DEA Confirms Providers Can Prescribe Controlled Substances Via Telemed

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The Department of Health and Human Services (HHS) and the Drug Enforcement Administration (DEA) have released clarification of United States Code contained in the Controlled Substances Act affecting Telehealth visits. 

 

President Trump in a Tuesday briefing said his administration would "encourage everyone to maximize use of telehealth to limit exposure to the virus."

 

The DEA has clarified that during a Public Health Emergency, which was issued by Secretary Azar of HHS on January 31st, 2020 due to the COVID-19 virus, that controlled substances may be prescribed via telemedicine without first conducting an in-person visit with the patient.  The Ryan Haight Act of 2008 established regulations and prohibited heathcare providers from prescribing controlled substances to patients that they haven’t first examined in-person.  Section 802(54)(D) of the Controlled Substances Act allows for the Ryan Haight Act to be circumvented during a public health emergency which would allow MDToolbox customers to electronically prescribe controlled substances (EPCS) for patients via telemedicine.

 

The DEA has stated three conditions for prescribing controlled substances via telemedicine:

  • The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of his/her professional practice
  • The telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system.
  • The practitioner is acting in accordance with applicable Federal and State law.

 

Not all States allow for EPCS via telemedicine, prescribers will need to ensure that they are following both their State law as well as the State law where the patient resides prior to prescribing via telemedicine.  Some states that allow for EPCS via telemedicine include Indiana, Michigan, Ohio, Florida, Delaware, New Hampshire, West Virginia, and Connecticut.  Prescribers should contact their State Medical and Pharmacy Boards as well as the State Boards where their patient resides to ensure their compliance.

 

HHS has also issued further clarification on the systems that can be used for a telemedicine visit, they have ensured penalties will not be enforced for using apps such as:

  • Apple FaceTime
  • Facebook Messenger video chat
  • Google Hangouts video
  • Skype

 

This is not an inclusive list and are examples of apps that can be used.  The app must be a private communication means that support both audio and video.  The DEA provided further clarification that public communication apps or streaming services are not to be used such as:

  • Facebook Live
  • Twitch
  • TikTok

 

The DEA has missed several deadlines to establish rules and a waiver system to allow electronic prescribing of controlled substances via telemedicine during a time in which we are not in a Public Health Emergency.  Reducing these road-blocks, as we are seeing with the emergency measures in place due to COVID-19 can help bring healthcare into the 21st century and help reduce stress on our medical system as well as help prevent infections.

 

We at MDToolbox applaud HHS and the DEA for removing the telemedicine restrictions and our team are watching for more regulation changes on a federal level that would allow electronic prescription of controlled substances via a telehealth practitioner.  You will find any policy and regulation updates here in our blog.  MDToolbox looks forward to working with telehealth providers and help provide tools and resources in combating healthcare system strain.  Contact us for more information or to start your free 30 day free trial.

New Legislation Reduces Telehealth Restrictions

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Emergency legislation has just been enacted that will allow for Medicare reimbursement for practices utilizing telemedicine to treat patients at home regardless of where they live.  The Coronavirus Preparedness and Response Supplemental Appropriations Act was introduced on Wednesday March 6th, 2020.  The bill was enacted and became law on the following Friday with near unanimous support in both the House and Senate.  The Act provides $8.3 billion in emergency funding to agencies responding to the Coronavirus outbreak.

 

The emergency funding is to be distributed by the Department of Health and Human Services (HHS) as follows:

  • $3.4 billion for the Office of the Secretary – Public Health and Social Services Emergency Fund (PHSSEF)
  • $1.9 billion for the Centers for Disease Control and Prevention (CDC)
  • $1.6 billion for international response efforts
  • $836 million for the National Institute of Allergy and Infectious Diseases (NIAID),
  • $61 million for the Food and Drug Administration (FDA)
  • $20 million is for the Small Business Administration (SBA)

 

The Act includes a provision entitled the “Telehealth Services During Certain Emergency Periods Act of 2020” which details a waiver removing restrictions on Medicare providers allowing them to offer telehealth services to beneficiaries regardless of whether the beneficiary is in a rural community.  The waiver becomes effective when either the President of the United States or Secretary of HHS declare a public health emergency.  Secretary Azar of HHS declared a public health emergency on January 31st, 2020 which was retroactive to January 27th, 2020.

