Unless there is a major reversal in the proposed 2023 Medicare Physician Fee Schedule, as of January 1, 2023, Michigan prescribers will be required to electronically transmit all prescriptions for controlled and non-controlled substances.
On October 3, 2022, the Michigan Department of Licensing and Regulatory Affairs (LARA) sent a formal statement to prescribers confirming that the Bureau of Professional Licensing (BPL) expects to begin enforcement of Michigan’s electronic prescribing standard at the beginning of the new year. Per the notice, “BPL’s enforcement of the electronic prescribing standard will coincide with the Centers for Medicare & Medicaid Services' (CMS) enforcement schedule for Part D prescription drug programs.”
Michigan’s statute allows for a waiver to be issued if a prescriber cannot meet the electronic prescribing requirements. The form and instructions for applying for the waiver is posted on the BPL website.
In addition to the waiver, Michigan’s statute provides the following exceptions to the e-prescribing mandate:
- If the prescription is issued by a prescriber who is a veterinarian licensed under this article.
- If the prescription is issued under a circumstance in which electronic transmission is not available due to a temporary technological or electrical failure.
- If the prescription is issued by a prescriber who has received a waiver from the department under subsection (7).
- If the prescription is issued by a prescriber who reasonably believes that electronically transmitting the prescription would make it impractical for the patient who is the subject of the prescription to obtain the prescription drug in a timely manner and that the delay would adversely affect the patient's medical condition. A prescriber who does not electronically transmit a prescription under this subdivision shall document the specific reason for his or her belief that the delay would adversely affect the patient's medical condition.
- If the prescription is orally prescribed under section 7333(3) or (4).
- If the prescription is issued by a prescriber to be dispensed outside of this state.
- If the prescription is issued by a prescriber who is located outside of this state to be dispensed by a pharmacy located inside of this state.
- If the prescription is issued and dispensed in the same health care facility and the individual for whom the prescription is issued uses the drug exclusively in the health care facility. As used in this subdivision, "health care facility" includes, but is not limited to, any of the following:
- A hospital.
- A hospice.
- A dialysis treatment clinic.
- A freestanding surgical outpatient facility.
- A skilled nursing facility.
- A long-term care facility that provides rehabilitative, restorative, or ongoing skilled nursing care to an individual who is in need of assistance with activities of daily living.
- If the prescription contains content that is not supported by the National Council for Prescription Drug Programs Prescriber/Pharmacist Interface SCRIPT Standard.
- If the prescription is for a drug for which the FDA requires the prescription to contain content that cannot be transmitted electronically.
- If the prescription is issued under circumstances in which the prescriber is not required to include on the prescription a name of a patient for whom the prescription is issued including, but not limited to, a prescription issued under section 5110.
- If the prescription is issued by a prescriber who is prescribing the drug under a research protocol.
- If the prescription is dispensed by a dispensing prescriber.
- If the prescription is for a dialysis-related drug that is administered as part of or incident to a home-based dialysis treatment.
See LARA’s updated Electronic Prescribing FAQs for more information on Michigan’s requirements.
As the enforcement date nears, the following tips are shared for prescribers interested in starting the electronic prescription of controlled substances (EPCS):
- If you’re using an electronic health record (EHR), check with your EHR vendor to determine which compliance pathway to follow (depends on whether the system is registered to an individual DEA number or to an institutional or shared DEA number) and whether the EHR software version being used is certified and approved for EPCS. If not, an updated version will be necessary before proceeding. If it is certified and approved, the following three steps need to be completed before a prescriber is legally able to EPCS:
- Complete identity proofing in order to obtain an authorization and authorization credential.
- Set-up two-factor authentication. This is how the application verifies the person using the application is someone who has been given access.
- Set software access. At each location where an EPCS application will be used for controlled substances, at least two individuals must be designated to manage access to the application. At least one must be a DEA registrant (a DEA authorized prescriber). These two individuals will set secure access controls for the electronic prescribing application software.
Surescripts has some easy to follow video tutorials on their website to help walk you through the basic steps toward EPCS.
- Prescribers without an EHR also have options. If you are currently using an electronic prescribing application for non-controlled medications, check with the vendor to see if they have a certified EPCS upgrade. If you are not using electronic prescribing at all, stand-alone electronic prescribing systems with EPCS are available that don’t require an EHR. There are systems designed to meet a variety of needs, from those that offer simplicity and basic functionality and can be used on a smart phone or tablet (e.g., DrFirst iPrescribe) to those that will offer a fuller range of functionality (e.g., DrFirst EPCS Gold). When you make your EPCS selection, the three steps outlined above for EHR users must be completed in order to send electronic prescriptions for controlled substances.
Whether you are adding EPCS to your EHR, upgrading your stand-alone eRx system, or just wading into electronic prescribing, getting started now is extremely important. This will not only ensure you are able to have a smooth transition and keep interruptions to patient care at a minimum, but also allow you to have a secure way to prescribe controlled substances.
Questions may also be directed to Dara J. Barrera.