Indiana Mandates Electronic Prescribing

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Indiana Governor Eric Holcomb recently signed SB176 into law. This Act mandates Indiana healthcare providers to electronically prescribe all controlled substances with an effective date of January 1st, 2021.  This bill began as an 8-line document allowing patients to transfer their prescription to another pharmacy.  Several amendments were made in the two weeks it took the Indiana House and Senate to pass the bill bringing it to 15 pages in length.

Other subsections include:

  • The Act amends several sections of state code by adding the phrase “or electronically transmit” to add electronic prescribing as a valid means of prescribing.
  • There are provisions in the Act for a waiver system with similar circumstances for approval as other states have enacted.  Some of these include: economic hardship, technological limitations, and other circumstances determined by the board.
  • Pharmacies are not required to verify if a controlled substance prescription received via written, oral, or fax falls within the state and federal laws.
  • The Act allows for advanced practice registered nurses to send prescriptions under their own credentials once they have met the requirements established by the board, previously nurse practitioners were required to send prescriptions under a supervising physicians’ credentials.
  • Telemedicine is also addressed in this Act.  Indiana has allowed for the prescribing of controlled and non-controlled (excluding opioids) prescriptions for telemedicine providers so long as certain criteria is met.  One regulation is that an Indiana licensed practitioner has seen the patient in person and developed a medical plan that the telemedicine prescriber is following. (Note: Stay tuned for our next blog concerning U.S. Wide Telemedicine Prescribing that goes into more details about the uncertainty of telemedicine and the current laws governing it.)

Indiana has remained below the national average for opioid-related overdose deaths since 1999, following the national trend and increasing in number of deaths.  However, the rate has increased sharply in recent years catching up with the national average.  If the rate continues as forecasted, it will pass the national average for the first time since the National Institute on Drug Abuse has been collecting data.  Prescription opioid overdose deaths decreased in 2011 but have begun to rise again in recent years along with heroin and synthetic opioid deaths.  Indiana enacted SB226 on April 26th, 2017, the Act limits the first fill prescription of opioids to seven days for adults.  The law also limits opioid prescriptions for minors to seven days.  Prescriptions can exceed seven days under certain circumstances, such as the doctor determines that the patient requires it and if the patient is in palliative care.[1]

Indiana currently has a 30.5% provider enablement for electronic prescribing of controlled substances, which is just below the national average of 33.4%.  Pharmacy enablement for EPCS is 97.8% which is above the current nation average for pharmacies, which is 95.2%.[2]  There will likely be a big push leading up to 2021 to secure electronic prescribing, MDToolbox encourages providers not to wait!

Indiana now aligns with several other states mandating electronic prescribing.  MDToolbox looks forward to working with providers throughout Indiana 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]http://www.hallrender.com/2017/06/21/new-indiana-law-imposes-a-seven-day-limit-on-opioid-prescriptions/

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

Tennessee Amends and Delays E-Prescribing Mandate

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Tennessee Governor Bill Haslam recently signed SB0810 into law.  This Act mandates Tennessee healthcare providers to electronically prescribe all controlled substances with an effective date of January 1st, 2021.  Tennessee had previously passed HB1993 which mandated EPCS for Schedule II drugs by January 1st, 2020.  This latest Act makes several changes to the prior legislation:

  • The new Act replaces Schedule II drugs with Schedule II-V.  Now, all controlled substances are required to be electronically prescribed. 
  • The required date for prescribers to follow the mandate has been postponed to January 1st, 2021 from January 1st, 2020. 
  • Tennessee pharmacies are now required to be able to issue partial prescriptions in their electronic system of Schedule II drugs by January 1st, 2020 or face action by The Board of Pharmacy.  Tennessee previously passed 63-1-163 which regulated pharmacies when filling partial prescription orders.  The new amendment requires the pharmacy’s electronic system to be able to split the medication orders should a patient only want a partial order, or if the pharmacy is low on stock of the Schedule II drug.

Tennessee has remained above the national average for opioid-related overdose deaths since 2003, rising even faster than the national trend in number of deaths.  While some states have had a flattening or reduction in prescription opioid overdose deaths in recent years, Tennessee has continued to trend upward.  The number of deaths from synthetic opioids and heroin had remained stable until 2014, when the numbers began to rise.

