Regulatory Compliance: The Road to E-Prescribing

CDA Practice Support

California prescribers had to switch to electronic prescribing by Jan. 1, 2022, as did prescribers in Utah, Nebraska, New Hampshire, Michigan and Maryland. California is now part of a majority of states that require the use of e-prescribing. In 2011, Minnesota was the first to require it, and in 2016, New York was the first to impose penalties.[1] In addition to state mandates, the Centers for Medicare and Medicaid Services (CMS) are set to implement a rule requiring that Medicare Part D prescriptions for schedule II, III, IV and V controlled substances be prescribed electronically.[2]

Although the move to e-prescribing seems swift, it began in 2003 when the Medicare Modernization Act required the establishment of standards for e-prescribing.[3] This was followed by the publication of a 2006 Institute of Medicine report, which found that medication errors are the most common medical errors and the cost of treating related injuries was over $3.5 billion annually. The report included among its many recommendations that all prescriptions be written electronically by 2010.[4] Not long after the release of that report, the California Healthcare Foundation published in 2008 an issue brief on the status of e-prescribing in the state. The brief included recommendations to get health care payers, pharmacies and health care providers on board to adopt e-prescribing.[5]

The DEA’s adoption of an e-prescribing regulation in 2010 was one of the necessary steps to standardizing the e-prescribing process. The DEA regulation establishes standards for ensuring that only authorized prescribers can prescribe controlled substances. Although CMS established in 2005 the first e-prescribing standards, it has since adopted the SCRIPT standard established by the National Council for Prescription Drug Program (NCPDP), a nonprofit, multistakeholder organization. The NCPDP standard facilitates the transfer of prescription data between prescribers, pharmacies, payers, health care facilities and intermediaries. E-prescribing software applications must comply with both of these standards.

The country’s opioid crisis was declared a public health emergency in 2017 and led policymakers to lean on e-prescribing to reduce drug diversion and protect against drug misuse.[6] The California legislation, which established the e-prescribing requirement, cites that e-prescribing for controlled substances would “significantly reduce, if not eliminate paper-based fraud and forgery while creating electronic records of controlled substance transactions, thereby strengthening surveillance and drug monitoring program in California.”[7] Assembly Bill 2789 was enacted in 2018 to require e-prescribing for controlled and noncontrolled substances except in specified circumstances. It also requires pharmacies to be able to accept e-prescriptions. At the request of impacted stakeholders, the effective date of the requirements was set for Jan. 1, 2022, three years after the legislation’s passage.

Other legislation approved in 2018 and later tightened the security of controlled substances prescription forms used in the interim before the e-prescribing mandate began. The legislation led prescribers to change their forms more than once to ensure the forms had all required elements. Even with mandated e-prescribing, prescribers should retain their forms in a secure location for use in situations when e-prescribing is not available or required, as described in the law.

E-prescribing can help reduce medication errors and improve patient safety. For example:

■ Pharmacists no longer need to struggle to read a prescriber’s handwriting.

■ Prescribers have access to a patient’s prescription history.

■ The availability of builtin alerts, for example, for potential drug interactions.

E-prescribing reduces drug diversion through fake prescriptions and allows for improved monitoring of controlled substance prescriptions. Applications can integrate with state prescription drug monitoring programs. However, recent studies suggest that the actual impact of e-prescribing on opioid prescriptions is not yet clear.[8,9]

Medication errors can still occur with e-prescribing. Because drug names can look similar, such as Celebrex and Celexa, prescribers should doublecheck that they have selected the correct drug. The Institute for Safe Medication Practices maintains a list of these confused drug names.

In 2020, industry media reported 66% of all prescriptions were e-prescribed in 2017 and 80% in 2019.[10] With more states mandating e-prescribing in the coming years, the percentage of prescriptions that are e-prescribed will rapidly increase.

REFERENCES

1. ID.me. A guide to state and federal EPCS requirements and deadlines. Accessed Oct. 15, 2021.

2., Centers for Medicaid and Medicare Services. E-prescribing. Accessed Nov. 2, 2021.

3. Bell D, Friedman M. E-prescribing and the Medicare modernization act of 2003, abstract. Health Aff (Millwood) Sep–Oct 2005;24(5):1159–69. doi: 10.1377/ hlthaff.24.5.1159.

4. The National Academies of Sciences, Engineering and Medicine. Medication errors injure 1.5 million people and cost billions of dollars annually; report offers comprehensive strategies for reducing drug-related mistakes.

5. California Healthcare Foundation. Getting connected: The outlook for electronic prescribing in California.

6. Office of the National Coordinator for Health Information Technology. Opioid epidemic and health IT. Accessed Nov. 2, 2021.

7. AB 2789 Senate Business, Professions and Economic Development analysis. Accessed Nov. 3, 2021.

8. Abouk R, Powell D. Can electronic prescribing mandates reduce opioid-related overdoses? Econ Hum Biol 2021 Aug;42:101000. doi: 10.1016/j.ehb.2021.101000. Epub 2021 Apr 9.

9.Everson J, Cheng A, et al. Association of electronic prescribing of controlled substances with opioid prescribing rates. JAMA Netw Open 2020 Dec 1;3(12):e2027951. doi: 10.1001/jamanetworkopen.2020.27951. PMCID: PMC7753903.

10. Jason C. What is e-prescribing and why is it vital for providers, patients.

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