President Bush approved legislation granting a six-month delay to a new
Medicaid prescription-pad requirement two days before it was to go into
effect. The new effective date is April 1, 2008.
The requirement calls for Medicaid prescriptions to be written on
tamper-resistant pads to be eligible for reimbursement.
The delay was sought by APA and other physician groups (Psychiatric News,
August 17). The original implementation date was October 1.
The Senate and House passed the measure (S 2085) in the last week of
September as part of a package of programs that were set to expire October 1,
and the president signed it that weekend.
"The purpose of the tamper-proof requirement is to combat fraud, not
create chaos for patients and pharmacies," said bill sponsor Sen.
Sherrod Brown (D-Ohio) in a written statement.
Physician groups sent letters to the Centers for Medicare and Medicaid
Services (CMS) in the months preceding the implementation deadline identifying
obstacles to the new requirement and warning that Medicaid beneficiaries may
have difficulties filling their prescriptions.
The requirement was tucked in a massive budget measure (PL 110-28), enacted
in May, which limited federal reimbursements of state Medicaid programs to
those states in which physicians are required to write prescriptions on
so-called tamper-resistant pads.
The prescription-pad mandate aimed to make it harder for patients to obtain
controlled drugs illegally and to save the government money. The Congressional
Budget Office estimated that the requirement will save taxpayers $355 million
over the coming decade, mainly through preventing fraudulent
APA sent an initial letter to CMS on July 23 to raise concerns about the
short implementation period for physicians to obtain the pads, whose design
requirements were never clearly defined in the federal law. In a September 21
follow-up letter, APA noted that its concerns about delays in physicians
obtaining appropriate prescribing pads were becoming reality.
"Since the initial APA letter, it has come to our attention that some
physicians are experiencing the predicted delays in obtaining
'tamper-resistant pads' due to the high demand causing supply shortages and
backlogged orders," said James H. Scully Jr., M.D., APA medical
director, in the September letter. "Unless and until an adequate supply
of 'tamper-resistant pads' is available to physicians, it will be a matter of
impossibility for them to comply with the statutory directive."
Those comments echoed the concerns of other physicians groups, including
the AMA, which sent letters to CMS urging a delay in implementing the
The AMA called for a six- to 12-month delay to make multiple fixes,
including creation of a consistent definition for"
tamper-resistant" and the need to exempt prescriptions dispensed
to beneficiaries with "retroactive eligibility."
Other concerns raised by APA included the possibility that the October 1
implementation of the prescription-pad requirement might have resulted in
discriminatory treatment against Medicaid beneficiaries, since filling their
prescriptions may cause additional administrative problems. Those problems
might have created a reason for physicians and pharmacists to avoid serving
Scully noted that among Medicaid beneficiaries is a group of about 6
million people who are dually eligible for Medicaid and Medicare, and nearly
half of these patients have a cognitive or mental impairment. Delays in
obtaining prescribed medications can cause substantial complications, even to
the point of decompensation, for many patients for whom psychotherapeutic
drugs are essential, he said.
APA information on tamper-resistant prescription pads is posted at<www.psych.org/downloads/TamperResistantPadNoticeFINAL.pdf>.▪