mandating electronic prescribing including:

• Kansas
• Maryland
• Michigan
• Mississippi
• Nebraska
• New Hampshire
• New Jersey
• Utah
• West Virginia

COVID-19 slowed nearly all state’s legislative progress in fighting the other public health crisis plaguing the US; the opioid epidemic, but MDToolbox applauds the States that continued with their planned legislation. Ultimately, 2020 saw only three states successfully pass their mandates during the interrupted legislative terms.  These states include:

• Maryland is requiring all controlled substance prescriptions to be electronically prescribed by January 1^st, 2022.  Maryland’s mandate specifies establishing a waiver not to exceed one year.
• Utah is also requiring all controlled substance prescriptions to be electronically prescribed by January 1^st, 2022.  Utah’s mandate details a two-year waiver as well as specific criminal charges and monetary fines for failure to comply with the eRx mandate.
• Michigan is requiring all prescriptions to be electronically prescribed by October 1^st 2021.  This is the shortest deadline for an electronic prescribing mandate that has been passed.  Michigan prescribers will not have long to learn about electronic prescribing and implement systems.  Fortunately, MDToolbox can get the majority or prescribers electronically sending prescriptions within 24 hours.  Michigan’s mandate makes mention of a waiver system but specifics have not yet been established.

The final state with a future mandate not yet mentioned in this blog is California, which will require electronic prescribing of all prescriptions by January 1, 2022.  Nebraska, New Hampshire and New Jersey have pending legislation for a mandate.

The CMS Federal Mandate

CMS has also begun requiring all Part D Medicare prescribers to begin sending electronic prescriptions for controlled substances as of 01/01/2021.  In a statement from CMS made on December 4^th, 2020, this requirement will not be enforced until January 1^st, 2022.  The agency is delaying enforcement of their EPCS mandate while it develops rules for the waiver system and enforcement process which were required by the passed legislation.  Please see our blog discussing the CMS EPCS requirements to make sure you remain compliant with the law!

If you reside in any of the states that have enacted mandates this year or prescribe controlled substances for Medicare patients, 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!

In just four months from now, starting in January 2021, CMS will require electronically prescribing controlled substances (EPCS) for Medicare Part D prescribers.

The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, HR6 - Public Law 115-271, was signed into law on October 24th, 2018. The Act’s primary purpose is to combat the growing opioid epidemic by:

• Teaching addiction medicine by increasing and strengthening the workforce
• Standardizing the delivery of addiction medicine and care
• Covering addiction medicine in a way that facilities the delivery of treatment

One of the more than 60 policies included is the Every Prescription Conveyed Securely Act. This Act will require prescribers to electronically prescribe controlled substances for Schedule II-V drugs covered under a Medicare Part D or Medicare Advantage prescription drug plan. While many states have enacted their own laws requiring e-Prescribing, this is the first federal mandate for EPCS.

According to Surescripts, 55.2% of prescribers in the US are currently enabled for EPCS.  This number is up drastically from only 32% in 2018 when the SUPPORT Act was signed.  The increase is likely due to state-level mandates, as well as the rise of telemedicine usage during the Covid-19 pandemic.

Additional relevant requirements set in place by the SUPPORT Act and CMS rulings that begin in 2021 include:

• Electronic prior authorizations will be required for all Medicare Part D covered drugs requiring a prior authorization. Electronic prescription programs will be required to securely transmit the requests and Part D sponsors and processors must respond electronically using a defined standard. A facsimile, proprietary payer portal, or an electronic form that does not meet the standards will not be counted as an electronic submission.
• Provisions to enhance states’ Prescription Drug Monitoring Programs (PDMPs). The goal is to ensure each state has a PDMP, improve their functionality, make sure all prescribers are utilizing the systems, and foster data sharing between states. Beginning October 1, 2021 states must require health care providers to check their PDMP for a Medicaid enrollee's prescription drug history before prescribing controlled substances to the enrollee.
• On May 23, 2019, CMS published a final rule (CMS-4180-F) requiring that Part D plans adopt one or more real time benefit tools (RTBTs) capable of giving prescribers clinically appropriate patient-specific real-time formulary and benefit information. This mandate is also effective January 1, 2021.

CMS is currently seeking public comments regarding the EPCS requirement. CMS is requesting input as to whether there should be exceptions provided and if so, what circumstances would qualify prescribers for an EPCS exception. CMS also wants feedback on whether penalties should be imposed for noncompliance with the EPCS mandate and if so, what the penalties should be. Comments can be made until October 5^th, 2020.  These rules and exceptions are expected to be provided before the 2021 deadline.

MDToolbox applauds this bipartisan legislation. We are continually encouraging providers to take advantage of the technologies we provide including Electronic Prescribing of Controlled Substances (EPCS), Electronic Prior Authorization (e-PA) and Real-time Price Transparency as they are important tools to use in fighting the devastating opioid epidemic and making electronic prescribing as convenient as possible for prescribers. Putting these federal mandates in place is an important step towards fully utilizing the available technology to save lives. 

