E-Rxs for controlled substances: The system has glitches

Kristin Sankwich

Richard MolitorIn 2010, the DEA published final criteria to enable the use of electronic prescriptions for controlled substances. The final rule allows practitioners to electronically prescribe schedule II-V medications and permits pharmacies to receive, dispense, and electronically archive these prescriptions. To ensure security, the DEA also mandated that an external third-party audit be performed on vendors’ e-prescribing software prior to use by practitioners and pharmacies.

In Washington State, electronic prescription transmission software must also be reviewed and approved by the Washington State Pharmacy Quality Assurance Commission (formerly known as the Board of Pharmacy). This, along with the DEA audit criteria, should ensure that systems are as robust as their vendors claim. Other states have similar policies in place.

In addition, Medicare has warned prescribers about consequences for failure to switch to electronic medical record systems (EMRs) before 2014. Failure to begin e-prescribing could result in reduced reimbursement for prescribers caring for Medicare D patients. With e-scripts becoming the preferred modality for transmitting prescriptions, there is the potential for this to affect pharmacy claims as well.

Pros and cons

There has long been talk of the advantages of electronic prescriptions, such as fewer medication errors, a streamlined prescribing process, and increased efficiency. While e-scripts most definitely reduce errors resulting from poor handwriting, the jury is still out on the reduction of other technical and clinical errors. Users must overcome a steep learning curve, and there are unanticipated programming deficits that ultimately must be corrected. In addition, keeping systems current with local laws and rules can be a daunting challenge for vendors.

Many prescribers and pharmacies now send and receive e-prescriptions. However, because of a lag time in obtaining review and approval of software by DEA-approved auditors, the current prescribing process has become a “hybrid” of both e-prescribing and traditional methods. This results in confusion for both prescribers and pharmacies.

For example, prescribers and their staffs must manage refill requests for controlled substances differently from the way they handle refills for non-controlled substances. Since DEA regulations prohibit pharmacies from providing a completed template for controlled substance refill requests, prescribers must do this themselves.  Pharmacy personnel may need to call the prescriber to verify that the prescriber’s software has passed DEA audit standards and that a controlled substance prescription is indeed valid.

As a result of these challenges, prescribers and pharmacies have been slow to implement the use of e-prescribing of controlled substances. The current list of approved systems indicates that universal use of e-scripts for transmission of all prescriptions is still a long way off.  

The disconnect

In May of 2014, we conducted a small survey of Kirkland, Wash., pharmacies, asking local retail pharmacists whether they had DEA-compliant software capable of accepting electronic prescriptions for controlled substances and whether they were currently receiving them.

The survey revealed that 40% of pharmacies had the software in place, but only 10% of the pharmacies surveyed were actually receiving prescriptions for controlled substances electronically.  One pharmacist mentioned that chain policy requires pharmacies to actually call and confirm all controlled substance e-scripts - which can add a significant delay in filling a prescription for the waiting patient - because of concerns regarding forgeries.

It’s hard to imagine how the current hybrid system represents an improvement over previous practice. 

Four years after the DEA issued its guidelines should ample time for vendors, pharmacies, and prescribers to implement universal electronic prescribing of legend drugs, including controlled substances.

As pharmacists, both new and experienced, we should have greater involvement in seeing that the e-prescribing process reaches its maximum potential by working together with our vendors and national leadership to get these audit approvals performed and functional systems in place. This will serve the not only the health and welfare of our patients, but our own operational efficiency, as well.

Kristin Sankwichis a PharmD candidate at the University of Washington School of Pharmacy. Richard Molitormanages a pharmacy in Kirkland, Washington. E-mail them at rmolitor@u.washington.edu.