CMS Clarifies Tamper-Resistant Prescription Pad Law
Physicians will be required to use tamper-resistant pads for handwritten prescriptions for Medicaid patients beginning Oct. 1.

If you use a pen and indelible ink to write prescriptions, you could be in compliance with a new federal law… for now.

According to the Centers for Medicare and Medicaid Services (CMS), beginning Oct. 1, 2007, Medicaid prescriptions must be written on tamper-resistant pads that meet one of three “industry standards” to prevent:

• Unauthorized copying
• Erasure or modification of information
• Use of counterfeit prescription forms

Since each state can define its own standards, the Pennsylvania Medical Society has asked the state Department of Public Welfare (DPW) to require that prescriptions be written in indelible ink. This would meet the second standard.

DPW will alert Medicaid providers through a policy bulletin when it sets its standard. The State Society also will notify members when a decision is made.

Using indelible ink would only be a temporary fix because tamper-resistant prescription pads will be required to meet all three standards by Oct. 1, 2008, CMS said. Any existing state law regarding tamper-resistant prescription pads will be deemed to meet or exceed CMS standards. Pennsylvania has no such law.

CMS said a variety of prescriptions will be exempt from the requirements, including:

• Refills of prescriptions written before Oct. 1, 2007
• Phoned, faxed, and electronic prescriptions
• Prescriptions paid for by a managed care entity, including DPW’s Health Choices

Emergency prescriptions will be allowed as long as the physician provides the pharmacy with a prescription within 72 hours.

Many physician and pharmacy groups have expressed concerns about the mandate. Although CMS has answered many concerns expressed by physician and pharmacy groups, the American Medical Association (AMA) said it is still urging a delay of the implementation date.

The Pennsylvania Medical Society and the AMA both signed a letter asking U.S. Department of Health and Human Services to delay so that:

• The department can come up with a consistent definition of tamper-resistant.
• States may amend their laws and regulations to be consistent with the federal mandate.
• The department and other organizations can educate providers.
• Government regulators can consider the impact of tamper-resistant prescription pads on dispensing and storage.
• The department can provide exemptions for prescriptions to beneficiaries with retroactive eligibility.

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