Last year, Tennessee passed HB1831: “TN Together Opioid Reform” which made several major strides toward the fight against opioid addiction.  The Act budgeted $30 million for prevention, treatment, and law enforcement tasks in relation to the opioid epidemic.  The Act also mandated that pharmacies check the State PMP registry.  The biggest change has to do with how much of a drug you can get and when. Under the new law, pharmacists can only partially fill a prescription for no more than half of the number of days it’s written for. And there are limits on prescriptions, too: General prescriptions are limited to a 10-day supply (and no more than 500 cumulative morphine milligram equivalents).[1]

Tennessee currently has a 23.5% provider enablement for electronic prescribing of controlled substances, which is well below the national average of 33.4%.  Pharmacy enablement for EPCS is 96.7% which is above the current nation average for pharmacies is 95.2%.[2]  HB1993, which was passed a year ago would have required EPCS of Schedule II drugs only 8 month from the writing of this blog.  There will likely be a big push leading up to 2021 to secure electronic prescribing, MDToolbox encourages providers not to wait!

Tennessee now aligns with several other states mandating electronic prescribing.  MDToolbox looks forward to working with providers throughout Tennessee to ease the transition and help provide tools and resources in combating the opioid epidemic.  With MDToolbox providers have access to tools such as Electronic Prescribing of Controlled Substances (EPCS) and convenient on the go mobile e-prescribing.  Contact us for more information or to start your free 30 day free trial.

 

[1]https://www.knoxnews.com/story/news/health/2018/06/29/tennessee-opioid-prescription-law-pharmacy/746208002/

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

Kentucky Mandates Electronic Prescribing

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Kentucky Governor Matt Bevin recently signed HB342 into law. This Act mandates Kentucky healthcare providers to electronically prescribe all controlled substances with an effective date of January 1st, 2021

Other subsections of this Act include:

  • The act contains provisions for a waiver to delay the mandate for a specified time period for e-prescribing in the event of economic hardship, technological limitations, or exceptional circumstances, these are to be determined.
  • Pharmacies are not required to verify if a controlled substance prescription received via written, oral, or fax falls within the state and federal laws.

Kentucky has remained above the national average for opioid-related overdose deaths since 2001, several years were double the national rate.  In 2000, only nine counties in the U.S. had overdose death rates of more than 20 per 100,000 people, and four of these were located in Kentucky.  By 2014, more than half of Kentucky counties had overdose rates that high.  This represents a quadrupling of deaths due to drug overdose, from less than 250 in 2000 to more than 1,000 each year since 2010.  According to the Kentucky Justice and Public Safety Cabinet, drug overdose deaths reached 1,248 in 2015. [1]

Over the past two decades, the Commonwealth has taken efforts to curb problems related to substance use. In 1998, Kentucky became one of the first states to launch a prescription drug monitoring program—the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system to monitor medical use of controlled substances, such as prescription opioid painkillers. KASPER has since been enhanced and now offers health care providers and pharmacies real-time 24-hour access to prescription information that can be used to monitor and prevent overuse of prescription medications.  Policymakers have also adopted policies aimed at reducing the impact of illegal drugs, such as passing the 2015 Senate Bill 192, which authorized expanded use of naloxone, a drug that treats opioid overdoses, and funded substance use treatment programs.[2]

Kentucky currently has only 18.9% provider enablement for electronic prescribing of controlled substances, which is below the national average of 33.4%.  Pharmacy enablement for EPCS is 98.1% which makes Kentucky one of the states with highest percentage of pharmacies ready to receive electronic prescriptions.  The current nation average for pharmacies is 95.2%.[2]  There will likely be a big push leading up to 2021 to secure electronic prescribing, MDToolbox encourages providers not to wait!

Kentucky now aligns with several other states mandating electronic prescribing.  MDToolbox looks forward to working with providers throughout Kentucky to ease the transition and help provide tools and resources in combating the opioid epidemic.  With MDToolbox providers have access to tools such as Electronic Prescribing of Controlled Substances (EPCS) and convenient on the go mobile e-prescribing.  Contact us for more information or to start your free 30 day free trial.