 

 “To protect public health, the bill will allow Medicare providers to extend telemedicine services to seniors regardless of where they live, at an estimated cost of $500 million,” House Speaker Nancy Pelosi said in a statement released on March 4th.

 

From the demographics of those infected and killed by COVID-19 internationally, the current data available shows that the elderly age group are most affected by the virus.  While the virus has only begun spreading rapidly in the US in the past two weeks, the Act will hopefully be pro-active enough to save lives by giving patients the option to stay home, away from hospitals and doctor offices to be triaged and seen remotely by care providers.

 

China needed to emergently construct temporary hospitals in a matter of days to handle the influx of patients seeking medical attention, the US could likely see a similar rise in hospital visits and admittances.  Further adoption of telehealth could help alleviate some of that strain on the healthcare system, reducing infection by keeping patients at home, allowing providers to see more patients, and by reducing the sheer numbers of people entering healthcare facilities.

 

MDToolbox has positioned itself to cater to both traditional and telehealth providers needing a simple feature-rich electronic prescribing solution that can be implemented in a minimal timeframe.  Our stand-alone electronic prescribing system is streamlined and easy to use with a much more gentle learning curve than larger EMRs.  Most prescribers can be electronically prescribing within 24 hours, minimal downtime before being able to send prescriptions electronically to more than 98% of the pharmacies in the U.S. including mail order pharmacies that can deliver directly to home-quarantined patients.

 

Although the Coronavirus Preparedness Act removes some of the restrictions hindering telemedicine, the DEA has missed several deadlines to establish rules and a waiver system to allow electronic prescribing of controlled substances (EPCS) via telemedicine.  The Ryan Haight Act of 2008 requires an in-person consultation at regular intervals prior to EPCS via telemedicine.  Reducing these road-blocks can help bring healthcare into the 21st century and help reduce stress on our medical system as well as help prevent infections.

 

We at MDToolbox applaud Congress and HHS for removing some of the telemedicine restrictions and our team are watching for more regulation changes on a federal level that would allow electronic prescription of controlled substances via a telehealth practitioner.  You will find any policy updates here in our blog.  MDToolbox looks forward to working with telehealth providers and help provide tools and resources in combating healthcare system strain.  Contact us for more information or to start your free 30 day free trial.

 

HHS Release Strategy to Reduce EHR Clinician Burden

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The U.S. Department of Health and Human Services (HHS) has released their Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs report. This report was required by the 21st Century Cures Act and is intended to reduce the effort and time required by clinicians to meet reporting requirements, record health information, and improve the functionality and intuitiveness of EHRs.

 

“Usable, interoperable health IT is essential to a healthcare system that puts the patient at the center” said HHS Secretary Alex Azar. “We received feedback from hundreds of organizations and healthcare providers on this new burden-reduction strategy, and the input made clear that there are plenty of steps still necessary to make IT more usable for providers and maximize the promise of electronic health records.”

 

Clinician burden is linked to EHR usability, the report was written considering input from more than 200 comments submitted in response to the draft report (released in November 2018) and recommendations. The report details three primary goals:

 

  • Reduce the effort and time required to record information in EHRs for health care providers when they are seeing patients
  • Reduce the effort and time required to meet regulatory reporting requirements for clinicians, hospitals, and health care organizations
  • Improve the functionality and intuitiveness (ease of use) of EHRs.

 

“The taxpayers made a massive investment in EHRs with the expectation that it would solve the many issues that plagued paper-bound health records,” said CMS Administrator Seema Verma. “Unfortunately – as this report shows – in all too many cases, the cure has been worse than the disease. Twenty years into the 21st century, it’s unacceptable that the application of Health IT still struggles to provide ready access to medical records – access that might mean the difference between life and death. The report’s recommendations provide valuable guidance on how to minimize EHR burden as we seek to fulfill the promise of an interoperable health system.”