The world has seen remarkable changes this year, the methods we receive healthcare being a significant part of that change. COVID-19 has hurried the adoption of telemedicine into mainstream usage during the declared public health emergency (PHE). Legislation has now been presented to keep telemedicine as part of standard healthcare and make its usage more convenient for both providers and their patients.

President Trump’s Executive Order on Improving Rural Health and Telehealth Access

President Trump signed executive orders on August 3^rd to promote the expansion of telehealth services. The Center for Medicare & Medicaid Services (CMS) outlined 135 services that are allowable via telehealth during the PHE, Trump’s executive order outlines that the services become permanently available via telehealth. The executive order also offers financial incentives for rural hospitals to continue seeing patients with a high-quality of care and directs the federal government to improve the healthcare communication infrastructure in rural areas.

“Telemedicine can never fully replace in-person care, but it can complement and enhance in-person care by furnishing one more powerful clinical tool to increase access and choices for America’s seniors,” said CMS Administrator Seema Verma. “The Trump Administration’s unprecedented expansion of telemedicine during the pandemic represents a revolution in healthcare delivery, one to which the healthcare system has adapted quickly and effectively. [1]

CMS Proposes Permanent Expansion of Telehealth

Consistent with Trump’s executive order, CMS proposed that many telehealth service payments should be expanded to be permanently covered past the PHE. A major hurdle hindering providers from adopting telemedicine as part of their practice is the disparity in the CMS reimbursement payment structure for in-person versus telehealth visits. During the PHE, CMS allowed parity in the payment structure for in-person and telehealth visits, making telehealth even more attractive for providers to participate. According to CMS, before the PHE, only 14,000 beneficiaries received a Medicare telehealth service in a week while in the last week of April, nearly 1.7 million beneficiaries received telehealth services.

Source: CMS Health Affairs Blog. Internal CMS analysis of Medicare FFS claims data, March 17, 2020 through June 13, 2020(using data processed through June, 19, 2020) Notes: Telemedicine is defined to include services on the Medicare telehealth list including audio-only visits, as well as virtual check-ins and e-visits. https://www.healthaffairs.org/do/10.1377/hblog20200715.454789/full/

Many medical providers and associations have requested that the parity remain to allow telehealth to continue growing due to the better hold on financial security. CMS is asking for input from stakeholders regarding what services should bee added to the Medicare telehealth list and the public comment period for the proposed rule is open until October 5, 2020.

Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act

Another barrier that providers are facing is the lack of inter-state licensing ability to be able to practice telemedicine for patients residing in other states. Senators Chris Murphy and Roy Blunt have presented the Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act which would grant providers the ability to treat patients in any state during and immediately following the PHE. The Act also establishes that the reciprocity can be reactivated should another PHE happen in the future, again reducing inter-state complications. Some states have reduced the requirements for providers to get a license, and some states have granted temporary licenses. Mandating nation-wide reciprocity could be invaluable to patient health during a worsening or future PHE.

DEA Telehealth Policies

EPCS

The Ryan Haight Act of 2008 established regulations and prohibited healthcare providers from prescribing controlled substances to patients that they haven’t first examined in-person. Section 802(54)(D) of the Controlled Substances Act allows for the Ryan Haight Act to be circumvented during a public health emergency which the DEA invoked on March 16, 2020. This currently allows MDToolbox users to electronically prescribe controlled substances (EPCS) for patients via telemedicine. Patients must be evaluated using a real-time, two-way, audio-visual communications device.

The DEA has missed several deadlines to establish rules and a waiver system to allow electronic prescribing of controlled substances via telemedicine when there is not a PHE. Reducing these road-blocks, as we are seeing with the emergency measures in place due to COVID-19 can help bring healthcare into the 21^st century and help reduce stress on our medical system and patients.

DEA State Registration

The DEA has also waived the requirement for state-specific registrations during the PHE. The exception to separate registration requirements across state lines was issued March 25, 2020 and allows prescribers who are registered in at least one state to prescribe controlled substances to patients in other states via telemedicine.

Opioid Use Disorders

The DEA, in partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA), also stated that it is allowing authorized providers to prescribe buprenorphine to new and existing patients with Opioid Use Disorder (OUD) via only telephone voice calls without first requiring an examination of the patient in person or via telemedicine. This exception is only during the PHE and prescribing practitioners must be DATA-waived.

Telehealth Response for E-prescribing Addiction Therapy Services (TREATS) Act

Not to be confused with the earlier mentioned TREAT act, the Telehealth Response for E-prescribing Addiction Therapy Services (TREATS) Act was introduced by Senators Rob Portman (R-OH) and Sheldon Whitehouse (D-RI) and looks to make some of the telehealth substance use disorder (SUD) treatment changes permanent.

