More states require e-prescribing to combat fraud and abuse

Efforts to combat prescription fraud and abuse are prompting states to mandate that prescribers transmit prescriptions to pharmacies electronically.

Starting in January 2017, Maine will be the latest state to mandate prescribers use electronic prescribing, or e-prescribing, to transmit prescriptions for controlled substances. Maine’s law also creates the Prescription Monitoring Program, sets limits for the strength and duration of opioid prescriptions, and is expected to reduce mistakes associated with handwritten scripts.

E-prescribing controlled substances is now legal in all 50 states. There could be a long road to adopting this practice in some regions, but New York, Minnesota, and Maine already require e-prescribing. Several other states including California, Missouri, and Vermont are considering similar legislation. Discussions are ongoing in Massachusetts, Texas, and Ohio.

New York has the most aggressive law. In March 2016, the second phase of New York’s Internet System for Tracking Over Prescribing, or I-STOP, law went into effect. The law requires all prescriptions to be sent through authorized e-prescribing systems to pharmacies. It also imposes penalties on providers who are not in compliance. Those penalties include fines, jail time, or loss or suspension of license. As with Maine, New York’s requirements are aimed at reducing over-prescribing opioids and preventing fraud.

There have been some challenges in the implementation of phase two of the I-STOP law. The law limits consumers from shopping for the best pharmacy to fill their scripts, and the Medical Society of The State of New York said the law is burdensome and costly to prescribers, especially those who do not prescribe a lot of prescriptions yet are still required to comply. Prescribers can apply for waivers, but it is a cumbersome process that is required each year.

On the other hand, pharmacists generally like the new regulations.

Andrew J. DiLuca, R.Ph., director of pharmacy services at Kaleida Health in Buffalo, NY, said the health system worked with its electronic health records vendor, Cerner, to accommodate the new requirements. DiLuca said pharmacists like the e-prescribing regulations because it improves patient safety.

“It has been incredibly effective,” DiLuca said. “With I-STOP, we have seen a dramatic drop in opioid scripts, in general, because prescribers can see in real time what the patient has at home, and they don't feel obligated to just give them a small script. We used to get a lot of RXs for five or seven day supplies to appease patients or to avoid risking not treating them properly.

“It has also greatly reduced handwriting errors and increased continuity of treatment for chronic pain patients as there are significantly less delays in getting prescriptions now that they are only between the pharmacy and prescriber.”

New York began implementing the I-STOP law in 2012, which required prescribers to use e-prescribing for controlled substances. The 2012 law also included an online, state-wide registry database that tracks a patient’s history of opioid use and can limit or entirely prevent doctor shopping.

The second phase was to take effect in 2015, but lawmakers delayed its implementation for one year to allow pharmacies and prescribers additional time to update systems and gain authorization. All vendors are required to obtain federal certification of the electronic health record software technology used to transmit the prescriptions. About 8 percent of the state’s 124,000 prescribers were granted extensions on the March 27, 2016, deadline. The state allows several exemptions from the law, but physicians must submit information on why they need the exemption or be at risk for noncompliance.

According to Surescripts, which assisted New York with its implementation, the state’s prescribers are outpacing their counterparts in other states in obtaining the necessary certification. Meanwhile, 95 percent of pharmacies in New York are able to receive prescriptions electronically.

“As we look beyond New York, we will continue to expand the connections we have with software vendors, providers, and pharmacies to broaden the utilization of e-prescribing for controlled substances and add considerable value to the nation’s healthcare system,” said Tom Skelton, Chief Executive Officer of Surescripts.

Traditional paper scripts have become harder to come by in recent years and utilizing electronic prescriptions is not new. However, expect the number of states requiring e-prescriptions for controlled substances, and eventually all prescriptions, to continue to grow.

Valerie Pillo is an analyst at DRG and specializes in physicians industry topics. Follow her on Twitter at @ValeriePilloDRG.