The first phase of a new requirement calling for physicians to use
tamper-resistant, paper prescription forms in the Medicaid program appears to
have gone smoothly.
Karen Sanders, associate director for publicly funded services at APA, said
no psychiatrists have called the Association's Managed Care Helpline about
treatment problems created by the new requirement since it went into effect on
"With this, no news is good news," Sanders said.
A spokesperson for the AMA also told Psychiatric News that her
organization had not received any reports of problems from physicians in the
first weeks the new requirement being in effect.
The requirement aims to limit fraud in hand-written or computer-generated
paper prescription forms by having physicians use prescription forms with at
least one antifraud feature for fee-for-service Medicaid patients. That
standard will tighten on October 1, when prescription forms will be required
to have three safety features.
The specified characteristics are one or more industry-recognized features
designed to prevent unauthorized "copying" of a completed
prescription or blank form, unauthorized "erasure" or"
modification" of information written on the prescription form by
the prescriber, and use of counterfeit prescription forms.
The new requirement does not apply to prescriptions issued electronically
or by fax or telephone.
The latest high-tech prescription forms are designed to protect against
fraud by making it extremely difficult for any part of the form to be
reproduced or altered and, if tampering does occur, to make such deception
easy to spot by licensed pharmacists and other legitimate prescription
Advocates of the new requirement anticipate that the expected drop in
fraudulent prescriptions will provide substantial savings. The Congressional
Budget Office estimated that the requirement should save taxpayers $355
million over the next decade, mainly by preventing the filling of fraudulent
The tamper-proof requirement was included in a massive budget bill (Pl
110-28) enacted in May 2007, and officials at the Centers for Medicare and
Medicaid Services (CMS) set the implementation date for last October. APA and
other physician organizations, however, sharply criticized CMS for the hasty
implementation (Psychiatric News, August 17, 2007). Physician groups
warned that many doctors would be unable to get access to so-called
tamper-resistant prescription pads before the deadline; failure to do so could
have limited Medicaid beneficiaries' access to medications. They lobbied
Congress to intervene and supported legislation (S 2085) that delayed the
implementation date for six months only two days before the requirement was to
go into effect (Psychiatric News, October 19, 2007).
In 2006, physicians wrote about 330 million prescriptions for Medicaid
beneficiaries, which was 11 percent of the nearly 3.1 billion total
prescriptions written each year, according to the author of the legislation,
Sen. Sherrod Brown (D-Ohio).
The tamper-resistant requirement was not entirely new—10 states had
already required it for some prescriptions.
Physicians should contact their state Medicaid program for additional
information since each state is allowed to add further restrictions beyond the
federal baseline standards. Every state Medicaid agency has issued its own
guidance on the prescription-form requirement.
During the six-month delay, CMS took steps to better inform physicians
about the tamper-proof requirement. The agency also fielded numerous inquiries
from physicians and pharmacists, held informational conference calls, and
issued additional written information.
"We remain committed to working with our partners in resolving any
issues that may arise," CMS officials said in a written statement in
April after the requirement went into effect.
Additional information on the new requirement is posted at<www.cms.hhs.gov/DeficitReductionAct/30_GovtInfo.asp>.▪