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Looming federal requirement calls for tamper-proof Rx pads for all Medicaid scripts
An Iraq war supplemental appropriations bill, P.L. 110-28, signed into law last May included a provision requiring the use of tamper-resistant pads for ALL prescriptions for Medicaid patients. The regulation was intended to make it more difficult for Medicaid beneficiaries to fraudulently obtain controlled substances, as well as to save money for the program.
A serious issue with this law is its implementation date, now set for Oct. 1.
The AMA has stated that this extremely short timetable could lead to significant prescription drug access problems for Medicaid patients.
“The implementation timetable is too short to educate prescribing physicians about the new law and is also likely too short to produce and distribute the enormous quantity of new prescription pads that will be needed,” said Edward Langston, M.D., a Hoosier and chair of the AMA Board of Trustees.
Indiana is one of several states that already requires tamper-resistant pads for prescribing controlled substances. In an e-mail survey, the ISMA learned only a slight majority of responding physicians use the tamper-proof or secure pads for all prescription-writing. This is likely due to cost since many identified cost of the pads as a problem, along with access to supplies. Some respondents indicated secure pads are difficult to find.
Recent developments
The AMA advised that the next step is for the Centers for Medicare & Medicaid Services (CMS) to issue guidance to state Medicaid directors. In the meantime, the AMA surveyed state medical societies about physician experience with tamper-resistant prescription requirements and provided the information to CMS. The ISMA contributed the information from its survey.
The AMA also advised CMS of physician concerns that federal requirements could conflict with state requirements and impose significant new costs on medical practices. The primary concern, however, is urging CMS to allow a transition period of 6-12 months for physicians to get up to speed on the regulation, as well as to provide for emergency dispensing when prescriptions are not written on tamper-proof pads.
Organized medicine is strongly encouraging current state requirements to be grandfathered or deemed in such a way that the federal standards would not conflict with states on issues such as the particular types of pads that would be acceptable.
CMS representatives indicated they are making a major effort to provide for emergency dispensing. But CMS does not believe it has authority to provide a delay in implementation or a transition period. Officials are trying to complete guidance for state Medicaid directors as quickly as possible; most questions regarding the requirement cannot be answered until this guidance is communicated.
EDS issued a Banner Page article on the provision. See BR200733 of Aug. 14.
On July 19, several members of Congress introduced H.R. 3090, the Patient and Pharmacy Protection Act of 2007, that would limit the tamper-proof prescribing pad requirement to Schedule II controlled substances instead of having it apply to all prescriptions. This would be helpful and a better fit between existing state requirements and the new federal requirement.
Yet, H.R. 3090 would only limit the requirement, not delay it. Continue reading ISMA Reports and e-Reports for further updates as the ISMA continues to work with the AMA on this issue.
e-Reports is the ISMA’s online version of this newsletter available about five or six days before the printed version, ISMA Reports. To immediately access information on this regulation and Special e-Alerts with other vital news for your practice, make certain the ISMA has your current e-mail address; it will not be sold, traded or shared.
Send your current e-mail address to Vicki Riley or call the ISMA.
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