Tamper-resistant pad requirement to go into effect April 1

October 15, 2007

Beginning April 1, all physicians must use tamper-resistant prescription pads for the non-electronic prescriptions they write for patients receiving Medicaid assistance for outpatient care. Here's what you need to know.

Key Points

Washington, DC-Ophthalmologists and other physicians now have more time to prepare for the use of the non-electronic prescriptions they write for patients receiving Medicaid assistance for outpatient care. The deadline for the required use of tamper-resistant prescription pads has been extended 6 months to April 1.

Congress passed a bill authorizing the change by Sept. 27, and the president signed it into law on Sept. 29.

The law, an effort to reduce unauthorized, improperly altered, or counterfeit prescriptions, will affect ophthalmologists, of course, but probably not as much as physicians in other areas of medicine, said Sue Vicchrilli, a certified ophthalmic technician and ophthalmic coding specialist. She is a coding executive with the American Academy of Ophthalmology.

Nuts and bolts

The tamper-resistant pad requirement applies to all outpatient medications, including over-the-counter medications in states that reimburse for these items, according to Dennis G. Smith, director, Center for Medicaid and State Operations, Centers for Medicare and Medicaid Services (CMS).

But the tamper-resistant prescription pad requirement, according to CMS, will not apply to refills on written prescriptions presented to pharmacies before April 1, or for prescriptions written for Medicaid patients in nursing facilities, intermediate care facilities for the mentally retarded, and other specified institutional and clinical settings. The requirement also will not apply when a managed care entity pays for the medication.

According to CMS, "To the extent permissible under state and federal law and regulation, our guidance does not restrict emergency fills of non-controlled or controlled dangerous substances for which a prescriber provides the pharmacy with a verbal, faxed, electronic, or compliant written prescription within 72 hours after the date on which the prescription was filled."

The good news, according to Vicchrilli, is that ophthalmologists may continue to call in, e-mail, or fax most prescriptions from their offices and will not have to bother with the use of the special pads.

'Tamper-resistant' defined

Between April 1 and Oct. 1, 2008, prescription pads need meet only one of the following three characteristics. After Oct. 1, the pads must have all three of these characteristics for payment to occur:

1) One or more industry-recognized features designed to prevent unauthorized copying of a completed or blank prescription form;

2) One or more industry-recognized features designed to prevent the erasure or modification of information written on the prescription by the prescriber;

3) One or more industry-recognized features designed to prevent the use of counterfeit prescription forms.

AMA pleased

The American Medical Association (AMA) agrees with CMS' new guidance, based on the real-life experiences of physicians practicing in states with existing tamper-resistant prescription pad laws, according to Edward Langston, MD, chairman, AMA Board of Trustees.

Dr. Langston, however, had expressed concern to Ophthalmology Times about the requirement's initial deadline, and the AMA was one of several groups working to have the deadline extended "to ensure a smooth transition for patients and physicians," he said. The organization, therefore, was pleased when Congress delayed the implementation date.

"The 6-month delay addresses physicians' concerns that the implementation deadline of Oct. 1 was unreasonable and could harm Medicaid patients' access to prescribed drugs," Dr. Langston said.

Who pays for pads?

Many state Medicaid offices are providing new prescription pads to their physicians at no cost, according to Vicchrilli, which she says is appropriate if Medicaid is requiring them.

According to CMS: "If a state elects to purchase compliant prescription pads for Medicaid prescriptions and provide them to prescribers at no cost or at a discounted rate, the cost of the prescription pads is reimbursable as an administrative expense."