E-Prescribing Mandate for Controlled Substances Takes Effect in New York

What do pharmacists need to know about the e-prescribing mandate?

New York pharmacists may only accept electronic prescriptions for controlled substances as of March 27, 2016.

The e-prescribing regulation of the state’s Internet System for Tracking Over-Prescribing law was issued back in 2013, but the mandate saw some delays, despite pharmacists’ preparedness.

Pharmacists should know that they can still accept hard-copy prescriptions dated before March 27, 2016, and fill them accordingly, since they were written before the e-prescribing mandate took effect.

Back in November 2015, the New York State Department of Health's Bureau of Narcotic Enforcement issued a letter to prescribers notifying them they will need to get electronic prescriptions for controlled substances (EPCS) software in accordance with federal law to be able to prescribe controlled substances. Prescribers were encouraged to purchase, install, and begin using the software as soon as possible.

EPCS software is being used to minimize medication errors, prevent prescription theft, minimize forgery, and integrate prescriptions directly into a patient's medical record. The use of e-prescribing will also stop retired practitioners, who still have prescription pads, from being able to continue prescribing through hard copies.

However, New York State Department of Health’s Bureau of Narcotic Enforcement suggests prescribers should keep their prescription pads in the event of a power outage or a system failure to allow patients to still be able to receive the medications for continuation of care.

Durable medical equipment prescriptions do not have to be sent electronically due to the fact that a hard copy is often required to receive payment from the third party, and this law specifically only pertains to drugs.

Physicians can still call in a 5-day supply or less for controlled substances and follow up with a hard copy via mail, but only if the doctor and pharmacy agree they cannot send/receive the electronic copy in a timely manner, and the delay would adversely impact the patient.

As always, under no circumstances will a facsimile be acceptable for a controlled substance. It cannot be converted into an electronic prescription even if a system error occurs.

If there are any issues with a controlled substance and the pharmacist needs to clarify information with the physician, the pharmacist can annotate the e-prescription and dispense accordingly as long as the software stores all annotations made and can be accessed electronically. The prescriber does not need to send a new prescription with the edits.

If the prescription comes over electronically without a maximum daily dose, it is still rendered a valid prescription and the pharmacist can annotate the prescription with a maximum daily dose after consulting with the physician, according to the law.

Some prescribers are exempt from this law, including veterinarians, Veterans Affairs prescribers, and prescribers with an approved EPCS New York waiver.

Prescribers can receive a waiver for 1 year or less from the commissioner of health if they have economic hardship, technological limitations out of their control, or other exceptional circumstances.

If a pharmacist receives a hard copy from a prescriber and is not sure if the prescriber falls under 1 of these categories, the Bureau of Narcotic Enforcement states pharmacists are not required to verify if they have a waiver. However, corresponding liability to dispense the controlled substance does still remain with the pharmacist.

Some prescribers are stamping their hard copies with a red stamp that has their New York waiver number on it to notify the pharmacy they can write hard copies in accordance with the new e-prescribing law.