Prescribers in Maine have less than 3 weeks until the mandate requiring all opioid prescriptions be sent electronically goes into effect. As of July 1^st, 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 3^rd 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

Primary nonadherence occurs when prescriptions written by a physician are never filled by the patient and is a common problem. A study published by JAMA Dermatology¹ shows that the use of electronic prescribing increases the likelihood of patients picking up their prescriptions.

The study looked at 4,318 prescriptions written for 2,496 patients. Of these, 803 patients received electronic prescriptions and 1,693 received written paper prescriptions. Overall, the primary nonadherence rate was 31.6%. However, when comparing the electronic prescriptions to the paper prescriptions, the primary nonadherence rate was lowered by 16%. Only 15.2% of patients who received an electronic prescription did not fill it. 

“Electronic prescribing has become one of the major criteria to evaluate meaningful use of electronic health records by health care professionals,” stated the researchers. “In this study, we demonstrated that e-prescribing is associated with reduced rates of primary nonadherence. As the healthcare system transitions from paper prescriptions to directly routed e-prescriptions, it will be important to understand how that experience affects patients, particularly their likelihood of filling the prescriptions.”

Why does e-prescribing increase adherence?   A huge part of it might be because e-prescribing eliminates the need to drop off the prescription at the pharmacy and can significantly reduce wait times.   Electronic prescribing allows the Pharmacy to begin filling a prescription before the patient has even left the Doctors office.   It is a huge difference to a patient who can just “swing by” the pharmacy and pick up their prescription, versus handing a prescription to the pharmacist and waiting for them to fill it.   Another factor, may be that many Pharmacies call to remind patients to pick up prescriptions.   If the patient doesn’t show up, the Pharmacy will follow up and remind them their prescription is ready and waiting.    A paper prescription many times never gets to a pharmacist, hence no one reminds them it is waiting.

Medication non-adherence can have many negative health consequences for patients. The JAMA study is a prime example of just how important e-Prescribing is to not only help prescribers and pharmacists, but to also improve adherence in patients. 

¹ Adamson AS, Suarez EA & Gorman AR. Association Between Method of Prescribing and Primary Nonadherence to Dermatologic Medication in an Urban Hospital Population. JAMA Dermatol.  2016. doi: 10.1001/jamadermatol.2016.3491

New York State Attorney General Eric Schneiderman’s office sent a letter¹ September 20th asking Governor Andrew Cuomo to veto two bills seen as loopholes to the newly implemented Internet System for Tracking Over-Prescribing (I-STOP) laws. I-STOP mandates electronic prescribing in New York and requires prescribers to check the state Prescription Monitoring Progarm (PMP) before prescribing controlled substances.  The goal is to prevent drug abuse and drug seeking and increase patient safety. Read more about I-STOP here.

The first bill (S.6778/A.9334)² relates to nursing homes. It would provide an exception to the requirement to e-Prescribe for prescribers in nursing homes. The reasoning behind the bill is that prescribers are not in nursing homes 24 hours a day and patients need to get their medications in a timely manner. The letter requesting the veto points out that oral prescription orders are already allowed in emergency situations which should suffice any true needs and the bill would only serve to weaken I-STOP. The Deputy Attorney General, Brian Mahanna, stated in the letter that healthcare errors and drug diversion are particularly problematic in nursing homes and electronic prescribing has proven to reduce them. Not only does electronic prescribing reduce errors such as illegible handwriting and increase patient safety, it offers the ability for an on-call Long Term Care prescriber to approve and send medications even when they are away from the facility. Many software systems (including MDToolbox) have easy to use mobile apps and web versions that can be securely accessed from wherever the prescriber is.

The second bill (S.6779-B/A.9335-B)³ would provide an exception to prescribers who write paper prescriptions from having to report them to the state Department of Health. I-STOP requires all prescriptions to be sent electronically, but there are three statutory exemptions. These include a temporary electrical or technical failure, if e-Prescribing would result in a delay that would adversely impact a patient’s health, or if the prescription is to be filled out-of-state.  Currently, if a prescriber writes a paper prescription because of one of these exemptions they are required to file a report with the Department of Health. The bill removes this requirement and only calls for a notation in the patient’s record. Mahanna states in his letter this bill would “create a gaping loophole in ISTOP’s universal e-Prescribing reporting requirements.” He points out that prescribers could avoid compliance with I-STOP and “doctor shopping” patients could lie about a prescription being filled out of state.

The two bills passed the NYS legislature earlier this year and were just delivered to the Governor.

