e-Prescribing Bill for Controlled Substances May Soon Be Law

Alicia Ault

October 24, 2017

Sponsors of a bill that would require electronic prescribing of controlled substances for Medicare beneficiaries are confident it will soon become law.

Speaking at a forum in Washington, DC, Reps. Markwayne Mullin (R-OK) and Katherine Clark (D-MA) said the bill, known as the Every Prescription Conveyed Securely (EPCS) Act, had the broad bipartisan support needed to gain passage, either as a stand-alone bill or attached to some other piece of legislation. Currently, it has five cosponsors.

Clark said the EPCS Act would be a "critical tool for doctors, for pharmacists, and for our seniors," because it would allow providers to determine in real time whether a patient had been elsewhere for these types of medications.

It would also help better manage medications and pain and reduce fraud, she said. The proposal is so important that "we will put it on any vehicle that we see, and I hope we can do it in the next few months," said Clark.

In 2015, every state began allowing e-prescribing of controlled substances. But uptake has been slow, especially because few states have required e-prescribing of any medications. More states are introducing legislation to do so, according to a blog maintained by Surescripts, an e-prescribing company.

Medicare currently provides incentives for e-prescribing, but it is not required, especially for controlled substances.

"This is just a hole that needs to be plugged," said Mullin, noting that overall, about three quarters of prescriptions are written electronically, but only 14% of opioids are e-prescribed.

Easier Access

Handwritten prescriptions can be easily forged, said Mullin. He wants to make it easier for patients who need controlled substances. In largely rural Oklahoma, patients must drive long distances to receive paper prescriptions.

Opioids are a growing concern in the Medicare population, Mullin and Clark noted.

The inspector general of the Department of Health and Human Services reported in July that 14.4 million of the 43.6 million Medicare beneficiaries ― one in three ― received at least one opioid prescription through Medicare Part D in 2016. Of those prescriptions, 80% were for schedule II or III opioids.

Five million Medicare beneficiaries received opioids for periods of 3 months or more. Of these, 3.6 million received opioids for 6 or more months, and 610,000 received opioids for 1 year.

The e-prescribing requirement under the EPCS Act would not take effect until 2020, and prescribers would be given many ways to claim an exemption to the law.

For instance, a prescriber could claim that economic hardship or technologic limitations prohibited implementation of the program, but only for up to a year. A waiver might also be granted in cases in which an electronic prescription was shown to delay a patient's ability to receive the prescription, and that the delay would have an adverse affect upon that individual's medical condition.

The e-prescribing requirement would not apply during public health emergencies and in clinical trials. In addition, the exemption would apply to drugs that are subject to a risk evaluation and mitigation strategy (REMS) if e-prescribing would prevent fulfillment of that REMS.

Provider Pushback

Both Clark and Mullin said that, not surprisingly, they had been receiving negative feedback from healthcare providers, owing to the fact that implementing e-prescribing for all controlled substances under Medicare would be expensive.

Even with the waivers and exceptions, "it will cost money," said Clark. "The burden will fall on doctors and hospitals, and that's where we are getting some resistance," she said. "But this is worth it," she added.

The opioid problem among persons receiving Medicare is as large as among other populations, said Clark, who added that e-prescribing would be a "critical tool going forward."

Both Clark and Mullin said they had received only enthusiastic responses from opioid manufacturers and distributors and pharmacy benefit managers.

At the forum, the chief medical officer of one of the nation's largest pharmacy benefit managers, Express Scripts, said his industry welcomed more mandatory e-prescribing. "We're really excited the federal government is getting into the act," said Steve Miller, MD.

e-Prescribing will increase convenience for Medicare beneficiaries, give them better access to needed pain medications, and eliminate fraud and abuse, said Dr Miller.

The collection of more data on the prescribing and dispensing of opioids ― which are often paid for in cash and are not tracked ― will help close the loophole on both physician shopping and pharmacy shopping, he said.

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