Electronic prescribing of controlled substances, or EPCS, is the electronic transmission of a prescription for a controlled substance to a pharmacy. Prescribers are encouraged to write and transmit prescriptions for controlled substances electronically to increase safety and security. By way of regulation pharmacists are permitted to receive, dispense, and archive the electronic prescriptions sent to them by the prescriber.
Controlled Substance Prescription
Controlled substances are drugs that have potential for abuse and dependence. These drugs are regulated by the federal Controlled Substance Act (CSA), which divides controlled substances into five categories called schedules.
In 2010, the Drug Enforcement Agency (DEA) revised its regulations, allowing physicians to electronically prescribe controlled substances through a certified electronic system. EPCS was seen as a way to help eradicate some of the issues created by paper prescriptions, such as forged or stolen prescriptions, by requiring authentication of prescribers, improving security standards, and auditing activity on EPCS platforms.
Today, various factors are driving mandated implementation among the states for e-prescribing of controlled substances. For legislators, EPCS is viewed as a systematic way to reduce levels of substance addiction and abuse in communities through institutionalizing careful monitoring and increased oversight of a patient’s prescription history and use of controlled substances.
Under DEA Title 21, the provider is responsible for ensuring the safety of EPCS. In order to electronically prescribe controlled substances, the provider must register with the DEA and obtain a DEA number. Then they must retain sole possession of any two factor authentication tokens and must not share their password with any other person or prescribing entity. The same responsibilities stand for the practitioner when issuing either a controlled substances prescription via electronic means or a paper or oral prescription.
EHR Technology Responsibilities
Under DEA Title 21 prescribers are required to use an EHR or prescribing technology that is certified by a third party auditor or a certification body. The certified product must link the registrant to at least one DEA registration number and ensure that they are the only registrant signing electronic prescriptions. Through the capabilities of certified technology, prescribers are able to obtain identify verification and engage in two factor authentication. This established standard is to ensure proper creating, signing, and refilling of controlled substance prescriptions.
Federal Mandate: Medicare Part D Practitioners
In 2018 the SUPPORT for Patients and Communities Act was passed by the federal government. The Act includes legislation that requires Medicare Part D practitioners to begin electronically prescribing Part D drugs requiring prior authorization on January 1, 2021. Medicare Part D prescribers in every state are subject to the above stated mandate and must comply.
EPCS Mandates among the States
As of November 1, 2019 there were six states with active EPCS mandates. The inauguration of 2020 will witness the implementation of EPCS mandates for an additional six states, and as the United States approaches the federal mandate implementation date of January 1, 2021, a general trend of state legislatures requiring EPCS will likely continue. The details of each state’s mandate differ, differences based upon the specified schedules of controlled substances that must be prescribed. It is imperative to the success and lawful abiding of the prescriber that they are aware of the schedules of controlled substances required under their state’s EPCS mandate and act accordingly. For more information on the details of each state’s EPCS mandate, please refer to the individual state links below.