1.https://www.scribd.com/document/324826179/2016-9-20-Ltr-to-a-David-Re-ISTOP#from_embed

2.  An act to amend the public health law and the education law, in relation to exceptions to requirements for electronic prescriptions 

3. An act to amend the public health law and the education law, in relation to electronic prescriptions 

All eyes have been on New York State as their I-STOP law requiring prescriptions to be sent electronically went into effect in March. Electronic Prescribing of Controlled Substances (EPCS) and non-controlled substances is mandatory across the state. Due to this mandate, New York leads the nation with the highest percentage of e-Prescribing pharmacies and prescribers. Other states are looking to New York to see how successful their mandate is and some have started to follow suit.

Maine is following New York by requiring controlled substance prescriptions to be sent electronically by July 2017. However, Maine is not requiring non-controlled substances to be prescribed electronically. It would follow that if prescribers are sending controlled substances electronically, they will most likely prescribe non-controlled substances through the same route though. Their law is in combination with required use of their state Prescription Monitoring Program (PMP) in an effort to combat opiate abuse. Read more about it in our post Maine to Require e-Prescribing of Controlled Substances.

Minnesota was actually the first state to require electronic prescribing. However, there are no penalties for writing paper prescriptions so many prescribers still pick up their paper pad when they need to prescribe. According to Surescripts’ National Progress Report¹, in 2015 Minnesota ranked 24^th compared with other states with less than 3% of their prescribers enabled for EPCS.

Massachusetts just launched an updated version of their state PMP to the tune of $6.2 million. They updated it with the aim of making it easier and faster for prescribers to use, as the old system was said to be very difficult to navigate and severely underutilized. The system now also offers interstate operability by giving Massachusetts prescribers access to data from other states. Currently, the number of other states’ data available is limited but the system has the potential to connect with up to 45 other states. Other updates include the ability to sync with EMRs, the ability to easily assign delegates to check the system on the prescriber’s behalf, and allowing for easy reporting to compare prescribing practices with other physicians. Starting October 15^th, prescribers will be required to check the state PMP any time they prescribe a schedule II or schedule III drug, as opposed to the current requirement of only checking the first time they prescribe one of these drugs.

Now that Massachusetts has their new PMP in place, it is rumored they may be the next state to require EPCS. They ranked number 9 in Surescripts’ National Progress Report with over 90% of their pharmacies enabled for EPCS, but the percent of prescribers with EPCS capabilities was only 4%. As of last week, 63% of their prescribers who had prescribed opioids were registered with the PMP but the number is growing daily.

At MDToolbox, we are watching closely in anticipation to see which state will be the next to take this important step in combating drug fraud and abuse.

1. 2015 National Progress Report http://surescripts.com/news-center/national-progress-report-2015/

Last week the governor of Maine signed into law “An Act To Prevent Opiate Abuse by Strengthening the Controlled Substances Prescription Monitoring Program.” In addition to mandated use of the state Prescription Monitoring Program (PMP), the law will require prescribers to electronically prescribe controlled substances.

The aim of the law is to reduce opioid abuse and heroin addiction. “Heroin addiction is devastating our communities,” said Governor LePage. “For many, it all started with the overprescribing of opioid pain medications. We can prevent many people from even trying heroin in the first place by putting these limits on the flow of pain pills into our homes. I am thankful to prescribers and pharmacists who helped to craft this legislation and ultimately support it before the Legislature. They recognize that the status quo hasn’t worked and it’s time for some serious reform.”¹

The law requires prescribers to do the following: 

1. Check the state Prescription Monitoring Program prior to writing scripts for opioids or benzodiazepines
2. Abide by prescription caps - seven days for acute pain and 30 days for chronic pain by January 2017
3. E-Prescribe Controlled Substances by July 2017
4. Attend addiction training every two years

This will be a big change for many prescribers. Currently, as little as seven percent of prescribers use the state PMP and according to Surescripts, less than one percent of controlled substance prescriptions were sent electronically in Maine in 2015.

Maine follows New York and Minnesota in mandating e-Prescribing of controlled substances, although Minnesota does not enforce the requirement. New York’s law, which requires e-Prescribing of both non-controlled and controlled substances, went into effect last month. Several more states have similar laws up for legislative discussion as well.

It’s clear that now is the time for anyone not e-Prescribing yet to get started. MDToolbox is offering free trials for anyone who wants to test out e-Prescribing as either a standalone solution for prescribers or an integration solution for Health IT vendors, click here for more information or contact us at 206-331-420 or info@mdtoolbox.com.

1. Governor Signs Major Opioid Prescribing Reform Bill, State of Maine Office of Governor Paul R. LePage, http://www.maine.gov/tools/whatsnew/index.php?topic=Gov+News&id=675718&v=article2011

The New York State Internet System for Tracking Over-Prescribing (I-STOP) Act mandates that all prescriptions, both controlled and non-controlled, be sent electronically. Last year the deadline for prescribers to meet the regulation was postponed until March 27, 2016. This new deadline is fast approaching.

