When is E-prescribing Mandatory for Psychiatrists?

E-prescribing is faster, simpler, and less prone to error than using paper or phoning in prescriptions. But not every provider finds e-prescribing attractive. The American Psychiatric Association has historically petitioned the Centers for Medicare and Medicaid Services to relax certain requirements around e-prescribing due to various challenges around its use. So many psychiatrists are asking, “Is e-prescribing mandatory? And if so, when?” In this post, we aim to answer both questions.

Benefits of E-prescribing 

E-prescribing is the electronic transmission of a prescription directly from a provider to a pharmacy using a special technology called an EHR (electronic health record). E-prescribing is rapidly replacing the old system where a psychiatrist either wrote a prescription by hand or called the prescription in to a pharmacy. 

Though errors can still occur with e-prescribing, it eliminates the potential for many of the issues found within the old system. Here are the top four benefits of e-prescribing.

  1. Better Accuracy

E-prescribing via EHR systems improves accuracy by making prescriptions easier to read. Pharmacists no longer have to decipher a prescriber’s handwriting in order to fill the script. It’s much less likely that pharmacists will make a mistake in filling a prescription as a result.

  1. Increased Efficiency

With e-prescribing, patients no longer have to wait for a psychiatrist to call in the script, nor do they have to take a paper copy of a prescription to a pharmacy and wait around for it to be filled. Since this is all done electronically and can be transmitted before the patient even leaves the office, the process is much more efficient.

  1. Fewer Risks of Interactions

Checking for potential drug interactions is important when prescribing a new medication. EHRs track prescription medications, and many have the ability to check for potentially harmful drug interactions before the prescription is filled, flagging the psychiatrist.

  1. Cost-efficient

Spending less time writing out prescriptions or waiting on the phone for the pharmacy means more free time. Since prescriptions can be transmitted with a few clicks, it frees up time for psychiatrists to spend with clients.

Of course, e-prescribing is not without its flaws and limitations. It requires an EHR that’s designed to make e-prescribing safe and easy (such as TheraNest’s). And, as with any new software, even the best EHRs have a bit of a learning curve. Furthermore, not all medical records are integrated — there may be information gaps if a healthcare system doesn’t share data, which eliminates the benefit of cross-checking for interactions. Even with these shortcomings, e-prescribing is still a far better option than the paper and pad system.

Federal vs. State Requirements for E-prescribing

The U.S. government has encouraged e-prescribing, and in 2009, providers started receiving incentives for using an EHR. The Drug Enforcement Agency (DEA) approved e-prescribing for controlled substances, such as the benzodiazepines, in 2010. 

Finding a way to regulate the use and distribution of controlled substances is a high priority given the recognized substance abuse crisis. As a result, the federal government and many states are taking a stand to battle this growing problem. Ten years after prescribers were approved to e-prescribe controlled substances, mandates are now rolling out requiring e-prescribing. These Electronic Prescribing for Controlled Substances mandates (EPCS) intend to eliminate paper subscriptions for all controlled substances. 

Federal Requirements

The president declared the opioid addiction epidemic a “National Public Health Emergency” in 2017.  A year later, the SUPPORT for Patients and Communities Act was signed, including initiatives to address the growing issues with opioid addiction and a federal mandate for EPCS. The focus on the opioid crisis has generated new regulations around all controlled substances. As of January 1, 2021, this federal mandate will require electronic prescribing for all controlled substances for Medicare Part D participants in the United States. All psychiatrists and other providers will be required to prescribe controlled substances via e-prescribing using certified EHR software. 

State Requirements

A number of states have hopped on board with EPCS, and some of them have gotten ahead of the federal legislation to require compliance. However, policies vary from state-to-state. Several states, including Arizona, Massachusetts, North Carolina, Oklahoma, and Rhode Island, started requiring compliance as early as January 1, 2020. As of this writing, 12 states currently have EPCS mandates, and 15 more are planning to implement mandates within the next year or so. These mandates apply to all EPCS in the state and not just for individuals who qualify for Medicare Part D.

How to Find the Requirements for Your State

It can be challenging to find EPCS regulations for your state, as each state does things a little differently. There isn’t one central hub for state regulations, so you need to search specifically for your state. As of November 2020, here are the states that have current EPCS mandates in place:

Following are the states with future plans to implement EPCS mandates and the date they will go into effect:

New Hampshire, Nebraska, New Jersey, and West Virginia all have legislation pending approval. The remaining states not listed have no legislation in effect nor legislation pending approval.

If you prescribe controlled substances in a state with upcoming legislation, it is essential that you familiarize yourself with the requirements and find an EHR well in advance of the implementation date, to ensure no disruption for your patients.

Is E-prescribing Mandatory? It Likely Soon Will Be

E-prescribing will not only save time for you and your patients, but it will also improve accuracy and help to reduce societal issues with prescribing controlled substances.  E-prescribing will be required for prescribing controlled substances for all Medicare Part D patients in the U.S. as of January 1, 2021, and many states have already implemented similar regulations for all EPCS or have provided future dates when such mandates will go into effect. Even if your state currently has no legislation in effect or implementation date listed, you should be prepared for future regulations to come. Implementing a certified EHR system now instead of later is a great proactive step.

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