Ensure Proper Handling of E-Rxs for Controlled Substances

You'll see more controlled substance Rxs sent via electronic prescribing...in an effort to prevent fraud, diversion, abuse, etc.

New laws mandating e-Rxs for controls take effect Jan 1 for AZ, FL, IA, NC, OK, and RI. Six states already require it...more will follow.

And a federal law will require e-prescribing for controlled meds billed to Medicare Part D starting in 2021.

But fewer than half of prescribers are set up to send e-Rxs for controls...even though nearly all pharmacies can accept them.

Ensure your team handles controlled e-Rxs properly...and follow your state laws and pharmacy policies.

Remind your techs to watch for multiple transmittals of an e-Rx...and to check sigs, notes, and dates for when to fill each one. A prescriber may send separate e-Rxs to be filled sequentially.

Keep in mind that controlled substance e-Rxs must contain the same info required on written Rxs...patient's address, DEA number, etc.

Feel comfortable printing out a hard copy of an e-Rx as a record if needed...but ensure it's labeled as a copy not valid for dispensing.

If there's a transmission failure, the prescriber may print and manually sign the e-Rx...and this hard copy will note the pharmacy it was originally sent to. Call to confirm it wasn't received or dispensed.

Handle any changes to a controlled e-Rx similarly to paper Rxs.

For example, you may be able to clarify certain info (sig, etc) with the prescriber...and note the change electronically. But the prescriber may need to send a new e-Rx to change the patient, drug name, etc.

Stay alert for meds prone to e-Rx errors. For example, e-Rx pick lists can lead to product selection mishaps with methylphenidate forms...depending on how the suffixes (CD, ER, etc) are displayed.

Get our CE, The Federal Controlled Substances Act, for guidance on partial fills, recordkeeping, transfers, etc...and use our chart, Strategies for Avoiding E-Prescribing Errors, to improve e-Rx safety.

Key References

  • www.deadiversion.usdoj.gov/pubs/manuals/pharm2/pharm_manual.htm (12-12-19)
  • www.deadiversion.usdoj.gov/ecomm/e_rx/faq/faq.htm (12-12-19)
  • www.deadiversion.usdoj.gov/fed_regs/rules/2010/fr0331.pdf (12-12-19)
Pharmacist's Letter. January 2020, No. 360101

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