 

Specifically, ONC and CMS looked at four key areas and offered strategies to address each area:

 

  •  Increasing public health reporting by working to increase provider PDMP queries, increasing adoption of EPCS, and developing a process to address the issue of inconsistent data collected by federal, state, and local programs.
  • Reducing clinical documentation requirements by leveraging health IT to standardize data and processes around ordering services and by reducing required documentation for patient visits.
  • Increasing health IT usability and standardization by promoting user interface optimization, promoting harmonization surrounding clinical content such as medication information, and simplifying order entry in EMRs to reduce burden.
  • Standardizing federal health IT and EHR reporting by simplifying program requirements such as the Merit-based Incentive Payment System (MIPS) and the Medicare Promoting Interoperability Program.

 

MDToolbox is optimistic that the medical industry will soon see improvements that stem from the research and public commentary addressed in this report as it is used to affect coming regulations and standards.  We are proud to have already addressed some of the key strategic areas for improvement detailed in the report.  With MDToolbox, providers have access to tools such as Electronic Prescribing of Controlled Substances (EPCS), convenient on the go e-prescribing with our mobile app, and prescribers can register for our PMP-gateway access option in most states.  Our engineers are continually developing methods and workflows to save providers and medical staff time and energy.  We offer a free 30 day free trial, so Contact us for more information!

OptumRx to require electronic prescribing for all controlled substances.

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OptumRx, the pharmacy benefit provider for United Healthcare, will require electronic prescriptions for all controlled substances for its home delivery pharmacy service effective March 1, 2020.  OptumRx has stated that they are “…part of a nationwide effort to require e-prescriptions for opioids and other controlled substances for its home delivery pharmacy. We’re joining with care providers and communities to help prevent opioid misuse and addiction.” MDToolbox commends OptumRx for being among the first home delivery pharmacy services to require EPCS (electronic prescribing of controlled substances).

 

At this time, the requirement does not apply to members residing in Alaska, Guam, Puerto Rico, or the U.S. Virgin Islands.  OptumRx is also not requiring prescribers who are exempt from either their State EPCS requirements or the SUPPORT Act EPCS requirements.  As states have created legislation for their own electronic prescribing mandates, some have allowed for prescribers to apply for temporary exemptions that will be honored by OptumRx.

 

2020 sees several more states requiring electronic prescribing such as Arizona, Florida, Iowa, North Carolina, Oklahoma, Rhode Island, and Virginia.  As of this week, 33 of 50 states have current or pending electronic prescribing mandate legislation.  Federal law will also require physicians to electronically prescribe controlled substances for Medicare patients effective January 1, 2021.  There will likely be more major mail-order and retail pharmacies requiring electronic prescribing in the near future, continue watching our blog for the latest news on electronic prescribing.

 

Please see our website for states that have either passed or have pending legislation that mandates electronic prescribing.  MDToolbox looks forward to providing tools and resources to assist providers throughout the United States to ease the transition and help our customers combat the opioid epidemic.  With MDToolbox, providers have access to tools such as Electronic Prescribing of Controlled Substances (EPCS) and convenient on the go e-prescribing with our mobile app!  We offer a free 30 day free trial, so Contact us for more information!

 

Massachusetts Delays Electronic Prescribing Mandate

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Massachusetts passed House Bill 4742An Act for Prevention and Access to Appropriate Care and Treatment of Addiction” in 2018 which mandated prescribers to electronically prescribe all controlled substances by January 1st, 2020.  The bill also required prescribers to utilize the state Prescription Monitoring Program (PMP) when writing a prescription for a Schedule II, III, or benzodiazepine.

 

After taking public comment in the summer of 2019, the Massachusetts Department of Public Health presented proposed amendments to the Public Health Council.  These amendments were approved at the end of September 2019.  The new amendments go into effect on 12/27/19, just ahead of the mandate deadline of 1/1/20. 

