Update on Tamper-Resistant Prescription Pads for Medicaid patients

The AMCNO has been monitoring the development of this issue and how it could impact a physician practice. As noted in previous emails, starting October 1, 2007, in order for Medicaid outpatient drugs to be reimbursable by the federal government, all written, non-electronic prescriptions must be executed on tamper-resistant pads. The Center for Medicare and Medicaid Services (CMS) has released guidance to the State Medicaid Directors to clarify this provision. According to a Medical Advisory Letter released by the Ohio Department of Job and Family Services (ODJFS) to be considered tamper resistant on October 1, 2007, a prescription pad must contain at least one of the following:

1. one or more industry-recognized features designed to prevent unauthorized copying of a completed or blank prescription form;

2. one or more industry-recognized features designed to prevent the erasure or modification of information written on the prescription by the prescriber; or

3. one or more industry-recognized features designed to present the use of counterfeit prescription forms.

In addition, no later than October 1, 2008, to be considered tamper resistant, a prescription pad must contain all three of the foregoing characteristics. At this time, CMS has not released information to clarify the exact nature of these “features” – information will be provided as it becomes available by the AMCNO or watch the ODJFS web site at http://jfs.ohio.gov/ohp/bhpp/omdp/POS.stm  for updated information.

This requirement applies to:

All written prescriptions presented at the pharmacy on or after October 1, 2007 regardless of when the prescription was written;
Written prescriptions for all outpatient drugs, including controlled, non-controlled, and over-the-counter drugs;
Written prescriptions for drugs provided in a long-term care facility;
Written prescriptions when Medicaid pays any part of the claim, including when Medicaid is not the primary payer, and
Written prescriptions billed to Medicaid after the date of service due to retroactive eligibility.

The requirement DOES NOT apply to:

Orders for medications administered in a provider setting (e.g., physician office or hospital outpatient or emergency department) and billed by the administering provider.
Refills of written prescriptions presented at a pharmacy before October 1, 2007;
Electronic, faxed or telephoned prescriptions; and
Prescriptions for which payment will be made by a Medicaid managed care entity (i.e., this requirement applies only to prescriptions written for patients who receive a monthly paper Ohio Medicaid card, not to prescriptions written for patients enrolled in a Medicaid managed health care organization)
Physician offices are NOT exempt

In addition, prescriptions will be covered if the physician provides the pharmacy with a verbal, faxed, electronic, or tamper-resistant written prescription within 72 hours of the date the prescription was filled.