In order to comply with I-STOP, prescribers must select and use a certified electronic prescribing computer application that meets all federal requirements for electronic prescriptions for controlled substances (EPCS).  This includes going through Identity Proofing and setting up 2-Factor authentication. The practitioner must also register each unique certified computer application used to electronically prescribe controlled substances with the New York State Department of Health (DOH), Bureau of Narcotic Enforcement (BNE).

The BNE recently sent out a letter to all prescribers advising the following:

“Please be aware that implementation timelines for EPCS software vary and may be lengthy. If you have not already begun this process, BNE strongly recommends that you begin immediately. Prescribers who have certified EPCS software and have completed the registration process are highly encouraged to begin electronically prescribing instead of using paper, to allow for time to resolve technical or workflow issues prior to the mandate’s effective date.”

MDToolbox has a simple signup process for both standard e-Prescribing and to setup EPCS. Most prescribers can complete the required ID proofing and 2-Factor Authentication setup within one day, but we also urge prescribers in NY to get started as soon as possible. This will ensure time to complete the application process and get all staff setup and trained.

To sign up for a free 30 day e-Prescribing trial with EPCS: New York e-Prescribing Account

Once you have signed up, you can register the application at:          

http://www.health.ny.gov/professionals/narcotic/electronic_prescribing/ropes.htm

Electronic Prescribing of Controlled Substances (EPCS) is now legal in all 50 States.  Missouri and Vermont were the last two states to authorize electronic prescribing of controlled substances.  Missouri’s regulations became effective July 30^th, 2015.  Today, August 28^th, Vermont became the final state to allow prescribers to legally prescribe controlled substances electronically for schedule II-V drugs.  Prescribers can now electronically prescribe controlled substances at any participating pharmacy in the United States. 

National EPCS availability is a key step in combating prescription drug fraud and abuse.  With the adoption of EPCS, patients will no longer be able to forge paper prescriptions.  Drug seeking behaviors and patterns will also be easier to identify and respond to.  With the increased electronic connectivity of pharmacies, medication histories will be more readily available.  All of these factors will also create a much safer environment for patients. 

The state of New York has passed legislation requiring prescribers to do all of their prescribing electronically starting in March next year.  As that deadline draws near and potentially other states follow, it will be necessary to stay current and have a viable EPCS solution.  Currently, the national average of pharmacies enabled for EPCS is 80.3%. Now that EPCS is legal in all states and as more states make EPCS a requirement, we expect to see more and more pharmacies coming online and allowing receipt of EPCS. 

MDToolbox offers both a certified stand-alone e-Prescribing solution, as well as an integratable solution for EHR or PM systems to add full e-Prescribing capabilities or add on just EPCS capabilities. MDToolbox is ready to help prescribers and software companies through the DEA requirements to get fully prescribing controlled and non-controlled substances electronically. Check out our EPCS page or contact us at info@mdtoolbox.com for more info.  

Surescripts recently released its 2014 National Progress Report and one of the most startling findings is that only 1.4% of providers are enabled for Electronic Prescribing of Controlled Substances (EPCS).¹

A much larger percent of pharmacies are setup to utilize EPCS. The national average of pharmacies enabled for EPCS is 74.9%.  A state by state comparison of the percent of pharmacies with EPCS capability, can be found on our EPCS page.

Even though EPCS is now legal in 49 states and D.C., its growth has been rather slow compared to the rates of non-controlled e-Prescribing. Surescripts’ report also found that 67%, or 1.2 billion, of all new prescriptions in 2014 were e-Prescribed. However, while there was a 400% increase in controlled substance e-Prescribing from 2013 to 2014, the number of controlled substance prescriptions was only 1.67 million.

Out of almost 70,000 total pharmacies and more than half a million e-Prescribing prescribers, the amount of pharmacies utilizing EPCS far surpasses the amount of prescribers.

While the statistics are surprising considering EPCS has been legal since 2010, there are several factors involved in the low percentage of prescribers. These include issues such as their software not being ready to meet the DEA requirements, as well as the number of steps that prescribers must go through to be setup for EPCS.

Though the steps involved may seem complex, e-Prescribing vendors are doing their best to make the process as smooth as possible for prescribers to utilize this important technology. MDToolbox has created a simple 4-step process that walks prescribers through completing the DEA requirements for EPCS that can be completed within minutes.* We also provide this EPCS solution as an integration option so that EHRs and other technology vendors can add the streamlined process to their existing workflow.

There are several benefits of EPCS including increasing patient safety and security, as well as reducing fraud and abuse. The easier it is for prescribers to setup and use EPCS, the more likely they will be to take advantage of the benefits and increase their usage.

