CINDY SANDERS

After a six-month reprieve, federal legislation is set to go into effect April 1, 2008, requiring Medicaid outpatient prescriptions to be presented to pharmacists on tamper-resistant pads containing at least one security measure.



In Tennessee, this new mandate impacts written prescriptions for TennCare patients. Exceptions to the tamper-resistant requirement include electronically transmitted prescriptions such as an e-prescription or a fax from a physician’s office, as well as prescriptions called in to the pharmacy by a physician or other recognized prescriber. Drugs administered on site at skilled nursing facilities and some other institutional and clinical settings are also exempt.



The legislation, which was slipped into the Iraqi War Supplemental Appropriations Bill, took many in the healthcare industry by surprise. After it became clear that it would be impossible to meet the original October 2007 start date, affected stakeholders were given an extra six months to gear up for compliance.



Official correspondence from the Centers for Medicare & Medicaid Services (CMS) to state Medicaid directors, said that, “The CMS strongly supports state program integrity measures and wants states to be aware that both e-prescribing and use of tamper-resistant prescription pads may reduce instances of unauthorized, improperly altered, and counterfeit prescriptions.”



While it might seem the easiest answer would be to rely strictly on electronically transmitted prescriptions, it’s important to note that a supply of tamper-resistant prescription pads should still be kept on hand as prescriptions for schedule II controlled substances cannot legally be transmitted electronically.



Baeteena M. Black, DPh, executive director of the Tennessee Pharmacists Association, said her chief concern is for patients. While the law will heavily impact TPA members, the bigger worry is that patients might see a disruption in receiving necessary medicines.



Once the law goes into effect, she explained, “Pharmacists are given no leeway. It’s very important for the entire prescriber community to learn about this.”

Although the federal mandate was limited specifically to Medicaid patients, the scope of the law is expected to be considerably broader in actual practice.

“It is for TennCare only, but realistically someone isn’t going to carry two prescription pads in their pocket,” pointed out Russ Miller, CAE, senior vice president of the Tennessee Medical Association.



Of the attempt to reduce fraud, he added, “It doesn’t hurt as long as it doesn’t unduly burden medical practices. You have to factor in that it’s an unfunded mandate.”



Dave Beshara, chief pharmacy office for TennCare, noted that, “There’s certainly a need for programs within the medical arena that help reduce fraud.”



He added that this program does put an additional layer of security into the prescribing process but said he’s taking a “wait and see” stance on effectiveness. As he pointed out, those bent on committing fraud often find ways around the technology, as has been seen with counterfeit money even in the wake of heightened security measures.



In an effort to lessen the chances for prescription abuse, Beshara said that CMS has focused on three broad security elements to make a prescription “tamper resistant.” Prescription pads must include the following characteristics for compliance:

• A design to prevent unauthorized copying of a completed or blank prescription form;


• elements to prevent erasure or modification of information written by the prescriber; and


• a design that prevents the use of counterfeit prescription forms.