| 1. Where can providers obtain tamper-resistant prescription pads? |
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Prescribers are encouraged to check with their current suppliers of prescription
pads. Providers may also obtain information on vendors of tamper-resistant
prescription pads online by using a keyword search of "secure prescription
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. The Texas Medical Association has published a list
of vendors approved for other states at the link below. These printers
meet the baseline requirements set by CMS.
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| 2. Is HHSC certifying approved printers/suppliers of tamper-resistant
prescription pads? |
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| No. At this time, HHSC is not certifying printers or suppliers. |
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| 3. What is the cost of tamper-resistant prescription pads? |
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| HHSC does not have cost information on prescription pads. Prices are available
from printers/suppliers. |
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| 4. Will the state reimburse medical providers for the cost of the tamper-
resistant prescription pads? |
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| No. |
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| 5. When will this rule become effective, and when are providers and
pharmacies expected to comply with this change? |
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Beginning April 1, 2008, Medicaid providers will be required to submit
all written prescriptions on tamper-resistant paper meeting all three
of the following characteristics
- Prevents unauthorized copying of completed or blank prescription forms.
- Prevents erasure or modification of information written on the prescription
form.
- Prevents the use of counterfeit prescription forms.
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| 6. Is this requirement limited to Schedule II controlled substances? |
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| 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 for a tamper-resistant
prescription. Providers should continue using these pads for all prescriptions
for Schedule II controlled substances. All other written prescriptions for
Medicaid recipients must be executed on tamper resistant paper. |
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| 7. Does this apply to Medicaid recipients enrolled in managed care
plans? |
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| Yes, because all prescriptions for all Medicaid recipients in Texas are
reimbursed through the Vendor Drug Program. Managed care entities do not
reimburse for out-patient prescription drugs for Texas Medicaid recipients
and therefore those prescriptions are not exempt from this requirement. |
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| 8. Are there any exceptions to having to use tamper-resistant written
prescriptions? |
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| Yes. Telephone, fax, and electronic prescriptions are exempt from this
requirement. Providers are encouraged to use these methods when submitting
prescriptions. |
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| 9. How can a pharmacist determine whether a written prescription is
tamper resistant? |
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A compliant, written prescription will have the following industry-recognized
features:
- Prevents unauthorized copying of blank or completed forms
- Prevents erasure or modification of completed forms.
- Prevents counterfeiting.
There are many suppliers of tamper-resistant prescription pads, so there
will be many variations in these features. HHSC strongly encourages providers
to use compliant pads that list their security features. Pharmacists are
expected to use their best professional judgment. If a prescription appears
to be written on plain paper, or the pharmacist has any doubts, the prescriber
should be contacted.
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| 10. If a patient presents with a prescription that is not on a tamper-resistant
pad and needs the medication right away, can the pharmacy fill the prescription?
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| Yes, the pharmacist may fill the prescription in full as it is written.
CMS requires that a compliant prescription be obtained within 72 hours of
filling the prescription. A compliant prescription is considered one that
has been faxed, telephoned, submitted electronically, or written on a tamper-resistant
prescription pad. Note: Prescriptions filled on an emergency basis due to
not being written on tamper resistant paper are not limited to a 72-hour
supply of medication. |
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| 11. What should providers do in the event that tamper- resistant prescription
pads are not available to them by April 1, 2008? |
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| Providers may submit prescriptions using an approved alternative method
such as by fax, telephone, or electronic prescription submittal. |
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| 12. Does this policy apply in cases of retroactive eligibility? What
if the patient was not eligible for Medicaid at the time of the visit? |
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| When a Medicaid recipient is retroactively eligible for Medicaid after
a pharmacy has already filled the recipient's prescription, CMS will presume
that the prescription was compliant with section 7002(b), unless there is
evidence that the prescription was non-compliant. This presumption applies
to the filling of the prescription that occurred before the recipient became
retroactively eligible for Medicaid. This presumption does not extend to
any refills that occurred after the date on which the recipient is determined
to be eligible for Medicaid. Such refills require that the pharmacy obtain
a new, tamper-resistant prescription in compliance with section 7002(b).
Alternatively, the pharmacy may obtain verbal confirmation of the prescription
from the prescriber or may obtain the prescription by facsimile or electronic
prescription. |
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| 13. Are all providers required to comply? |
| Yes. All providers writing prescriptions for Medicaid clients are required
to comply, irrespective of specialty or the setting in which they practice.
All written prescriptions are required to be submitted on tamper-resistant
prescription pads. |
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| 14. Are tamper-resistant prescriptions required when Medicaid is the
secondary payer? |
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| Yes. Per federal law, tamper-resistant prescriptions are required for
all written Medicaid prescriptions. |
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| 15. Are refills exempt from this rule? |
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| Refills of written prescriptions are only exempt if the
original written prescription was presented at a pharmacy before April 1,
2008. |
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| 16. Are tamper-resistant prescriptions required in facilities? |
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| Only hand-written prescriptions provided directly to the patient are required
to be executed on tamper-resistant prescription pads. Prescriptions for
patients in nursing homes and other facilities, where the patient does not
handle the prescription directly, are exempt from this requirement. However,
if the facility provides a written prescription to be filled by the client
directly, it must be written on a tamper-resistant prescription pad. |
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| 17. Are "drug orders" written for a resident of a nursing
facility exempt from this rule? |
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| Yes. Drug orders transmitted directly from a nursing facility to a pharmacy
are exempt, as the patient does not directly handle the prescription. |
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| 18. Are prescriptions printed in a practitioner's office from a patient's
medical record exempt from this requirement? |
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| (Revised August 2008) No. If the prescription
order is presented to the pharmacy on paper, it must contain at least one
feature from each of the three categories of tamper-resistance to comply.
Faxed and other electronic “drug orders” that go directly to the
pharmacy are exempt. Tamper-resistant printer paper may be used and is available
from suppliers of compliant prescription pads. |
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| 19. Does this requirement apply when a prescription is provided for
an over-the-counter drug? |
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| Yes. This applies to all prescribed outpatient drugs, including over-the-counter
drugs. |
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| 20. Are prescriptions written prior to April 1, 2008, but filled after
April 1, 2008, exempt from this rule? |
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| No. Any new written prescription filled on or after April
1, 2008, must be executed on a tamper-resistant prescription pad, irrespective
of the date the prescription was written. |
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| 21. Does this mean the 72-hour
emergency supply can be used for a non-compliant prescription? |
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| No. For non-compliant tamper-resistant prescription pad prescriptions,
the pharmacy should fill the prescription as written. The pharmacy must
obtain a verbal, faxed, electronic, or compliant written prescription from
the prescribing provider within 72 hours after the date on which the prescription
was filled. |
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