Opioid Epidemic Goes Mainstream: Get the Facts on E-Prescribing & EPCS

CNN recently held an hour-long Town Hall discussion on the opioid epidemic, and with New York’s recent enactment of its I-STOP legislation and Maine following closely behind, as well as recent high-profile overdose deaths, this is all positioning the opioid epidemic as a mainstream issue facing our country.

CNN’s Dr. Sanjay Gupta blames doctors for over prescribing these highly addictive drugs and says “American doctors must lead the way” to end the epidemic, yet there is no silver bullet to combat the issue. Surescripts sees multiple tactics, including technology, education and regulation as part of the solution to the epidemic. With some states mandating electronic prescribing, they are making great strides to improve efficiency, ensure patient safety and combat drug diversion. But quite a bit of confusion and misinformation still exists among physicians, pharmacists and patients alike.

So we would like to answer some of the most common questions and address the most glaring misconceptions we hear from our end-users.

Does mandatory e-prescribing mean a patient can no longer choose the pharmacy where they would like their prescriptions filled?

• No, quite the opposite. Ultimately, it’s the patient’s decision, for both controlled and non-controlled prescriptions, as to which pharmacy they would like their prescriptions sent. E-prescribing, whether it is mandated—as is now the case in New York—or not, does not inhibit patients from choosing their preferred pharmacy. Nearly all pharmacies (98%) in the United States are enabled for e-prescribing. Prescribers just need to ask their patients which pharmacy they would like their prescription sent to prior to sending it electronically.  And if a patient changes her decision as to which pharmacy she wants to go to after the prescription is sent, it is a routine practice for pharmacies to transfer prescriptions to one another.   

Does e-prescribing limit a patient’s ability to compare prices and choose the most affordable option?

• E-Prescribing actually enables prescribers to proactively choose the most affordable medications so backend price comparisons won’t be necessary.  Most prescribers have access to representative formulary and benefit information at the point of care, while electronically sending prescriptions. This information enables prescribers to choose medications covered by the patient’s insurance – the most affordable options for patients. Without this formulary and benefit information prescribers have no way of knowing what medications are covered. This often leads to higher than expected out of pocket costs when filling prescriptions. Because of Surescripts’ broad connectivity with the nation’s pharmacy benefit managers (PBMs), we have the ability to access benefit and eligibility data for 74 percent of the United States. This means that for most patients, their care providers will be able to choose affordable, covered medications when prescribing.

Is it true that prescribers and pharmacists are not able to change or cancel a prescription after it has been sent electronically?

• This is an unfortunate misperception. Within the Surescripts network, there are two functionalities known as “CancelRx” and “RxChange”. Pharmacies can use RxChange to request a change to a prescription, to which prescribers can respond in various ways.  Conversely, if a prescriber wants to adjust a prescription, they can cancel the existing prescription using CancelRx and initiate a new prescription.  If you are a physician or pharmacist and you do not believe you have these functionalities enabled within your EHR or pharmacy system, please contact your vendor representative to request it as soon as possible.

As a provider, is it difficult to become enabled to electronically prescribe controlled substances (EPCS)? What steps are involved and where can I find more information?  

• There are only four steps that providers must take in order to become EPCS enabled:

1. Confirm that your EHR software is certified for EPCS and has completed all of the updates required
2. ID proofing with your EHR software
3. Obtain credentials for secure two-factor authentication prescription signing
4. Set secure access controls

For more in-depth information, including step-by-step instructional resources for both solo practices and large institutions, physicians and their staff should visit getEPCS.com or contact Surescripts for more information.

How do the regulations for e-prescribing controlled substances differ from standard e-prescribing?

• The main differences are in relation to certification of the technology, security, and provider compliance. To enable EPCS, both the provider’s EHR and the pharmacy’s practice management system must meet all of the technology requirements of the Drug Enforcement Administration’s (DEA) EPCS rule.  In addition, prescribers must follow the steps outlined on getEPCS.com.

In order for providers to become EPCS compliant, does the DEA itself need to approve each prescriber’s EHR software or visit each practitioner’s individual office?

• No. While the EHR software does have to be certified according to DEA specifications, this is done at the vendor level, not at the prescriber level. Practices should check with their EHR vendor to see if the application they are using is already certified and audited, and if not, discuss the necessary steps needed to achieve compliance.  If you are not sure if your practice’s EHR software is certified and approved for EPCS, please visit getEPCS.com, use the button labeled “Find your EHR status,” or ask your EHR vendor.

In terms of security, what are the details behind the requirements of digital signatures for EPCS?

• The specific type of digital signature process that physicians must use requires  two factor authentication. To have two factor authentication, you must use any two of the following as part of the digital signature process: something you know, something you are, or something you have. A comparable reference outside of healthcare is when consumers access their bank accounts using ATMs, where you use something you know (a PIN code) and something you have (a physical ATM card).
• In terms of EPCS, the “something you are” category—mainly biometrics—are becoming more common. The use of fingerprint scanning is one of the two factor options that is on the rise. But in addition, you still need a code or token that you use in combination with a biometric in order to satisfy DEA requirements.

By clarifying some of the misinformation that exists, we hope to drive broader adoption and utilization of EPCS, as the technology has a critical role to play in combating the nation’s prescription opioid abuse epidemic. Prescribers, pharmacists and technology providers all play a key role in improving security, saving time and resources, and delivering quality care to patients.

For more information, please visit getEPCS.com and follow @Surescripts on Twitter for the latest information.