Resistance from docs, inconsistent interpretation leading to problems
Replacing the prescription pad
There were several factors that prompted the DEA to come up with the EPCS requirement in the first place. Doctors traditionally have written prescriptions on a prescription pad, and the reputation doctors have earned for having poor handwriting is often more than just a stereotype, says Debra Spitler, vice president of business development at IdenTrust. “There was significant damage resulting from pharmacists being unable to read prescriptions,” she says.
The DEA realized that it was important to regulate the prescribing of controlled substances because of prescription pad theft and other drug fraud.
For doctors to obtain a prescription pad, they must register with the DEA and obtain a registration number indicating that the pad is legitimate. People have been known to get jobs in hospitals and clinics just to put themselves in a position to steal prescription pads.
The DEA realized that it was important to regulate the prescribing of controlled substances because of prescription pad theft and other drug fraud
“There is a huge industry around this,” Spitler says, adding that the pads can go for $60,000 to $150,000 on the black market. “The pads are being stolen and used to write prescriptions for fictitious people and then the drugs are sold,” she says.
It is legal at the federal level for doctors to electronically prescribe controlled substances, and late in 2015 all states began allowing the practice. Some states, however, are moving to actually require e-prescribing as the only method to prescribe controlled substances.
New York became the first state to do so when it passed the Internet System for Over-Prescribing Act, or I-STOP, in 2012. The law requires all prescriptions to be electronically transmitted.
New York’s mandate was supposed to go into effect last March, but the deadline was extended to March 27, 2016. Other states have been exploring e-prescribing options, including Florida, Illinois, Massachusetts, Texas and Utah.
E-prescribing readiness remain low
Despite the fact that e-prescribing is legal at both the state and federal level, the readiness on the part of electronic health records providers is reportedly low. Research by e-prescription network Surescripts found that the national average for readiness below 5%.
“I think we’re going to see the federal government step in and force states to require electronic prescriptions for controlled substances in order to receive federal funding for various things,” Spitler says. She believes that awareness about addiction will help drive this shift and that it will prove to be a necessity.
Kaufman says that doctors and even some pharmacies still don’t realize that it’s legal to e-prescribe controlled substances. “More people are coming to the realization, and people are using it more and more,” he says.
Sullivan believes that the advantages of patient safety and convenience should motivate the industry to streamline EPCS and two-factor authentication requirements.
“It’s to everybody’s benefit that we adopt these kinds of guidelines and continue to work with federal and state governments to make these less onerous so that people will adopt them quickly,” he says.