Family physician will have to use tamper-resistant methods to transmit prescriptions for Medicaid patients as of Oct. 1, but they will have some flexibility in how they do so, according to an Aug. 17 letter (3-page PDF; About PDFs) from CMS to state Medicaid directors.
CMS Describes Rules for Tamper-Resistant Prescriptions
Electronic, Faxed or Vocal Prescriptions OK
By News Staff
8/24/2007
The letter tells administrators that CMS will pay for prescriptions that are faxed, sent electronically or confirmed verbally by the prescribing physician.
"If the physician faxes the prescription, that will be OK," said Greg Martin, AAFP state health policy analyst. "It's OK if they verbally transmit the information by sending the patient to the pharmacy, then verbally confirm that prescription (via telephone). The rule is aimed more at preventing patients from altering the prescription than at physicians."
The new regulation stems from passage of the U.S. Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007. The law denies federal reimbursement to states for Medicaid patients' prescriptions that are not written on tamper-resistant prescription pads as of Oct. 1.
According to the letter from CMS, the requirement for tamper-resistant pads does not apply to
"If the physician faxes the prescription, that will be OK," said Greg Martin, AAFP state health policy analyst. "It's OK if they verbally transmit the information by sending the patient to the pharmacy, then verbally confirm that prescription (via telephone). The rule is aimed more at preventing patients from altering the prescription than at physicians."
The new regulation stems from passage of the U.S. Troop Readiness, Veterans' Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007. The law denies federal reimbursement to states for Medicaid patients' prescriptions that are not written on tamper-resistant prescription pads as of Oct. 1.
According to the letter from CMS, the requirement for tamper-resistant pads does not apply to
- refills of written prescriptions presented to a pharmacy before Oct. 1;
- e-prescriptions transmitted to the pharmacy;
- prescriptions faxed to the pharmacy;
- prescriptions communicated to the pharmacy by a prescriber via telephone;
- prescriptions a managed care organization pays for;
- medications provided in nursing facilities, intermediate-care facilities for the developmentally disabled, and other "specified institutions and clinical settings"; or
- 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 rule does apply "to all outpatient drugs, including over-the-counter drugs in states that reimburse for prescriptions for such items," according to CMS.
Although CMS encourages e-prescriptions, the agency will reimburse states for the cost of purchasing compliant prescription pads and providing them to physicians at no cost or at a discounted rate, the letter says.
Although CMS encourages e-prescriptions, the agency will reimburse states for the cost of purchasing compliant prescription pads and providing them to physicians at no cost or at a discounted rate, the letter says.
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