Walmart announced, in a statement to USA TODAY, that it will delay its self-imposed January 1, 2020 effective date for the mandated use of electronic prescribing for controlled substances (EPCS) for all controlled substances, with no exceptions. This decision follows on the heels of a letter sent by the American Medical Association (AMA) opposing the mandate, urging a delay due to the likelihood for patient harm and highlighting inconsistency with federal law.
Per Walmart spokeswoman Marilee McInnis, "We recognize not all provider networks and prescribers will have the technology and systems in place to accommodate this requirement, so we will continue to take written prescriptions so patients are not unintentionally negatively affected by this process."
AMA President Patrice A. Harris, MD, MA, provided the following statement to USA Today:
“The AMA welcomes Walmart’s decision to delay implementation of an electronic prescribing mandate that would have resulted in harm to millions of Americans, including many in rural areas who rely on Walmart as the only pharmacy in reasonable distance. The policy, which the AMA urged Walmart to delay, was not developed in consultation with the nation’s physicians, who support electronic prescribing of controlled substances, but want to see it implemented in a manner that supports—rather than disrupts—patient care.”
"The AMA will continue to work with physicians, pharmacists, and other partners in health care to improve medication adherence, including removing barriers that impede physicians from electronically prescribing controlled substances."
While Walmart’s delay provides temporary relief to many practices that do not yet have the capability to utilize EPCS and their patients, federal legislation passed and signed into law last year requires the use of EPCS for all controlled substances under Medicare Part D by January 1, 2021. Additionally, 27 state Legislatures have already adopted EPCS mandates and the Michigan Legislature is currently debating legislation that would require prescribers to electronically transmit all prescriptions, including those for controlled substances.
Below are some tips for prescribers interested in starting EPCS.
Prescribers using an electronic health record (EHR), should check with their EHR vendor to determine which compliance pathway they must 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 their practice is using 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.
Watch the American Academy of Family Physicians’ brief and helpful webinar covering the key steps for getting started here.
Prescribers without an EHR also have options. If currently using an electronic prescribing application for non-controlled medications, check with the vendor to see if they have a certified EPCS upgrade. If 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., Dr. First iPrescribe) to those that will offer a fuller range of functionality (e.g., Dr. First EPCS Gold). When you make your EPCS selection, steps 1-3 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, are upgrading your stand-alone eRx system, or are just wading into electronic prescribing, getting started now is extremely important. This will not only ensure you are able to have a smooth transition, keep interruptions to patient care at a minimum, but also allow you to have a secure way to prescribe controlled substances.
If you have further questions regarding electronic prescribing, please contact Dara J. Barrera at email@example.com or 517-336-5770.