The bill adds to and replaces language in the current Telehealth for Substance Use Disorder Treatment codes. The changes would allow a Schedule III or IV medication to be prescribed for the purpose of treatment for an Opioid Use Disorder via “1 in-person medical evaluation or 1 telehealth evaluation”.  The bill then clarifies that the “1 telehealth evaluation” shall not be construed to imply that a single telehealth evaluation demonstrates the usual course of professional practice. The medical provider will need to continue follow-up and management of the patient and medication after the initial in-person or telehealth visit per current guidelines.

Continue to follow our blog and social media for information related to telehealth and electronic prescribing. MDToolbox looks forward to providing tools and resources to assist telemedicine providers throughout the United States to ease the transition, helping our customers increase the efficiency of their office and combat the opioid epidemic. With MDToolbox, prescribers have access to tools such as Electronic Prescribing of Controlled Substances (EPCS), the ability to check most State’s PMPs without having to separately login to their State portal, 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.cms.gov/newsroom/press-releases/trump-administration-proposes-expand-telehealth-benefits-permanently-medicare-beneficiaries-beyond

2020 has seen massive growth for telemedicine due to the pandemic. Many much-needed policy changes have been put in place in response, including allowing prescribers to prescribe both non-controlled and controlled medications to patients without first seeing them in person during the public health emergency. The CDC has also issued guidelines recommending telehealth to expand access to essential health services during and beyond the COVID-19 pandemic. Stay tuned as we will dive further into the policies and other proposed changes next week. In this post, we focus on the many benefits of e-prescribing in telemedicine.

The increase in patient access to healthcare via telemedicine is a powerful tool, one that appears to be highly desired by patients. A recent report presented by the Department of Health and Human Services detailed that 43.5% of Medicare fee-for-service primary care visits were conducted via Telemedicine in April of this year, up from just .1% of visits in February before the public health crisis had been declared.

Electronic prescribing has many advantages for prescribers practicing telemedicine and telehealth. Sending prescriptions electronically can drastically improve a prescriber’s workflow by being able to transmit prescriptions to the pharmacy quickly and efficiently, avoiding the traditional stresses of mailing a paper prescription, making phone calls, or dealing with pages of faxes so that remote patients can receive their medications.

Here are five ways MDToolbox offers one of the best e-Prescribing software services to save telemedicine practices time & money:

1. Electronic prescribing will improve the safety and quality of care that providers can provide patients.

E-prescribing can reduce drug errors by eliminating handwriting and illegibility issues with prescriptions, sending the prescription digitally ensures the order is clear.  Some electronic prescribing systems (such as MDToolbox) allow for pulling medication fill history for patients automatically, so even if the patient cannot recall their medications, the prescriber will have quick access to a record of it. MDToolbox can improve patient safety by alerting for any drug to drug interactions, drug allergy interactions, drug to condition interactions, and duplicate therapy conditions. These alerts could save a patient’s life.

2. With MDToolbox, patient medication history can be checked in as little as one click.

The opioid epidemic plaguing our country has resulted in many states mandating checking the state specific Prescription Drug Monitoring Programs (PMPs) prior to prescribing certain controlled substance medications. MDToolbox allows prescribers in most states to be able to check this data directly within the prescription writer, saving prescribers time so they can move on to their next virtual visit quickly and efficiently.

3. Satisfy Medicare MIPS requirements by meeting Meaning Full use.

MDToolbox is certified to meet Meaningful Use requirements necessary for the Merit Based Incentive Payment System (MIPS).  By using MDToolbox, prescribers are able to increase their scores and maximize their payment adjustments received by Medicare.  Please see our Meaningful Use Certification page for specifics on certifications.

4. Electronic prescribing saves patient’s money and increases patient satisfaction.

MDToolbox allows for viewing the price of the specific medication the provider is prescribing at their patient’s specific pharmacy as they are writing the prescription. The system will present potential alternatives that may save the patient money by making a brand or pharmacy change. This could also save the practice valuable time avoiding a patient calling back to change pharmacies if they find the price too high where the medication was prescribed.

5. Meet State and National mandates to electronically prescribe.

States are continuing to pass legislation requiring all prescribers to send electronic prescriptions. Arkansas, Colorado, Delaware, Indiana, Kansas, Kentucky, Massachusetts, Missouri, Nevada, South Carolina, Tennessee, Texas, Washington, and Wyoming have mandates going into effect in 2021. See our State Map for information on current and pending legislation. Some States detail extensive penalties for not complying with their electronic prescribing legislation. In addition, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act will require EPCS at the national level starting in January 2021.

MDToolbox looks forward to providing tools and resources to assist telemedicine providers throughout the United States to ease the transition, helping our customers increase the efficiency of their office and combat the opioid epidemic. With MDToolbox, prescribers have access to tools such as Electronic Prescribing of Controlled Substances (EPCS), the ability to check most State’s PMPs without having to separately login to their State portal, 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!