Controlled substance e-prescribing now legal in all 50 states

Controlled Substances

Electronic prescribing of controlled substances, including opioids, is now legal in all 50 U.S. states. On September 15, 2015, Vermont became the final state to take this step, which permits e-prescribing of controlled substances but does not require it. Until now, many states, including Vermont, allowed e-prescribing of Schedule III–IV drugs but held back on Schedule II drugs. Now all drug schedules in all states are allowed to be e-prescribed. 


“We certainly believe that because of the enhanced security associated with e-prescribing of controlled substances, the opportunity for abuse, misuse, and fraudulent activity is going to be dramatically reduced,” said Ken Whittemore, BSPharm, MBA, senior vice president of professional and regulatory affairs at Surescripts, a nationwide health information network. 


The long road to adoption


Until recently, one-half of all U.S. states prohibited e-prescribing of controlled substances.


In 2010, the Drug Enforcement Administration (DEA) published an interim final rule giving practitioners the option to write prescriptions for controlled substances electronically, as well as allowing pharmacies to receive, dispense, and archive electronic prescriptions. 


“It became incumbent upon a number of stakeholder groups in the pharmacy industry to tackle the issue and bring states into alignment with the DEA’s rule,” Whittemore told Pharmacy Today.


Many pharmacy stakeholder groups, including APhA, the National Alliance of State Pharmacy Associations (NASPA), the National Association of Chain Drug Stores, and Surescripts, worked together over a 5-year period to rework some state laws, a process that can take a long time. 


Krystalyn Weaver, PharmD, BSPharm, NASPA vice president of policy and operations, said the new provisions will help pharmacists ensure that a prescription comes from a legitimate prescriber. “Electronic prescribing of controlled substances offers one solution to secure the drug supply chain,” said Weaver.


Pharmacists are ready


The good news is that pharmacy is well prepared to receive e-prescriptions for controlled substances, as well as dispense and archive them, according to Whittemore. 


However, prescribing practitioners have some catching up to do with pharmacies that are ready on the receiving end. 


Using data from Surescripts, a study published in the January 2015 American Journal of Managed Care found that pharmacies with technology in place to accept e-prescriptions for controlled substances increased from 13% in 2012 to 30% in 2013. By contrast, only 1% of all prescribers were capable of e-prescribing for controlled substances in 2013. However, between 2012 and 2013, the number of e-prescriptions for controlled substances grew dramatically from 1,535 to 52,423. 


Whittemore said when Surescripts looked back at their data, it became apparent that physicians and other prescribers didn’t become interested in adopting e-prescribing capabilities until a large percentage of U.S. pharmacies could receive prescriptions electronically. Such a point now appears to have been reached with e-prescriptions for controlled substances, as currently slightly greater than 80% of ambulatory pharmacies nationally are capable of receiving them.


“We are hoping that that same kind of dynamic takes effect and physicians will say, ‘If I want to prescribe this controlled substance [electronically], the pharmacy will be able to receive it,’” said Whittemore. 


Lengthy and time-consuming software auditing and prescriber identity proofing processes are likely factors that have stalled physician adoption of e-prescribing of controlled substances. For pharmacists, the initial setup is much easier. In addition, there has not been enough incentive for physicians to adopt e-prescribing for controlled substances. E-prescribing was a requirement under the federal meaningful use electronic health record (EHR) program, which incentivizes the use of EHRs through financial payments. However, e-prescribing of controlled substances was specifically exempted from meaningful use stages 1 and 2. 


“Going forward, there should be a focus on the prescriber end of things because it takes two to communicate, and pharmacy has stepped forward very nicely,” said Whittemore. 


Surescripts created a website at www. getepcs.com to disseminate information and move the process along: “We welcome pharmacists to share this and educate physicians in their community about it,” said Whittemore. 


DEA also has information for pharmacists and prescribing practitioners about e-prescribing of controlled substances; visit www.deadiversion.usdoj.gov/ecomm/e_rx/index.html.