 

The approved amendments that were adopted include:

  • Delay full implementation of the ePrescribing mandate until January 1, 2021;
  • Clarify pharmacists’ role related to filling prescriptions submitted under an ePrescribing exception or waiver;
  • Expand the Schedule VI exception from individuals with a MCSR for Schedule VI only to all Schedule VI medications;
  • Clarify prescriptions that cannot be issued electronically under federal or state law or regulations, including those prescriptions the FDA requires contain elements, such as an attachment, that are not supported through current ePrescribing systems; and
  • Add two additional ePrescribing exceptions as follows:

o   Prescriptions for residents of nursing homes through January 1, 2023, or such later date as determined by the Department; and

o   Prescriptions issued in response to a declared public health emergency, diseases dangerous to public health, or other urgent public health matter. 

 

The Massachusetts Department of Public Health stated that education and guidance will be forthcoming throughout the remainder of 2019 and through 2020.  This will also include additional guidance to prescribers and facilities regarding the waiver process if more time (past 1/1/21 deadline) is necessary.

 

MDToolbox recommends adopting electronic prescribing and integrating it into your practice as early as possible to be prepared to meet any approaching deadlines.  Please see our website for other states that have either passed or have pending legislation that mandates electronic prescribing.  MDToolbox looks forward to providing tools and resources to assist providers throughout the nation to ease the transition and help our customers combat the opioid epidemic.  With MDToolbox, providers have access to tools such as Electronic Prescribing of Controlled Substances (EPCS) and convenient on the go e-prescribing with our mobile app!  We offer a free 30 day free trial, so Contact us for more information!

State Legislative Sessions 2019 - A State-of-the-States Report

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Most state legislative sessions have come to a close for 2019.  There are a handful of states that have year-round legislative sessions (MA, MI, NJ, NY, OH, PA, WI), but the majority of 2019 state legislation being drafted has either passed or died.  We saw a record number of States this year that have passed electronic prescribing mandates.  As of the writing of this blog, 27 of the 50 states have an active or pending mandate! 

 

States that have passed a mandate in 2019 are listed below:

 

States requiring e-prescribing of all prescriptions:

 

  • Delaware (1/1/21)
  • Florida (7/1/21 or upon license renewal)

 

States requiring e-prescribing of controlled substances:

 

  • Arkansas (1/1/21)
  • Colorado (7/1/21 or 7/1/23 for solo practitioners)
  • Indiana (1/1/21)
  • Kansas (7/1/21)
  • Kentucky (1/1/21)
  • Missouri (1/1/21)
  • Nevada (1/1/21)
  • South Carolina (1/1/21)
  • Texas (1/1/21)
  • Washington (1/1/21)
  • Wyoming (1/1/21)

 

Two states have enacted amendments to their previously passed mandates.  Tennessee has made several major changes to their mandate.  The amended Act expands the mandate to cover not only Schedule II drugs, but all controlled substances.  The effective date has also been postponed to January 1st, 2020.  Arizona has also amended their mandate passed in 2018.  Arizona had initially set effective dates of January 1, 2019 for prescribers in counties with populations more than 150,000 and July 1, 2019 for prescribers in rural counties with less than 150,000 residents.  The amended mandate has an updated effective date of January 1st, 2020 for all counties in the State.

 

The majority of states share language in their bills, however there are a few state mandates that contained unique provisions in the wording of their legislation.

  • Missouri’s mandate states that electronic prescriptions of controlled substances can be substituted with a written prescription at the direct request of the patient, maintaining an avenue for written prescriptions.

 

  • Florida’s mandate has a provision that allows for practices that exclusively use paper charts to not follow the state mandate requiring electronic prescribing.  In speaking with a prescriber in Florida, they were waiting for clarification on this provision before making any prescribing arrangements as the provision’s wording is not entirely clear as to what constitutes an electronic health record as is written in the Act.

 

  • Washington’s mandate requires that medical entities with ten or more prescribers must use an EHR that is integrated with the state Prescription Monitoring Program (PMP) database.  The EHR must demonstrate both sending and receiving of PMP data.  A waiver process will be made available for this requirement.