Click here for more on EPCS for prescribers

Click here for more on EPCS for technology vendors

*Time varies based on token selection and results of identity verification

1.  2014 National Progress Report http://surescripts.com/news-center/national-progress-report-2014#public

New York State has officially delayed the requirement to send all prescriptions electronically one year until March 27, 2016. The delay came just two weeks before the original I-STOP mandate was set to go into effect. Under I-STOP, providers will be required to send both non-controlled and controlled substances electronically. Paper prescriptions will no longer be allowed.

The main reason for the delay was stated as a lack of software vendors being ready.  While most software has the ability to electronically send non-controlled prescriptions, some are still lacking the ability to electronically prescribe controlled substances (EPCS). EPCS capability requires completing an audit by a DEA-approved auditor to prove that certain security measures are in place. 

The advantages of e-Prescribing are plentiful from patient safety to efficiency in prescribing to combatting doctor shopping. However, many of these benefits could be lost by either using software that isn’t truly ready or rushing into trying to use software that is complex. The additional time will be beneficial for prescribers. Providers can now pick the solution that is right for them without being rushed and get their practice adjusted to e-prescribing more slowly.

The delay will also take some of the pressure off those vendors who are still trying to add EPCS capabilities. While MDToolbox was one of the first vendors to be approved by the DEA for sending controlled substances, we understand the complexities involved in becoming an approved vendor. It is not an easy process. This additional year will give EHRs and other software vendors the necessary time to implement the requirements as smoothly as possible into their workflows and ensure they do not lose their providers to other vendors. Many vendors have chosen to partner with other vendors to help them meet the requirements. This is a great way to integrate EPCS and the required features such as Identity Proofing, 2-factor authentication, and Permissions without having to exert many resources. Having all of the required features come together in a package that can seamlessly integrate takes a lot of the legwork, expenses, and stress out of the process.

Whatever path vendors and prescribers choose to take, they must seize this opportunity to guarantee they are fully ready when the new deadline comes around.

Click here for further information on adding MDToolbox EPCS to your software

Click here for further information on MDToolbox standalone e-Prescribing software

The recent rescheduling of hydrocodone combination products and the requirement to use special approved prescription paper for Schedule II drugs in Texas, has caused many prescribers to turn to e-Prescribing as an alternative. As prescribers look to this electronic alternative, there are several questions that come up as the Texas Department of Public Safety (Texas DPS) has given out some state specific guidelines. Here’s what prescribers need to know:

Is e-Sending Schedule II drugs allowed in Texas?

In October of 2013 the Texas DPS accepted the same requirements, with a few updates of their own, as the DEA in regards to sending Schedule II controlled substances electronically. ¹

What are the Texas State Guidelines?

In order to comply with the Texas DPS guidelines, there are several things prescribers must be aware of and know before they start using an EPCS program. Prescribers must make sure that their vendor is certified by the DEA, meaning that they passed the required third party audit. Prescribers will also want to be sure that the vendor has EPCS capability activated for their state. Prescribers must also make sure that all their necessary credentials are included when e-Sending a prescription.

DPS, DEA and APN Numbers

The numbers prescribers now put down for paper prescriptions, their DPS, DEA and APN numbers for advanced practice nurses must also be on their electronic prescriptions as well. When prescribers are setting up their e-prescribing account they want to make sure that this information can be entered in the appropriate fields.

APNs will also enter their prescriptive authority identification number for all prescriptions written.  APNs and physicians assistants with prescriptive authority should also keep in mind they must include the DEA and DPS number of their supervising practitioner on all prescriptions schedules III-V.²

Control Numbers

Paper prescriptions written in the state of Texas for schedule II drugs require that each prescription be printed on DPS required paper that has a unique Control Number listed for the pharmacy to record. With e-prescribing all control number information, locating, and documenting is now handled entirely on the pharmacies end electronically.

What Does This Mean Now?

Texas DPS completed their beta testing of EPCS March 1, 2014. The purpose of which was to monitor Schedule II prescriptions for abuse, prescribing patterns, patients attempting to get prescriptions from multiple doctors, and fraudulent prescriptions. Also, to make sure all reporting on both the provider’s end and the pharmacy’s end was done accurately and in a timely manner.

After the results of the testing came back, the outcome was clear. Provider’s information was safer, as their DPS and DEA numbers were no longer floating around on written prescriptions for people to try to forge prescriptions with. The DPS information is also now easier and faster to track with everything being electronic. Patients’ information was also safer and relayed faster as there was no longer the constant need to rely on a phone or fax for patient information that may or may not have made it to the desired party on the other end.

Electronically prescribing controlled substances has proven to not only be a viable alternative to paper prescriptions in Texas, but an improvement. To get more information on EPCS or to start sending controlled substance electronically contact us at info@mdtoolbox.com or visit our EPCS page.

1. https://www.pharmacy.texas.gov/EPCS.asp
2. http://www.dps.texas.gov/RSD/ControlledSubstances/News/index.htm.