 

[1]https://www.healthy-ky.org/res/images/resources/Full-Substance-Use-Brief-Final_12_16-002-.pdf

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

Arizona Delays E-Prescribing Mandate

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Photo Credit: Gage Skidmore

Arizona Governor Doug Ducey signed House Bill 2075 into law on February 14th, 2019.  This bill amends and addresses issues with the Arizona Opioid Epidemic Act (HB 1001) that was signed into law on January 26th of 2018.  In an effort to combat opioid abuse, the law mandates that prescribers electronically prescribe schedule II controlled substances. The original deadlines were January 1, 2019 for prescribers in counties with populations more than 150,000 and July 1, 2019 for prescribers in rural counties with less than 150,000. However, there were several concerns that the original law was passed rather quickly and significant changes have been made to the policy in the latest bill.

The Arizona State Board of Pharmacy1 lists the major provisions to HB 1001 as:

  • Moves the 2019 implementation dates for urban and rural counties to January 1, 2020 for all counties.
  • Allows for written prescriptions if the e-prescribing system is not operational or available in a timely manner, the occurrence must be noted in records maintained by the pharmacy for a period of time set by the Arizona Board of Pharmacy.
  • Exempts requirements for Indian Health Services and federal facilities.
  • Eliminates the waiver process through the Arizona Board of Pharmacy but provides rulemaking authority in consultation with a Task Force to add additional exceptions.
  • Delays e-prescribing requirements for veterinarians until e-prescribing software is widely available.
  • Allow for prescriptions to be faxed if the prescription is compounded for direct administration to a patient, residents of a long-term care facility and hospice patients.
  • Resolves a statutory conflict that inadvertently imposed a prohibition on physician assistants prescribing more than a 72-hour dosage of opioids or benzodiazepines.
  • Contains a retroactive clause to December 31, 2018 so the legislation takes effect immediately once it becomes law.

Over 40,000 healthcare providers2 in Arizona applied for a waiver to exempt themselves from the requirement to e-prescribe.  The waivers were granted to those who lacked adequate internet access or faced other hardships restricting their access to use e-prescribing software.  With the passing of HB 2075, on January 1st 2020 almost all providers in the state of Arizona will need a method of e-prescribing controlled substances per the law as there will not be a waiver process. 

While the deadline has been extended for providers to adopt e-prescribing in Arizona, MDToolbox encourages prescribers not to wait. The advantages of e-prescribing are countless and it’s been proven to be an important tool for preventing opioid abuse. Contact us today for a demo or free trial to see just how easy it is!

 

1. https://pharmacy.az.gov/important-law-changes

2.https://www.kgun9.com/news/local-news/legislation-fixes-problems-with-arizona-opioid-measure

Pennsylvania Joins in Combating Opioid Epidemic

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Pennsylvania Governor Tom Wolf recently signed Act 96 into law. This mandates Pennsylvania providers to electronically prescribe controlled substances II-V within a year of the bill passing.

The goal is to eliminate fraud associated with written prescriptions. Per the National Institute on Drug Abuse (NIDA), in 2016, there were 2,235 opioid-related overdose deaths in Pennsylvania. Prescription opioid overdoses alone increased from 411 to 729 deaths since 2010 [1].  The bill focuses on illegal drug diversion and combating the opioid epidemic. Between June 2017 and June 2018, eight drug gang arrests for illegal paper prescriptions were made in Pennsylvania, totaling more than 60,000 illegally diverted opioid prescriptions[2].

Providers who do not follow suit with the new law can face charges of $100 up to $5,000 per year. However, there are some exceptions which include:

  • When electronic prescribing is unavailable due to temporary technological or electrical failure
  • Prescriptions issued by a practitioner and dispensed by a pharmacy located outside the Commonwealth
  • Prescriptions issued by a practitioner in an emergency department or health care facility when an electronic prescription would be impractical or would cause undue delay
  • For a patient in a hospice, nursing home or residential health care facility
  • For controlled substance compounded prescriptions and prescriptions containing elements that are not able to be accomplished with electronic prescribing
  • For a prescription issued pursuant to a valid collaborative practice agreement, a standing order or a drug research protocol
  • For a prescription issued in an emergency situation
  • The pharmacy receiving the prescription is not set up to process electronic prescriptions; and
  • For controlled substances that are not required to be reported to the prescription monitoring program system.

If providers do not meet an exception, they do have the option to apply for an exemption based upon economic hardship, technical limitations, or exceptional circumstances.

Pennsylvania now aligns with many other states headed towards mandating electronic prescribing. MDToolbox looks forward to working with providers throughout Pennsylvania 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.

Federal Opioid e-Prescribing Law Passes

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This week President Trump signed into law the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act1. The legislation is aimed at combating the opioid epidemic by focusing on several information technology tools that help prevent prescription fraud and abuse.