 

  • Colorado allows for practitioners who write less than 25 prescriptions for controlled substances per year to not have to adopt electronic prescribing.

 

Michigan currently has pending legislation for their mandate and is currently being deliberated in committee.  There is also an anticipated update to the Ryan Haight act as required per 2018’s SUPPORT Act regarding telemedicine.  The deadline established in the SUPPORT Act is October 24th, 2019.  Watch our blog or check our social media accounts for any updates regarding either of these legislation changes.

 

If you reside in any of the states that have enacted mandates this year, MDToolbox encourages prescribers to do their research and adopt a solution early to ensure that they comply with state regulations.

 

Please see our website for other states that have either passed or have pending legislation that mandates electronic prescribing.  MDToolbox looks forward to providing tools and resources to assist providers throughout the United States to ease the transition and help our customers combat the opioid epidemic.  With MDToolbox, providers have access to tools such as Electronic Prescribing of Controlled Substances (EPCS) and convenient on the go e-prescribing with our mobile app!  We offer a free 30 day free trial, so Contact us for more information!

Florida and Delaware Mandate Electronic Prescribing

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Florida and Delaware Governors Ron DeSantis and John Carney have both recently signed electronic prescribing mandates into law.  Florida HB831 mandates healthcare providers to electronically prescribe all medications with an effective date of either July 1st, 2021, or upon license renewal (beginning January 1st, 2020).  This bill was a bipartisan initiative that was amended several times in both the house and senate before being enacted.  Delaware HB115 mandates healthcare providers to electronically prescribe all medications with an effective date of January 1st, 2021.

 

Other subsections of the Florida Act include:

  • The Act makes changes to the required information included on written prescriptions.
  • There are provisions in the Act for a waiver system with similar circumstances for approval as other states have enacted.  Some of these include economic hardship, technological limitations, and other circumstances determined by the board.
  • The Act establishes that penalties may be issued if a prescriber fails to keep control over their prescription pads and authorized access to their electronic prescribing software.
  • A large portion of the Act amends prior legislation that gives power to the “agency” that governs Florida health practitioners and practices.  There are several tasks detailed for the agency to complete pertaining to medications, pharmacies, and Medicaid.

 

Other subsections of the Delaware Act include:

  • There are provisions in the Act for a waiver system with similar circumstances for approval as other states have enacted.  Some of these include economic hardship, technological limitations, and other circumstances determined by the board.
  • Pharmacies and dispensers are not required to verify that a prescription presented to the pharmacy via other means than an electronic prescription is legally able to be filled.

 

Florida is currently above the national average for opioid-related overdose deaths, with 16.3 deaths per 100,000 people while the national average is 14.6 deaths.  Prescription opioid overdose deaths continued to gradually rise until 2011, then decreased until 2015.  Heroin, prescription Opioids, and synthetic opioid deaths have all risen drastically since then.[1]  Florida implemented their PMP in 2011 and also began restricting some controlled substances.  In 2017, Florida declared a state of emergency due to the Opioid epidemic and began writing additional legislation.  HB21 was a major change enacted in 2018 that required usage of the State Prescription Monitoring Program (PMP), required additional opioid training for prescribers, and placed limitations on the number of pills that can be prescribed.

Delaware is also currently above the national average for opioid-related overdose deaths, with 21.7 deaths per 100,000 people while the national average is 14.6 deaths.  Overdose deaths remained consistently above the national average from 2008 to 2016 and have risen drastically in 2016 and 2017 with 37.0 deaths per 100,000 people in 2017.[2]  Delaware enacted legislation that restricted opioid prescriptions to 7 days beginning in 2017.  Long-term opioid treatment is available, but only after certain criteria is met including regular queries of the State Prescription Drug Monitoring Program.

Florida currently has a 15.3% prescriber enablement for electronic prescribing of controlled substances; Delaware has a 20.3% prescriber enablement.  Both states are significantly below the national average of 35.4%.  Pharmacy enablement in Florida for EPCS is 92.9% which is the second lowest of any State in the US.  Delaware currently has a 99.5% pharmacy enablement, the national average is 95.4%.[3]  MDToolbox encourages providers not to wait until the last minute to setup electronic prescribing!

