More and more states are mandating e-prescribing. Some states require e-prescribing only for CII controlled substances, some for all controlled substances, and some require e-scripts for all medications.

States with current e-Rx mandate laws are:

    • Connecticut (e-prescribing for controlled substances only, no penalties for non-compliance)
    • Maine (e-prescribing for controlled substances only, penalties provided)
    • Minnesota (all prescriptions, no penalties)
    • New York (all prescriptions, penalties)

State with future e-Rx mandate laws are:

    • Arkansas (e-prescribing for controlled substances only, provides for penalties, starts in 2021)
    • Arizona (CIIs only, no penalties, starts in 2020)
    • California (all prescriptions, starts January 1, 2022)
    • Iowa (all prescriptions, starts in 2020)
    • Kentucky (e-prescribing for controlled substances only, starts in 2021)
    • Massachusetts (e-prescribing for controlled substances only, starts in 2020)
    • New Jersey (EHR must be able to accept, process, and transmit prescriptions for CIIs, starts May 1, 2019)
    • North Carolina (applies to highly abused CIIs and CIIIs, starts January 1, 2020)
    • Oklahoma (e-prescribing for controlled substances only, starts in 2020)
    • Pennsylvania (e-prescribing for controlled substances only, starts October 24, 2019)
    • Rhode Island (e-prescribing for controlled substances only, starts in 2020)
    • Tennessee (CIIs only, starts in 2020)
    • Virginia (for opioids only, starts in 2020)
    • Wyoming (e-prescribing for controlled substances only, starts in 2021)

States with pending legislation on e-prescribing:

  • Colorado (CII-IV only)
  • Florida (all prescriptions)
  • Kansas (all controlled substances)
  • Michigan (all prescriptions)
  • Missouri (all prescriptions)
  • South Carolina (all controlled substances)
  • Texas (all controlled substances)
  • Washington (all prescriptions)
  • West Virginia (all prescriptions)

If you are not in one of the above states, it is likely that your state will be added to this list next. If not, e-prescribing is unavoidable anyway because Medicare will require all Part D scripts to be transmitted electronically starting in 2021.

The Drug Enforcement Administration (DEA) has allowed e-prescribing since 2010. But a practitioner must use a EPCS-certified software. In order to be EPCS-certified, the system must meet strict DEA requirements for credentialing, software certification and dual factor authentication (among others). Therefore, it is important to know your vendors, their certifications, and their audit records. Surescripts – for example – is one of the platforms facilitating e-prescribing. However, the company was investigated and charged with illegal monopolization of e-prescription markets. Read FTC’s announcement here.

While e-prescribing is supposed to resolve ambiguities in prescriptions, sometimes it creates them. For example, e-prescriptions have “Notes” section. Prescribers may add additional information that is relevant in this field. This field, however, is often a source of miscommunication. For example, “Notes” may state “dispense 60 tablets” but there is already a quantity field indicating 60 tablets. This creates some uncertainty regarding the prescriber’s intent and therefore a pharmacist must call to verify and resolve the uncertainty. In addition, pharmacy must train staff and offer tech support at all times. And when dealing with any healthcare technology, it must comply with HIPAA and all relevant regulations, such as security breach notification and similar state laws. If you work with e-scripts, what are your hurdles?