Arkansas Mandates Electronic Prescribing

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Arkansas Governor Asa Hutchinson recently signed Act No 447/SB174 into law. This Act mandates Arkansas healthcare providers to electronically prescribe all controlled substances with an effective date of January 1st, 2021.  Arkansas does not recognize Marijuana as a Schedule I drug.  The state has added a Schedule to their classification; Schedule VI, and classified marijuana as such.  The act refers to all controlled substances as Schedule II-VI.

Other subsections of this Act include:

  • Schedule III and Schedule IV drugs shall not be filled or refilled more than six months after the date of prescribing or be refilled more than five times unless renewed.
  • 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.
  • 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 practitioner licensing board can issue a $250 fine for each violation of failure to e-prescribe a controlled substance.

Arkansas has remained below the national average for opioid-related overdose deaths since 2009.  However, in 2016 Arkansas was one of just eight states to fail the “National Safety Council: Prescription Nation” report that analyzed prescription drug usage state-by-state.   Arkansas was found to be ranked second in the list of highest rate of opioid prescribing states in the US[2].  The state government has worked hard since this ranking to get opioid prescriptions under control by requiring opioid education for practitioners, psychological therapy for patients while they are taking controlled substances, and additional support for inmates.

Arkansas currently has only 24.6% provider enablement for electronic prescribing of controlled substances, which is below the national average of 33.4%[3].  There will likely be a big push leading up to 2021 to secure electronic prescribing, MDToolbox encourages providers not to wait!

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

 

[1]https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state/arkansas-opioid-summary

[2]https://www.nwaonline.com/news/2018/nov/11/arkansas-and-the-opioid-epidemic-201811/?opinion

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

 

Wyoming Mandates Electronic Prescribing

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Wyoming Governor Mark Gordon recently signed Enrolled Act No 66/SF0047 into law. This Act mandates Wyoming providers to electronically prescribe all controlled substances with an effective date of January 1st, 2021.  The Act has provisions for the state board to provide some exemptions to the requirement for emergencies and has the power to grant an extension to a dispenser or practitioner; however, being granted an extension is not guaranteed.

Other subsections of this Act include:

  • Prior to writing a prescription for a controlled substance, providers are required to search the state PMP database, as well as every 3 months thereafter for as long as the patient remains on a controlled substance.
  • Pharmacies must submit their dispense data on controlled substances to the state daily.
  • All prescribing providers are required to take 3 hours of continuing education every two years related to the responsible prescribing of controlled substances when they renew their license.
  • All Schedule II prescriptions require either written or electronic prescription until the 1/1/21 mandate, oral orders will not be accepted.
  • All Schedule III and IV prescriptions shall not be refilled more than six months after the prescribed date, and not refilled more than five times unless renewed. 

In recent years, Wyoming has fallen below the national average for opioid-related overdose deaths.  However, prior to 2015 Wyoming was above the national average for 5 consecutive years[1].  The state trends continue to rise along with the national average of opiate-related deaths.  Wyoming currently has only 17.5% provider enablement for electronic prescribing of controlled substances[2], well below the national average.  There will likely be a big push leading up to 2021 to secure electronic prescribing, MDToolbox encourages providers not to wait!

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

[1]https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state/wyoming-opioid-summary

[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

Walmart to Limit Opioid Prescriptions and Require EPCS

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Walmart recently announced they will be implementing two new policies aimed at combating opioid abuse1. They include:

  • Restrict initial acute opioid prescriptions to no more than a seven-day supply, with up to a 50 morphine milligram equivalent maximum per day
  • Require e-prescriptions for controlled substances (EPCS)

The policies will apply to all Walmart and Sam’s Club pharmacies in the United States and Puerto Rico. The 7-day limit policy is set to be enforced within the next 60 days. The EPCS requirement will not go into place until January 1, 2020 but it is an important piece since electronic prescriptions prevent fraud and minimize errors.

While many states have either already implemented or are in the process of implementing laws to limit opioids and require EPCS, this is the first large pharmacy chain we have seen implement such measures. Some states limit opioid prescriptions to fewer than 7 days in which case they will default to the state law.

“We are taking action in the fight against the nation’s opioid epidemic,” said Marybeth Hays, executive vice president of Health & Wellness and Consumables, Walmart U.S. “We are proud to implement these policies and initiatives as we work to create solutions that address this critical issue facing the patients and communities we serve.”

Walmart also plans to give access to the controlled substance tool, Narxcare, to all pharmacists, provide naloxone recommendations for patients at risk of overdose, and have additional trainings and education on opioid stewardship by the end of this summer.

At MDToolbox, we agree that these are all important measures to take in the fight against the opioid epidemic. We continually urge prescribers not to wait for such policies to be enacted and to start e-Prescribing controlled substances as soon as possible. Find out more about EPCS or contact us for a demo to see how easy it is to implement.

1. https://news.walmart.com/2018/05/07/walmart-introduces-additional-measures-to-help-curb-opioid-abuse-and-misuse