Please see our website for other states that have either passed or have pending legislation that mandates electronic prescribing.  MDToolbox looks forward to providing tools and resources to assist providers throughout Florida and Delaware to ease the transition and help our customers combat the opioid epidemic.  With MDToolbox, providers have access to tools such as Electronic Prescribing of Controlled Substances (EPCS) and convenient on the go e-prescribing with our mobile app!  We offer a free 30 day free trial, so Contact us for more information!

 

[1]https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state/florida-opioid-summary

 

[2]https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state/delaware-opioid-summary

 

[3]https://surescripts.com/enhance-prescribing/e-prescribing/e-prescribing-for-controlled-substances/

Missouri Mandates Electronic Prescribing

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 Missouri Governor Mike Parson recently signed SB275 into law. This Act mandates Missouri healthcare providers to electronically prescribe all controlled substance medications contained in Schedules II-IV with an effective date of January 1st, 2021.  Missouri was very determined to pass an EPCS mandate, as they had at least 6 pieces of legislation pending that contained a mandate.  SB275 contains many elements of the additional pieces of legislation that were being debated.

 

Other subsections of the Act include:

  • The Act states that electronic prescriptions of controlled substances can be substituted for a written prescription at the direct request from the patient.
  • There are provisions in the Act for a waiver system with similar circumstances for approval as other states have enacted.  Some of these include economic hardship, technological limitations, and other circumstances determined by the board.
  • The Act establishes penalties for practitioners who do now follow regulations established in this Act.
  • The Act establishes the “Joint Committee on Substance Abuse Prevention and Treatment”, a new commission consisting of Senate, House, and governor-elected members to explore solutions and modify legislation for the state of Missouri pertaining to substance abuse.
  • Regulations for the cost of Medication-Assisted Treatment (MAT) are established within the Act.
  • Dentists are no longer allowed to prescribe extended-release opioids and any doses greater than 50 Morphine Milligram Equivalents per day.
  • Several other state regulations are changed including: Drug trafficking offenses, practitioner credentialing procedures, nicotine replacement therapy, and collaborative practice arrangements between physicians and physician assistants.

 

Missouri is currently above the national average for opioid-related overdose deaths, with 16.5 deaths per 100,000 people while the national average is 14.6 deaths.  Prescription opioid overdose deaths continued to gradually rise until 2010, then have remained stable.  Heroin deaths have gradually risen since 2007 and synthetic opioid deaths have all risen drastically since 2014, up from ~100 to 618 in 2017.[1]  Missouri is the only state in the US to have not established a Prescription Drug Monitoring Program (PDMP).  However, St. Louis County, MO created their own PDMP for use within their county.  Jackson County, MO has partnered with St. Louis County to use their PDMP.  Prescribers across the state have joined the PDMP on a voluntary basis, tired of waiting for Missouri State Legislators to establish an official state-wide PMP.  There is currently no state legislation for establishing a PDMP.

Missouri currently has a 25% prescriber enablement for electronic prescribing of controlled substances, which is below the national average of 35.4%.  Pharmacy enablement for EPCS is 97.9% which is above the national average for pharmacy enablement is 95.4%.[2]  There will likely be a big push leading up to 2021 to secure electronic prescribing, MDToolbox encourages providers not to wait!

Please see our website for other states that have either passed or have pending legislation that mandates electronic prescribing.  MDToolbox looks forward to providing tools and resources to assist providers throughout Missouri to ease the transition and help our customers combat the opioid epidemic.  With MDToolbox, providers have access to tools such as Electronic Prescribing of Controlled Substances (EPCS) and convenient on the go e-prescribing with our mobile app!  We offer a free 30 day free trial, so Contact us for more information!

