So the only place I seem to be able to see this new nationally applicable Rx policy is at Medscape and I have to join them first.
Seems an awful lot of the country is not doing this but I can make them do it according to the OP and MMM.
Hummmmm
Wonder why the DEA and the Rx sellers are not all over this. How can they get in trouble if it is legal & permissible? It is good for 10-650 Hydrocodone tabs? I need mail order from your ( OP & MMM ) RX since my doc can send it to their Fax… Right?
Two years ago isn’t exactly new.
True, but it seems to be new enough that many (most?) doctors and pharmacies aren’t on board yet. It’d be interesting to see how much of the foot-dragging is driven by state regs and how much by local DEA passive vs aggressive stance and how much by simple industry inertia.
20 years ago, in Indiana, controlled substances had to be prescribed on triplicate forms. I don’t know the current standard.
In Wisconsin (at least within my system), narcotics require paper prescription (but not triplicate, don’t know if special paper required, 'cuz all paper prescriptions done on special paper), E-prescription not allowed.
It’s possible that E-scrips might be allowed if our system and pharmacy’s system were securely compatible in a way they are not currently, IDK.
This has been this way for years, which goes to LSL Guy’s point.
Yes. Make photocopies and try to get each copy filled at a different pharmacy.
Well, no. I wasn’t trying to make that claim (in fact, I thought the opposite might be true). I was just asking the question, and I didn’t think I knew enough to draw a firm conclusion.
I know how photocopies work. I know from experience that you can usually tell the difference between an original and a copy. Some documents include watermarks to make the difference more noticeable. But how can you tell an electronic copy from an electronic original? If I make a PDF on my computer and email it to you, how do you know that I didn’t BCC ten other people? If you and those ten people compared their PDF files, every single one of the files would be absolutely identical. There’s really no such thing as “original” and “copy”. So, it seemed to me that paper is more secure in this regard. But I knew that there are probably aspects of this that I’m unaware of, things I don’t know about. So I was asking.
I hadn’t considered the fact that the patient is out of the loop when it’s done electronically. That’s a good point. It’s easier to make copies but the patient never has the chance to do so. The tampering would have to be done by someone in the doctor’s office or the pharmacy.
This is my 1,000th post
In most states, that’s no longer an issue because pharmacies are required to check the state’s prescription drug monitoring registry (e.g. E-Forcse) before filling scripts for schedule II+ drugs.
But before that, the solution was just to hope that pharmacists would catch the forgery. They are remarkably good at it. But pharmacists wouldn’t have a hope of catching fraudulent electronic scripts.
Reading an article on the Texas Medical Association website, I came across this:
“Sending prescription requests to a pharmacy through an electronic vendor helps reduce the risk of prescription fraud. But doctors who are using EPCS have encountered some challenges, including pharmacies not certified to accept the electronic requests.”
So it may be that the pharmacy the OP used can take non-Schedule II prescriptions electronically, but isn’t certified to take controlled substance scripts yet. I know that in Texas at least, this information goes not only to the pharamacy, but the Dept. of Transportation (motor vehicles to the rest of the world).
https://www.texmed.org/NecessaryPain/
“f the pharmacies with EPCS-certified software systems, only 25 percent had actually filled a prescription of this kind, Dr. Schade says. Walgreens and H-E-B Pharmacy are two chains that accept EPCS. Dr. Schade says physicians’ best bet is to call their local pharmacies and ask whether they have EPCS-certified software.”
DEA’s Pharmacist’s Manual outlines the requirements.
Things have been changing since at least 2005 (when there was sort of a government/industry kerfuffle over the distinction between electronic vs. digital signatures).
Yes, e-scribing controlled substances is available in all states but the following from that Medscape article puts it into perspective:
Not all pharmacies are set up for it either.
It must also be commented that being set up for electronic prescribing of controlled substances is more than just a software “tweak.” The standard required is “two-factor authentication” and if a physician group is not prescribing large volumes of controlled substances enabling your terminals with biometric identification, for example, is not worth it when the alternative is quick and easy of the printer spitting out the script, signing it, and handing it to the patient. The main alternative to biometrics is an app on a smartphone that can deliver a one time one use token per script shared between the prescriber and the pharmacy. Will that slow the provider down and make more of their time dealing with the computer and even less with the patient compared to grabbing and signing the script from the computer? Yup. Is it worth it? Not sure.
Mind you as a pediatrician I have been Jonesing for our group to do it as it saves parents of kids on ADD meds a fair amount of hassle … but really the volume of controlled substance scripts in most practices is not so large and the advantage over paper not so big that many are in a rush to put this upgrade over all the other projects in the queue. We just finally got the bar code scanners for immunizations! (Which saves nursing time, reduces the possibility of errors, and will help better manage inventory.)
According to this information I found
“Schedule II controlled substances require a written prescription and may not be dispensed without one unless the
prescribing involves an emergency dispensing of schedule II controlled medications, consistent with federal regulations.
Schedule II controlled substance prescriptions cannot be refilled.”
http://drphilipfisher.com/statutes/A_Guide_to_WV_State_Opioid_Prescribing_Policies.pdf
I know when I had certain medications, I had to have paper, and that was as recent as last year.
That article is from 2008. Nine years ago, I have no doubt that was true.
There are reasons you may have needed to fill those restricted medications with paper Rx forms last year, as mentioned above. But the reasons do not include that being the only way those prescriptions are allowed to be filled under state or federal law; all of those laws and regulations have been changed to allow e-prescribing.
You are correct, e-prescribing of Schedule II drugs is now allowed.
But as DSeid noted, it’s not easy for a lot of practices to set up that sort of connection. My practice setting is so far behind the curve that we still have to hand-write the prescriptions. Our next move is to try to get them set up for printing. E-prescribing may be a long ways off yet.