INTELLIGENCE IN ACTION

Electronic Prescribing for Controlled Substances: 20 Years of Persistence and Progress

I practiced pharmacy for the first 16 years of my career. There was no e-prescribing when I started out, not to mention electronic prescribing for controlled substances (EPCS). Paper and telephone were all we had. We’ve come a long way: EPCS wasn’t even legal in all 50 states until 2015, but today, most states require it.

Here’s the letter sent to me from the Drug Enforcement Administration (DEA) after the first meeting between the DEA and the healthcare industry to discuss the possibility of allowing EPCS.

The letter is dated March 12, 1998, a few years before Surescripts was founded, when I worked for the National Community Pharmacists Association (NCPA), and more than a decade before the very first e-prescription for a controlled substance was sent across the Surescripts network, on August 4, 2011.

 

“Balancing the need to accommodate this expanding and ever-growing technology in any proposed regulation against the need to maintain adequate safeguards and diversion prevention controls presents DEA with a daunting task.”

– Patricia M. Good, Chief Liaison and Policy Section, Office of Diversion Control, Drug Enforcement Agency

As the DEA’s Patricia Good wrote in 1998, it was a “daunting task” to balance the digital transformation of healthcare with the need for safe and effective prescribing of controlled substances—although not just for the DEA, but for healthcare organizations nationwide.

The DEA was concerned that bad actors would use EPCS to generate illegitimate prescriptions for controlled substances and send such forged prescriptions to dozens of pharmacies at a time, for example. That’s partly why it took a decade since the first meeting in 1998 for the DEA to publish its proposed rule for EPCS in 2008.

Then we grappled with implementing it: What must we do to make EPCS a reality? How can we help our EHR and pharmacy customers modify their software for EPCS? That took more time, as you can see in the key EPCS milestones below.

Key EPCS Milestones

  • 2001: Surescripts is founded to drive the digital transformation of healthcare with e-prescribing.
  • 2004: Only 4% of prescribers have adopted e-prescribing (and EPCS wasn’t even an option).
  • 2007: Surescripts testifies before the Senate Judiciary Committee, encouraging the DEA to allow EPCS. This same year, e-prescribing (but not EPCS) becomes legal in all 50 states.
  • 2008: The DEA proposes a rule to allow for EPCS.
  • 2010: DEA “interim final rule” allows enabled prescribers and pharmacies to begin to engage in EPCS.
  • 2011: The first EPCS transaction is sent across the Surescripts network.
  • 2015: EPCS becomes legal nationwide. Surescripts processes 4 million EPCS transactions in the first half of the year. Surescripts announces its “Get EPCS” initiative to drive adoption.
  • 2021: The Centers for Medicare & Medicaid Services (CMS) requires Part D providers to use EPCS. At year-end, 74% of all prescribers are enabled for EPCS. Surescripts processes 256.9 million EPCS transactions (73% of all prescribed controlled substances).
  • 2022: 35 states currently mandate EPCS (representing 75% of the U.S. population).
EPCS Manadates Map

I’d say that EPCS adoption nationwide has been a success: Most prescribers today can electronically prescribe opioids to patients who are in legitimate need of pain relief, as well as prescriptions for other controlled substances, and these prescriptions are safely and securely delivered to pharmacies.

But there is more work to be done.

Let’s keep our focus on safe and effective prescribing. Let’s finish the job and get all prescribers enabled for EPCS.

EPCS creates workflow efficiencies for healthcare professionals and improves patient safety. Transitioning to EPCS is the right thing to do. Visit GetEPCS.com to get started today.

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