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Readers Write: Interesting Times for ePA and EPCS

August 12, 2015 Readers Write No Comments

Interesting Times for ePA and EPCS
By Connie Sinclair, RPh

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These are interesting times in the e-prescribing world. Readers may recall that NCPCP approved the SCRIPT electronic prior authorization (ePA) transaction standard in July 2013. Several state legislatures have passed laws requiring support for the NCPDP ePA transaction 24 months after its adoption, which brings us to right now. With Missouri’s new e-prescribing of controlled substances (EPCS) rules becoming effective July 30, EPCS is allowed in all 50 states and DC, with only Vermont holding out on EPCS of Schedule II substances.

Having been involved with electronic prescription applications for almost 30 years and today tracking what states are legislating and regulating, it is gratifying to see the tremendous progress the industry has made in terms of adoption and in advancing e-prescribing to become the standard of care. Even EPCS, which was considered one of the biggest hurdles, is now legally a done deal.

EPCS not only provides better tracking and deterrence of controlled substance diversion and abuse, it also helps patients get the medication they need in a more timely manner. Orthopedic patients no longer have to hobble into their surgeon’s office when they need pain relief prescriptions. Adults and children who are on ADHD meds can also avoid unnecessary trips to the doctor for maintenance med prescriptions.

Some might say, “Whew, we’re done.” Not so fast. Although EPCS is allowed and transaction flow for controlled substance prescriptions is certainly increasing, we still have a long way to go to get adoption to levels that are equal to non-controlled substance prescribing. Anecdotal evidence suggests that many practices are unaware of the legality of EPCS, most likely because they do not yet have access to an EPCS certified version of their EHR. Also, many states are watching New York very closely to see the impact of mandatory e-prescribing and EPCS effective March 2016, and some are expected to follow suit.

While EHR vendors have been slogging their way through MU requirements, industry stakeholders, prescribers, standards organizations, and legislators have been busy advocating for prior authorization (PA) reform. As I am sure most HIStalk readers are aware, the traditional and cumbersome PA process is a huge sore spot for prescribers and patients alike who believe it hinders patients from getting needed medication per their doctors’ orders. Over the last few years, state legislators have taken note and have approved new laws requiring reform and automation of the process. 

A big part of my current job is to monitor state law. Seven states had July 2015 effective dates for some level of support for electronic prior authorization. In addition, four states already require electronic submission of the PA form and three additional states have laws on the books with future effective dates regarding ePA support. As always, the devil is in the details as each state has a different interpretation of what constitutes an electronic prior authorization. Most states impose the requirement to support ePA on the health plan, but EHR vendors should take note because at least two states impose the requirements on the provider.

As patients and as caregivers for patients as well as EHR stakeholders, we should all be encouraged by the progress of the ePA and EPCS initiatives and do what we can to keep things moving along in the right direction.

Connie Sinclair, RPh is director of the regulatory resource center of Point-of-Care Partners of Coral Springs, FL.

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