 

[1]https://www.drugabuse.gov/opioid-summaries-by-state/missouri-opioid-summary

[2]https://surescripts.com/enhance-prescribing/e-prescribing/e-prescribing-for-controlled-substances/

Texas and Nevada Mandate Electronic Prescribing

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Texas Governor Greg Abbott recently signed HB2174 into law, Nevada Governor Steve Sisolak has also signed AB310 into law.  Both Acts mandate Texas and Nevada healthcare providers to electronically prescribe all controlled substance medications with an effective date of January 1st, 2021.

Both Acts contain provisions for a waiver system with similar circumstances for approval as other states have enacted.  Some of these include economic hardship, technological limitations, and other circumstances determined by the board.  Reapplying for a waiver for subsequent years is also covered.

 

The Texas Act also establishes:

  • The Act allows for partial filling of Schedule II prescriptions, but only for patients in long-term care facilities or for hospice patients with a medical diagnosis documenting a terminal illness.
  • Pharmacies and dispensers are not required to verify that a prescription presented to the pharmacy via other means than an electronic prescription is legally able to be filled.
  • The Act clarifies what specific information needs to be contained in both written and electronic prescriptions.
  • Prescribers and pharmacists are required to complete two hours of continuing education on procedures of prescribing and monitoring controlled substances.  This education must be completed within one year of receiving a license to prescribe or dispense controlled substances.
  • Prescribers are unable to write prescriptions that exceed a 10 day supply when being written for acute care.

 

The Nevada Act also establishes:

  • The Act establishes penalties for practitioners who do now follow regulations established in this Act.
  • More than half of the Act amends various pieces of Nevada code discussing potential penalties for medical staff.

 

Texas is currently well below the national average for opioid-related overdose deaths, with 5.1 deaths per 100,000 people while the national average is 14.6 deaths.  Prescription opioid overdose deaths peaked in 2006 and have remained mostly stable since.  Heroin deaths have gradually risen since 2000 and synthetic opioid deaths have remained stable until 2014, when they began to rise.  Texas also has a lower than average opioid prescription rate, this number has been decreasing since 2012[1]  Effective 9/1/19, pharmacists and prescribers will be required to consult the state PMP prior to dispensing or prescribing controlled substances.

 

Nevada is currently also below the national average for opioid-related overdose deaths, with 13.3 deaths per 100,000 people while the national average is 14.6 deaths.  Prescription opioid overdose deaths continued to gradually rise until 2010, then have been reduced or remained stable.  Heroin deaths have gradually risen since 2011 and synthetic opioid deaths have slightly risen since 2015.[2]  Nevada passed SB459 in 2015 which mandated that Nevada prescribers check the state Prescription Drug Monitoring Program for controlled substance prescriptions.  AB474 was passed in 2017 which was considered “a comprehensive measure that addresses misuse, abuse, and diversion through enacting prescribing protocols at appropriate levels.”[3]

Texas currently has a 31.1% prescriber enablement for electronic prescribing of controlled substances while Nevada has nearly half the enablement of Texas.  Pharmacy enablement for both states is near the national average of 95.4%.[4]  There will likely be a big push leading up to 2021 to secure electronic prescribing, MDToolbox encourages providers not to wait!

Please see our website for other states that have either passed or have pending legislation that mandates electronic prescribing.  MDToolbox looks forward to providing tools and resources to assist providers throughout Texas and Nevada to ease the transition and help our customers combat the opioid epidemic.  With MDToolbox, providers have access to tools such as Electronic Prescribing of Controlled Substances (EPCS) and convenient on the go e-prescribing with our mobile app!  We offer a free 30 day free trial, so Contact us for more information!

 

[1]https://www.drugabuse.gov/opioid-summaries-by-state/texas-opioid-summary

[2]https://www.drugabuse.gov/opioid-summaries-by-state/nevada-opioid-summary

[3]https://oig.hhs.gov/oas/reports/region9/91801004_Factsheet.pdf

[4]https://surescripts.com/enhance-prescribing/e-prescribing/e-prescribing-for-controlled-substances/

Centers for Medicare & Medicaid Services Releases Parts C and D Final Ruling

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The Centers for Medicare & Medicaid Services (CMS) issued their final ruling for improving and modernizing the Medicare Part C (Medicare Advantage) and Part D programs on May 16th, 2019.  This 201-page document primarily focuses on implementing changes that will save money for patients as healthcare and prescription costs continue to rise. 

