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Tamper Resistant Prescriptions |
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Pursuant to federal law (H.R. 2206 / Public Law 110-28, U.S. Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act, 2007), effective April 1, 2008, prescribing practitioners will be required to use tamper-resistant prescription paper when writing a prescription for any drug for Medicaid recipients. The Texas Health and Human Services Commission (HHSC) requested an exemption to this regulation for its Medicaid providers. However, the federal Centers for Medicare and Medicaid Services (CMS) determined that it does not have the statutory authority to grant an exemption to federal law. This regulation applies to all written prescriptions submitted for payment through the Vendor Drug Program (VDP) for all Texas Medicaid beneficiaries. The regulation does not apply to prescription orders transmitted to a pharmacy via telephone, fax, or electronically. According to CMS, the purpose of tamper-resistant prescription pads is to reduce instances of unauthorized, improperly altered, and counterfeit prescriptions. In order for a written prescription to be considered tamper resistant by CMS, the prescription paper must meet the following three characteristics:
The tamper-resistant requirement is only mandatory for prescriptions written for Medicaid clients. However, HHSC encourages prescribers to adopt the use of tamper-resistant paper for all their patients. It will reduce their over-all risk and will avoid the confusion of determining which pad to use for which patient. |
| 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. Effective 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 (Appendix A) 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 patient presents a written prescription and the pharmacist is unsure whether the prescription is compliant, the prescribing practitioner should be contacted for verification. See the NCPDP Guide of Summary 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. The National Council for Prescription Drug Programs (NCPDP) has developed a guide to many of the available features. Prescribers should refer to the NCPDP Guide of Summary Features before 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. The Texas Medical Association sent a message to physicians on February 1, 2008. The notice is available on their website (www.texmed.org) under the link "Tamper-Resistant Rx Pads Required April 1." The notice also includes a consolidated list of vendors of compliant pads. 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. Links to printers approved by other states are provided below:
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The Centers for Medicare and Medicaid Services (CMS) previously stated that prescriptions printed from electronic medical records (EMRs) or E-Prescribing applications would need special copy-resistant paper to be in compliance with the tamper-resistant prescription pad regulation. CMS has recently clarified this regulation and has stated that prescriptions printed from EMRs or E-Prescribing applications may be printed on plain paper and will be fully compliant if they contain at least one feature from each of the three compliance categories listed. CMS has identified at least two features that can be incorporated into computer generated prescriptions printed on plain paper to prevent passing a copied prescription as an original prescription. One feature would be the use of a very small font that is readable when viewed at 5x magnification or greater, and illegible when copied. Another feature would be a “void” pantograph accompanied by a reverse “Rx”, which causes a word such as “Void” to appear when the prescription is photocopied. The National Council for Prescription Drug Programs (NCPDP) has developed guidance and examples of best practices and examples of tamper-resistant prescriptions (handwritten and EMR generated). |
| Additional Resources |
TRPP Compliance Referral Form |
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