Use of Tamper Resistant Prescription Pads Effective April 1, 2008

Effective April 1, 2008, the federal government (CMS) will require that all prescriptions provided on behalf of Medicaid patients covered by traditional Medicaid be written on tamper-resistant prescription pads. The prescriptions are required to have, at a minimum, a single tamper-resistant feature. This requirement will not currently apply to Medicaid recipients covered by any Medicaid managed care plan.

Listed below is a short synopsis of what physicians and their staff may expect once this requirement is in full effect on April 1, 2008: 

Overview of tamper resistant prescription pad law 

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. To be considered tamper resistant a prescription pad must contain at least one of the following:

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

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

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

Beginning October 1, 2008, a prescription pad/paper must contain at least one feature in each of the three categories listed above. In addition, beginning October 1, computer-generated prescriptions must be printed on paper that meets the above requirements. In addition, at a point one year after the implementation date, in order for prescriptions pads to be considered tamper resistant, a prescription pad must contain all three of the foregoing characteristics. 

The requirement, once implemented, will apply to:

  • All written prescriptions presented at the pharmacy on or after the published implementation date 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, once implemented, 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 the implementation date;

  • 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. 

Physicians interested in obtaining compliant prescription pads may contact the AMCNO for more information.