 The costs of oral brand-name drugs increased annually by 9.2% from 2008 to 2016, while oral specialty drugs increased 20.6%[1].  These numbers are only expected to continue rising, putting additional strain on patient budgets.  The national average inflation rate is roughly 2%, therefor prescription drugs are increasing 5-10 times as rapidly as the cost of living.

 

 

The price-tiered chart above shows how often prescriptions are being abandoned at the pharmacy due to drug prices.  An average of 10.7% of prescriptions under $30 are abandoned, while 69% of prescriptions over $250 are abandoned.[2]  A large percentage of those patients who abandoned their prescriptions do not follow-up with their medical provider for another potentially cheaper alternative.  Some patients may also take their medications off-label by skipping days, potentially resulting in even higher future healthcare costs.  Prescription non-adherence has been estimated to produce up to $300 billion in avoidable healthcare costs per year in the US.[3]

 

https://www.healthcarefinancenews.com

 

The CMS ruling contains many updates to Medicare policy including:

  • Forcing sponsors to include formulary for all 6 categories/classes of drugs.  There was a proposed exception to exclude a class of drug from their formulary if the price rose too high, this exception was not included in the ruling. 
  • Part D EOBs must contain information on drug price increases and include alternative therapy options and their pricing to better inform patients of possible ways to have a lower out of pocket cost
  • The ruling prohibits sponsors from issuing “gag clauses” to pharmacies, which previously prohibited the pharmacy from advertising a cheaper cash price for a prescription.
  • There are additional regulation changes for Step Therapy requirements with Medicare Advantage on Part B drugs.
  • The final part of this ruling focuses on giving patients and prescribers better access to prescription drug pricing via their EHR or electronic prescribing system.

 

The CMS ruling will require that Medicare Part D sponsors adopt a tool that displays real-time price benefit information that is capable of integrating into e-prescribing software by January 1st, 2021.  This means the tool must be functional by the deadline but not necessarily available in EHRs or e-prescribing software yet.  As of the date this blog was published, many of the EHRs and e-prescribing software on the market do not have the ability to show real-time pricing/benefit information at the point of prescribing.  Some vendors do have the ability so long as the feature has been added and the patient’s particular insurance plan has made that information available to EHRs.  For example, MDToolbox is proud to have the ability to display patient formulary information, drug prices, and preferred drug levels for patients on plans that support it.  The number of patients with accessible Medicare Part D pricing will continue to grow as the plan sponsors are required to make their pricing available.

 

 

 

Surescripts, a health information network hub that digitally connects healthcare providers to pharmacies and PBMs/insurance companies recently released their 2018 research showing that being able to view the real-time benefits caused prescribers to change their medication selections 28% of the time, actively saving the patient money.  The average cost saving per prescription written by a family practice in 2018 was $57, the average saving for a psychiatry office was $228 per prescription![4]

The increase in usage of Electronic Prescribing throughout the US means better protections and convenience for both prescribers and patients.  Real-Time Benefit Pricing will save patients money and help keep their satisfaction in their medical providers.  We look forward to working with providers throughout the US to better empower themselves, better inform their patients, and help provide tools and resources for making their practice more efficient.  With MDToolbox providers have access to tools such as Electronic Prescribing of Controlled Substances (EPCS) and convenient on the go mobile e-prescribing.  Contact us for more information or to start a free 30 day free trial.

 

[1]https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.05147

[2]https://catalyst.phrma.org/69-percent-of-patients-abandon-medicines-when-cost-sharing-is-more-than-250

[3]https://www.pharmacytimes.com/contributor/timothy-aungst-pharmd/2018/06/does-nonadherence-really-cost-the-health-care-system-300-billion-annually

[4]https://surescripts.com/news-center/national-progress-report-2018/