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In order for a written prescription to be considered tamper resistant by the Centers for Medicare & Medicaid Services (CMS), the prescription paper must meet the following three characteristics:

  • Prevent unauthorized copying of completed or blank prescription forms.
  • Prevent erasure or modification of information written on the prescription form.
  • Prevent the use of counterfeit prescription forms.

The tamper-resistant requirement is only mandatory for prescriptions written for Medicaid clients, it is not a requirement for the CHIP, CSHCN, or KHC programs.  If a client with both Medicaid and CSHCN eligibility presents a written, non tamper-resistant prescription to a pharmacy provider, the pharmacy may not bill CSHCN to circumvent the tamper-resistant pad regulation.  HHSC encourages prescribers to adopt the use of tamper-resistant paper for all their clients. It will reduce their overall risk and will avoid the confusion of determining which pad to use for which client.

CMS has stated that special copy-resistant paper is not a requirement for prescriptions printed from electronic medical records (EMRs) or ePrescribing generated prescriptions. These prescriptions may be printed on plain paper and will be fully compliant with all three categories of the tamper-resistant regulations, provided they contain at least one feature from each of the three categories.

Schedule II Controlled Substances

CMS has determined that the prescription forms for Schedule II controlled substances, issued by the Texas Department of Public Safety (DPS) under the Texas Prescription Program, meet the baseline standards set forth above. Providers should continue using these pads for all prescriptions for Schedule II controlled substances. These pads should not be used to write prescriptions for non-Schedule II drugs.

Beginning April 1, 2008, federal law requires Medicaid agencies to limit reimbursement for written (and non-electronic) prescriptions to only those executed on tamper-resistant pads. Prescribing practitioners should take necessary steps to ensure that tamper-resistant paper is used for all written or printed prescriptions provided to Medicaid clients, or that compliant, non-written alternatives are used for transmitting prescriptions, such as by telephone, fax, or electronic submittal. Pharmacies are required to ensure that all written Medicaid prescriptions submitted for payment to the Vendor Drug Program are written on a compliant tamper-resistant pad.

Exceptions

Prescription orders transmitted to a pharmacy electronically, by telephone, or by fax are exempt from this requirement. Prescribing practitioners are encouraged to submit prescriptions through one of these approved processes whenever possible to ensure continuity of care and access to necessary medications for Medicaid recipients. The tamper-resistant requirement also does not apply to refills of a written prescription that was dispensed at a pharmacy before April 1, 2008. Please see the Questions and Answers section of the March 2008 notice for additional exemptions and exceptions.

Access to Care

The tamper-resistant prescription pad requirement is intended to reduce forged and altered prescriptions and deter drug abuse. It is not intended to restrict recipient access to medically necessary pharmaceuticals. If a Medicaid recipient presents with a non-compliant prescription, the pharmacist can obtain telephone verification from the prescriber and dispense the prescription in full (as written). The pharmacist must note the verification on the original written prescription. The pharmacist may also fill the prescription and obtain a compliant prescription by facsimile, electronic prescription, or re-written on tamper-resistant paper within 72 hours after the date the prescription was filled.

Any time a client presents a written prescription and the pharmacist is unsure whether the prescription is compliant, the prescribing practitioner should be contacted for verification.  Please refer to the National Council for Prescription Drug Programs (NCPDP) Summary of Features for a list of tamper-resistant features that are commonly available. To assist pharmacists in determining if a prescription is in compliance with the tamper-resistant requirements, prescribers are encouraged to purchase prescription paper that lists the security features.

Obtaining Prescription Pads

Prescribers may select their supplier of CMS-compliant prescription pads. Information on available vendors may be obtained online by using a keyword search of "secure prescription pads."

There are many compliant features available from security prescription vendors. Please refer to the NCPDP Summary of Features to learn about many of the available features prior to ordering tamper-resistant prescription pads or paper.

Pharmacists have voiced concerns about how to identify a tamper-resistant prescription. HHSC encourages pharmacists to call the prescriber every time they have a question. HHSC strongly encourages all prescribers to order tamper-resistant prescription pads that clearly list the security features. This will reduce the number of calls and cause the least workflow disruption for both pharmacists and prescribers.

In addition, some states such as California, Florida, Indiana, Kentucky, Maine, West Virginia, and Wyoming currently have tamper-resistant programs in place whereby they certify specific printers for tamper-resistant prescription pads. These printers meet the baseline requirements set by CMS.

Compliance Referral Form

If you are a Vendor Drug Program contracted pharmacy and you believe HHSC's educational assistance may benefit a prescriber’s compliance with this federal law, please complete the Texas Medicaid TRPP Compliance Referral Form and fax to 817-321-8064.