“Identity theft is so easy, and I’ve seen this problem becoming bigger every week.”
prescribe controlled substances using a paper system should check their DPS profiles even more frequently. Physicians must write all schedule II
prescriptions on an official DPS prescrip- tion pad. A pad of 100 forms costs $9. Physicians can obtain schedule II pre- scription pads from DPS by faxing (512) 424-5380.
“I have also instituted an office policy that does not allow office staff to call in any controlled substances,” Dr. White said. “I usually check my own profile on a monthly basis, but I overlooked it for one month. During that time: BAM!” Physicians can check their patients’ and their own profiles on the DPS pre- scription access website, www.texaspatx .com/
Login.aspx. Dr. White says while it is a necessary
When pharmacists encounter one of
these red flags, they can call the pre- scribing physician to confirm the medi- cation or search the patient’s DPS profile to look for signs of drug abuse. Mr. Wiesner says prescription fraud also is a huge problem.
“Pharmacies encounter that every sin- gle day,” he said.
In these cases, he says, someone
pretending to be a physician or office staff member calls the prescription in to the pharmacy outside normal business hours, or a patient brings in a paper prescription written on a stolen or du- plicated prescription pad.
Pharmacists who fill these often see
a surge in similar prescription requests either the same day or in the days im- mediately following, Mr. Wiesner says. He says hydrocodone is high on the list of controlled substances that people try to obtain illegally. (See “TMA Oppos- es Schedule Change for Hydrocodone,” page 60.) “We trust pharmacists to use profes- sional judgment,” he said. “I think our folks tend to err on the side of the pa- tient when they can.” Mr. Wiesner says EPCS is the most ef-
ficient way for physicians and pharma- cists to keep controlled substances from people who would abuse them. “It’s the safest route, 100 percent,” he
said. Mr. Wiesner says when a physician 58 TEXAS MEDICINE July 2014
sends an EPCS to H-E-B, the prescription must pass through Surescripts, an inter- mediary that looks at multiple data, in- cluding the drug in question. Surescripts also checks to see if the prescribing phy- sician’s EPCS software is DEA-certified. If it is, the prescription is sent to an H-E-B pharmacy for processing. If a physician’s EPCS system is not certified, Surescripts will push the prescription request back to the physician, instead of forwarding the request to the pharmacy. Even with EPCS, Mr. Wiesner says, physicians should continue to expect calls from pharmacists who want to clarify and authenticate prescription dos- ages, directions, or drug interaction de- tails. But ultimately, EPCS will help pre- vent prescription abuse and protect both pharmacists and physicians, he says.
Staying vigilant Given Dr. White’s ordeal, she says e-pre- scribing is the safer route for physicians who want to avoid prescription fraud. “But it’s going to be a lot more work,” she said. “It’s just so embryonic at this point.” Dr. White says she believes EPCS will get easier, but in the meantime, physi- cians must be vigilant by getting to know their local pharmacists and check- ing their DPS profiles and their patients’ profiles for signs of prescription fraud. She says physicians who refuse to participate in EPCS and continue to
resource, the DPS website is difficult to use. For example, only physicians, reg- istered nurses, physician assistants, or licensed vocational nurses have access to the site. Other office personnel, even those with access to HIPAA-sensitive in- formation, can’t access the site. “This translates into considerable time
required to perform appropriate search- es on individuals attempting to procure prescriptions for controlled substances,” Dr. White says. “In addition, the website has the ability to track physician pre- scribing trends, so why can it not notify a physician in the event of activity on their profile, say by email?” Dr. Schade says EPCS is still a new practice, and it will take time to get more pharmacies to install or update software to be EPCS-certified. “This is in its infancy. We expect there
will be problems. Nothing just takes off,” he said. He predicts it will take two to five
years for EPCS to become a convenient way for physicians to safely prescribe medications.
“The world is moving forward. The technology is moving forward,” he said.
“I have faith that e-prescribing will even- tually become the standard of care.”
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