Tamper-resistant Rx Pads Pose Challenges

In late May 2007, as part of the Iraq War Supplemental spending bill, Congress authorized a provision that will force all prescriptions filled in the Medicaid program to be written on tamper-resistant paper. It is a massive change in the way Medicaid prescriptions are handled, but, thankfully, community pharmacy--with the Coalition for Community Pharmacy Action (CCPA)--was able to convince the Bush administration to delay its implementation from October 1, 2007, to March 2008.

Currently, most physicians do not use these types of pads, and as of press time it was unclear whether sufficient supplies of them would be readily available. As a result, if it had been implemented, millions of Medicaid prescriptions across the country might not have been eligible for reimbursement. If prescriptions are not written on tamper-resistant paper, pharmacists will be put in the position of either having to turn patients away or having to fill at least emergency supplies of the prescription, knowing that reimbursement could eventually be denied or recovered by the state Medicaid program.

In August 2007, the Centers for Medicare & Medicaid Services (CMS) issued a state Medicaid directors guidance on how to best implement the tamper-resistant prescription-pad requirement mandated for Medicaid prescriptions. Under that guidance, there is a small degree of leeway in the federal statute's operation. CMS allows states to implement a prescription-pad standard for legend and prescribed OTC drugs that mandates only 1 of 3 characteristics: forms must be copy-proof, erasure- or alteration-proof, or counterfeit-proof. Down the road, CMS will require that states enforce all 3 of these characteristics. The agency has also exempted electronically submitted, faxed, and verbal prescriptions from its mandate. Medicaid managed-care prescriptions are also exempt.

Emergency supplies may be dispensed when a noncompliant prescription is presented, but the pharmacist must subsequently confirm the prescription with the prescriber, within 72 hours, verbally, electronically, by fax, or by presentation of a compliant prescription. Pharmacists may want to consider calling a prescriber to verify any script if it is unclear whether or not it meets the necessary requirements. This simple action could possibly help prevent state recoupment of Medicaid reimbursement down the road. Further, it is important to consider the regulations put in place by neighboring states and to take measures to ensure compliance across state borders.

With our success in delaying implementation, the CCPA still needs you to contact your state Medicaid director, asking support for a statewide education program to inform physicians of the need to use a tamper-resistant pad. A statewide educational program could also inform pharmacists about how the new rule will work. With your support,we can ensure that all Medicaid patients are able to continue safely receiving their prescription drugs from a community pharmacy.