Important Information on Tamper-Proof Prescription Requirement
CMS has now released guidance to State Medicaid Directors on the October 1, 2007 requirement for handwritten prescriptions to be written on tamper-resistant prescription pads in order to be covered by Medicaid, which is available at the following links:
http://www.cms.hhs.gov/SMDL/downloads/SMD081707.pdf
http://www.cms.hhs.gov/DeficitReductionAct/Downloads/Tamper.pdf
The AMA views the guidance as responsive to most of the recommendations that we received from state and specialty medical societies and transmitted to CMS last June, early in the CMS process. For example, you will note that all current state requirements and standards are deemed to meet the new CMS standards, that states who provide the pads to physicians at no cost can treat the expenditure as a Medicaid administrative cost, that as long as the prescription is provided on either a tamper-resistant pad or faxed, phoned in within 72 hours of it being filled at the pharmacy it will be covered, and that the standards for the actual prescription pads are very flexible, with pads required to meet one of three standards by October 1, 2007 and not having to meet all the standards until October 1, 2008. Finally, you will note that many prescriptions are exempt from the new requirements, including nursing home prescriptions, refills of prescriptions written before October 1, and phoned, faxed and electronic prescriptions.
Please note the following key elements of the guidance:
Exemptions
Prescriptions provided in nursing facilities and certain other settings are exempt
Refills of written prescriptions presented at a pharmacy before Oct. 1 are exempt
Electronic, faxed and telephoned prescriptions are exempt
Prescriptions paid for by a managed care entity are exempt
Requirements
By Oct. 1, 2007, prescription pads must meet one of the following standards, and by Oct. 1, 2008 they must meet
all three:
Features to prevent unauthorized copying
Features to prevent erasure or modification of the prescription
Features to prevent use of counterfeit prescription forms
All existing state laws and requirements for tamper-resistant prescriptions are deemed to meet or exceed the CMS standard.
Emergencies:
Prescriptions will be covered as long as the physician provides the pharmacy with a verbal, faxed, electronic, or tamper-resistant written prescription within 72 hours of the date the prescription was filled.
Costs: States that purchase compliant prescription pads for Medicaid prescriptions and provide them to physicians at no cost or at a discounted rate may
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