One of those tools is e-Prescribing. One of the more than 60 policies included is the Every Prescription Conveyed Securely Act. Beginning in January 2021, prescribers will be required 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.

Another tool included in the law is electronic prior authorization. Also by January 2021, electronic prior authorization will be required for Medicare Part D covered drugs. Electronic prescription programs will be required to securely transmit the requests. A facsimile, proprietary payer portal, or an electronic form that does not meet the standards will not be counted as an electronic submission.

The legislation also contains 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.

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) and Electronic Prior Authorization (e-PA) as they are important tools to use in fighting the devastating opioid epidemic. Putting these federal mandates in place is an important step towards fully utilizing the available technology to save lives. 

 

1. H.R.6 - SUPPORT for Patients and Communities Act https://www.congress.gov/bill/115th-congress/house-bill/6

 

Massachusetts To Require Electronically Prescribing Controlled Substances

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Massachusetts Governor Charlie Baker recently signed a bill that will require prescribers to electronically prescribe controlled substances.  The bill, An Act for Prevention and Access to Appropriate Care and Treatment of Addiction1, is intended to address the growing opioid problem. The opioid epidemic has claimed more than 2,000 lives in Massachusetts in both 2016 and 2017.

As the name of the new expansive law indicates, it’s focused on strengthening education and prevention efforts, strengthening intervention and harm reduction strategies, and improving access to treatment. Two focuses of prevention relate specifically to prescribers:

  • Mandates prescribers to send controlled substance prescriptions electronically starting January 1, 2020.
  • Requires prescribers to check the state prescription monitoring program (PMP) each time a prescription for a schedule II or III, or a benzodiazepine is issued.

“The opioid and heroin crisis has tragically claimed scores of lives and broken families across the Commonwealth, and this new bill will serve as our latest tool kit to address the public health crisis through increased access to treatment, education, and prevention,” Baker said. “While there is still much work to do, this bipartisan bill will support the fight against this horrible epidemic by holding providers more accountable for prescribing practices, taking stronger steps to intervene earlier in a person’s life, and expanding access to recovery coaches.”

MDToolbox urges prescribers to take full advantage of e-Prescribing and to not only send controlled substances electronically, but all prescriptions as soon as possible. The opioid epidemic continues to worsen and this is an easy way for prescribers to help combat it. Currently, a meager 15% of prescribers in Massachusetts are enabled for EPCS. Prescribers shouldn’t view it as a new technological burden, but as a tool they can use in their practice to aid in their day to day prescribing tasks.  By prescribing all prescriptions electronically in one easy workflow, both time and money will be saved. MDToolbox offers all prescribers a free 30 day trial to see just how beneficial e-Prescribing and EPCS can be. Contact us for more information.

1. https://malegislature.gov/Laws/SessionLaws/Acts/2018/Chapter208

Senate Passes Bill Requiring EPCS

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Earlier this week, the United States Senate passed The Opioid Crisis Response Act of 2018. The bill is focused on battling the opioid epidemic and was almost unanimously passed with a 99-1 vote. According to the Centers for Disease Control and Prevention, overdose deaths killed an estimated 72,000 Americans in 2017 and the total estimated "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. The bill provides $3.8 billion in funding.

The bill contains a large number of different proposals from five Senate committees. One of those proposals requires prescribers to electronically prescribe controlled substance prescriptions for Medicare Part-D covered medications. The Centers for Medicare and Medicaid Services (CMS) would be responsible for specifying a list of exceptions and outlining the penalties for failing to comply with the e-prescribing requirement. 

Other provisions in the Opioid Crisis Response Act of 2018 include:

1.       The STOP ACT—to stop illegal drugs, including fentanyl, at the border
2.       New non-addictive painkillers, research and fast-track
3.       Blister packs for opioids, such as a 3 or 7-day supply
4.       More medication–assisted treatment
5.       Prevent “doctor-shopping” by improving state prescription drug monitoring programs
6.       More behavioral and mental health providers
7.       Support for comprehensive opioid recovery centers
8.       Help for babies born in opioid withdrawal
9.       Help for mothers with opioid use disorders
10.     More early intervention with vulnerable children who have experienced trauma

This bill comes after similar legislation passed through the House in June. Senate Health, Education, Labor and Pensions Committee Chairman, Lamar Alexander, R-Tennessee, said he is working to combine the bills "into an even stronger law to fight the nation’s worst public health crisis, and there is a bipartisan sense of urgency to send the bill to the President quickly." A combined version is expected to reach President Donald Trump’s desk for signing by early October.

