Oct. 1 deadline looms for 3 Medicaid prescription security features

Washington -- Written Medicaid prescriptions by Oct. 1 must have at least three features to prevent unauthorized copying, erasure or modification, and counterfeiting under a federal tamper-resistant prescription law.

This deadline is the second implementation phase of the law, adopted by Congress in May 2007. The first phase required physicians to issue prescriptions with at least one security feature by April 1, 2008. By Oct. 1, physicians who issue written prescriptions must be using pads that have three features built in.

The law does not apply to electronic, faxed or phoned prescriptions, or prescriptions for medications paid for by Medicaid private insurers.

Stakeholder groups, including the National Council for Prescription Drug Programs -- a standards organization for the pharmacy industry -- are not expecting physicians, pharmacists or state Medicaid programs to have many problems complying with the Oct. 1 deadline, said Phillip Scott, NCPDP's senior vice president for business development.

"It appears to me that most states have initiated what was required for the Oct. 1 deadline," he said.

In April, some pharmacists still didn't know about the law and its security features requirement, said Marcie Bough, PharmD, director of federal regulatory affairs for the American Pharmacists Assn. "More people should be aware of it this time around than in April."

The key remaining issue with the tamper-resistant law likely was resolved at a June 26 meeting convened by the NCPDP, Scott said. Physicians using electronic medical records systems were concerned that the law on Oct. 1 would require them to adjust their systems to use copy-resistant paper for printing prescriptions.

Physicians with an EMR need to print prescriptions for a number of reasons, said Peter Basch, MD, an internist and co-chair of the Physicians Electronic Health Record Coalition, which represents physician organizations -- including the American Medical Association -- on health information technology issues. For example, the Drug Enforcement Administration does not yet allow physicians to transmit prescriptions electronically for controlled substances, though it has proposed regulations to do so. Dr. Basch, whose practice has used an EMR for 11 years, prints up to 40% of his prescriptions.

Changing an EMR to print in a new format on a new type of paper can be difficult and expensive, Dr. Basch said. Also, copy-resistant paper costs between $60 and $100 per ream. However, the NCPDP, advised by the Centers for Medicare & Medicaid Services, since has clarified that physicians can use plain white paper as long as they adopt three security features.

One recommended security feature is micro-printing, the process of printing thin lines that upon close examination are seen to be lines of text. If photocopied, the lines blur.

Another easy-to-adopt, EMR-friendly security feature, Dr. Basch said, is printing asterisks or number signs before and after the number of pills on the prescription to prevent, for example, a 50 from being changed to a 500. A third possible option is listing a description of security features on the prescription.