Update on Tamper-Resistant Prescription Pads: Micro printing or a printed void pantograph will now satisfy Category 1 copy resistance and enable practices to avoid the high cost of acquiring special tamper-proof prescription paper.
As of October 1, 2008, all fee-for-service Medicaid prescriptions that are either handwritten or printed from an EHR/e-prescribing application will be required to have a minimum of 1 feature from all three Centers for Medicare & Medicaid Services categories of tamper-resistant features.
CMS has now clarified those requirements for printed prescriptions generated via EHR or e-prescribing systems and has determined that compliance for these prescriptions within Category 1 (copy resistance) can be achieved without using special paper. Special paper can still be used for printing, but the overall guidance from the NCPDP and CMS to State Medicaid Directors is that copy resistance can be met with using micro printing or a printed void pantograph. These features enable practices to avoid the high cost of acquiring special tamper-proof prescription paper.
Review of Centers for Medicare & Medicaid Services Requirements
By October 1, 2008 handwritten or printed prescriptions must contain a feature within all three categories. While the law specifies the term, “prescription pad,” the CMS stated that these requirements also apply to computer-generated prescriptions that are printed using paper inserted into the printer:
One or more industry-recognized features designed to prevent unauthorized copying of a completed or blank prescription form
One or more industry-recognized features designed to prevent the erasure or modification of information written on the prescription by the prescriber
One or more industry-recognized features designed to prevent the use of counterfeit prescription forms
Review the updated summary of features that could be used on a tamper-resistant pad/paper in compliance with the CMS guidelines. Click here for sample tamper resistant scripts.
Exemptions
The following exemptions have been defined by the CMS in the letter issued to State Medicaid Directors on August 17, 2007.
The tamper-resistant requirement does not apply to the following:
Written prescription refills presented to a pharmacy before April 1, 2008.
Prescription orders transmitted to a pharmacy electronically, by telephone, or by fax.
Prescriptions for patients in nursing homes and other facilities, where the patient does not handle the prescription directly.
Compliance
Although CMS guidance is clear, the enforcement, definition, and interpretation of this legislation have been left up to each individual state and states have the right to issue their own guidance, as long as it is not less restrictive than the CMS guidance. If you or your practice does not meet the exemptions listed above, you must understand your state's interpretation of this law by reviewing the Tamper-Resistant Prescription Pad Security Features Required by States Prior to April 1, 2008.
Some states may have issued guidance without full comprehension of the changed CMS position, and without understanding the implications of their decision for EHR users. While CMS will attempt to have states understand this clarified guidance, it may be necessary to work with your own state, if its current guidance is not in keeping with the clarified CMS guidance, to help them to revise its guidance.
Suggested next steps:
Contact your EHR vendor and/or health system or practice administrator to make sure that your EHR will be able print prescriptions that are tamper resistant, as defined by the CMS rules. Many EHR and e-prescribing systems already allow for micro printing of a signature line that satisfies the Category 1 requirement. Micro printing produces a very small font which is legible when viewed at a 5x magnification or greater, but illegible when copied. For micro printing to be effective, this feature must be printed in a 0.5 font or less.
Contact your State Medicaid director's office to make sure that they have received the new advisory from the NCPDP-CMS and are either accepting it as the October 1 rule for their jurisdiction or creating their own guidance informed by this advisory. If there is an existing rule that does not take into account this new advisory, appeal the advisory. While states certainly have the choice to create a rule that is more conservative than the CMS advisory, it should be informed by this updated advisory, and should not make printing a tamper resistant prescription from an EHR impossible because of the exorbitant costs of special paper or printers.
Contact the pharmacies you prescribe to, and make sure they are aware of this new advisory, and give them voided samples of your new October 1 compliant prescriptions.
If you have any additional questions or concerns regarding Tamper Resistant Prescriptions or e-prescribing, please contact Itara Barnes at or (404)633-3777.
