had actually filled a prescription of this kind, Dr. Schade says. Walgreens and H- E-B Pharmacy are two chains that accept EPCS. Dr. Schade says physicians’ best bet is to call their local pharmacies and ask whether they have EPCS-certified software.
Individual pharmacists also may decide not to fill any prescription they choose. Dr. Schade says only one phar- macist of the initial 20 was willing to fill an electronic request for a schedule II controlled substance.
Pharmacy perspective On March 1, after completing a small pi- lot program with a select group of phy- sicians and pharmacists, DPS released guidelines to aid accurate reporting of EPCS to the Texas Prescription Program, which the Texas Legislature created in 1982 to track schedule II prescriptions. The law requires pharmacists to report schedule II prescriptions to the program within seven days of filling the prescrip- tion. (See “Helpful Links,” below.) The complete guides are available at www
.texmed.org/EPCS-DPS. According to the guides, physicians using EPCS should take the following three steps to save time and improve se- curity and patient safety:
• Confirm with your e-prescribing soft- ware vendor that the software ap- plication is EPCS-certified per DEA requirements. Physicians can check health information network Sure- scripts’ website, http://surescripts .com/network-connections/mns/pre scriber-software, for a list of EPCS- certified vendors.
• Confirm your software vendor has no- tified Surescripts that both the soft- ware and the prescriber have been certified and are eligible to transmit schedule II through V electronic pre- scriptions. If Surescripts is not noti- fied, the transaction will be blocked before it reaches the pharmacy.
• Understand that not all pharmacies are certified to accept EPCS transac- tions. This may result in the prescrip- tion being returned when a doctor attempts to transmit it electronically.
TMA is offering a free continuing medical education course on risk evalua- tion and mitigation strategies specifically for physicians who prescribe schedule II controlled substances. The three-hour course,
www.texmed.org/OpioidREMS, is presented by the Florida Medical Association.
Many pharmacists are reasonably
skeptical about filling e-prescriptions for schedule II controlled substances. In June 2013, Walgreens entered into an $80 million settlement with DEA after the agency charged Walgreens with fail- ing to properly account for the sale of many narcotic painkillers. Walgreens has since changed its policy to require phar- macists to take additional steps to verify the identity of the prescribing physician when many controlled substances are involved.
Though Walgreens’ case was not spe- cific to e-prescribing, pharmacist Dennis Wiesner, senior director of government affairs, privacy, and pharmacy for H-E- B, says the DEA’s recent crackdown on pharmacies has left many pharmacists second-guessing themselves when filling narcotic prescriptions.
• Questionable drug combinations and quantities;
• The physical distance between the prescribing physician’s office and the pharmacy, distance between the pre- scribing physician and the patient’s home address, and distance between the patient and the pharmacy; and
• Cash payment.
Mr. Wiesner says if a patient asks him to fill 200 or more tablets of hydro- codone, or a combination of a popular “drug cocktail” such as hydrocodone, ca- risoprodol, and alprazolam, he will take further action to confirm the prescrip- tion. And if a patient has traveled a long distance to the pharmacy, it could be a sign that other pharmacies refused to fill the prescription.
“You just become a little bit more cau- tious,” he said. Mr. Wiesner says H-E-B, which in- stalled EPCS software in its 240 Texas pharmacies more than a year ago, trains its pharmacists to look for red flags. He says the red flags apply to electronic and paper prescriptions and include:
Helpful links
The following websites will help ease your way through the process of e-prescribing and better protect you against pre- scription fraud:
• Texas Prescription Program:
http://bit.ly/1mSMc8F • Electronic prescription of controlled substance guidelines for physicians and pharmacists:
www.texmed.org/EPCS-DPS
• Surescripts electronic health care network:
http://surescripts.com
• Drug Enforcement Administration Practitioner’s Manual for controlled substances:
http://1.usa.gov/1qAxG71
• Department of Public Safety prescription access website:
www.texaspatx.com/Login.aspx
July 2014 TEXAS MEDICINE 57
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