California Prescribers Required to Check State Database

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Starting October 2, 2018, prescribers in California will be required to check the state’s prescription monitoring database, Controlled Substance Utilization Review and Evaluation System (CURES), before prescribing Schedule II, III, or IV drugs. California is one of 39 states that mandate prescribers to check prescription monitoring databases in an effort to combat the opioid epidemic. By checking a database before prescribing, prescribers can identify “doctor shoppers” who go from doctor to doctor to obtain multiple prescriptions.

Prescribers will now be required to check CURES if it is the first time prescribing the scheduled drug for the patient or if it has been four months since the last time they checked the database for the patient. The check must be completed no earlier than 24 hours or the previous business day prior to the prescribing, ordering, administering or furnishing of a controlled substance to the patient.

All prescribers who were authorized to prescribe or dispense Schedule II-IV controlled substances were originally required to just register to use CURES by July 1, 2016. The requirement to check the database was to start six months after the state certified the database was ready. The California Department of Justice (DOJ) certified CURES was ready for statewide use on April 2, 2018.

If prescribers do not comply, it could result in disciplinary proceedings against a practitioner’s license. The Medical Board of California states in their CURES Mandatory Use FAQs1, “Failing to consult CURES is a violation of the law and it could result in the issuance of a citation and fine, or could be a cause of action In an accusation that leads to disciplinary action. Disciplinary action could be a public reprimand, suspension, probation, or revocation. Each violation of the law is reviewed on a case-by-case basis.”

The Medical Board of California also recommends that prescribers either note in the patient’s chart that they checked the CURES database or print the report and put it in the patient’s file to document that the check was completed.

MDToolbox makes it convenient for prescribers to check CURES by providing a link directly to the database from within the prescription writer. The system also automatically makes note that the database was checked for the prescriber. For more information and to request a free trial, see California E-Prescribing or contact us at info@mdtoolbox.com.

 

1. Medical Board of California CURES Mandatory Use FAQs http://www.mbc.ca.gov/Licensees/Prescribing/CURES/CURES_FAQ.pdf?utm_source=link&utm_medium=email&utm_campaign=CURES&utm_content=faq

Oklahoma Latest State to Require E-Prescribing to Prevent Opioid Abuse

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Oklahoma recently became the latest state to enact an e-prescribing law in order to prevent opioid abuse. Governor Mary Fallin signed into law House Bill 29311 which will require prescribers in Oklahoma to electronically prescribe Schedule II through V controlled substances starting January 1, 2020.

The bill allows for a few exemptions in certain circumstances such as for veterinarians or prescriptions that are administered through an on-site pharmacy at facilities like nursing homes. It also states that waivers or extensions can be granted through the licensing board. There aren’t any details on what will constitute a waiver or extension at this time though. Other states who offer waivers and extensions will grant them for reasons like a lack of proper technology such as internet or computers.

If a prescriber is granted an e-prescribing waiver, they will be required to use official prescription forms provided by the Oklahoma State Bureau of Narcotics and Dangerous Drugs Control. Pharmacists will not be required to verify that a prescription falls under an exception.

Currently, only 12% of prescribers in Oklahoma are enabled for EPCS. However, 96% of pharmacies are able to receive electronic controlled substance prescriptions.

Attorney General Mike Hunter is convinced requiring e-Prescribing “will have a material impact on this leakage of opioids into the hands of addicts.” E-prescribing can help put a stop to prescriptions being forged which an opioid task force found out could easily be done. During their research, a real prescription was scanned, altered, and printed on security paper. Almost all experts, including pharmacists and DEA agents, were fooled by the fake prescription. Tulsa County Director of Governmental Affairs Terry Simonson said, “It was so easy. It was just kind of mind-boggling that that's all it took.”

E-Prescribing offers many benefits in addition to preventing forged prescriptions. MDToolbox can help prescribers in Oklahoma, as well as nationwide, start utilizing all of those benefits. See Oklahoma E-Prescribing for more information or to request a free trial to start e-Prescribing today.

 

   1. http://webserver1.lsb.state.ok.us/cf_pdf/2017-18%20ENR/hB/HB2931%20ENR.PDF