Prescribing

What You Need to Know About Mandatory E-Prescribing Controlled Substances

 

As you’re probably already aware, all physicians are required to electronically prescribe controlled substances under state and federal laws that took effect Jan. 1.

If you’re still unclear about the law, the waivers, and the exceptions, the Texas Medical Association has created a “frequently asked questions” (FAQ) document that can help you understand the requirements.

View the FAQs  

Texas Medical Board Posts More Details on E-Prescribing Waivers

 

Prescribers who demonstrate financial or technical hardships, or other exceptional circumstances, can apply for a waiver that, if approved, will grant a one-year delay.

There also are several exceptions to the e-prescribing mandate that do not require a waiver, including a temporary technological or electronic failure, certain emergencies, or when a physician or physician’s delegate issues a prescription to be dispensed by an out-of-state pharmacy.

More information on these waivers and exceptions, and a list of frequently asked questions are available on TMB’s website. You can also access the waiver form through your MyTMB account.

Get More Info on the Waivers  

E-Prescribing of Controlled Substances Required Jan. 1

 

Although state law and Medicare policy requires electronic prescriptions for all controlled substances beginning Jan. 1, Texas prescribers have several options for delaying implementation for at least another year.

The Texas Medical Board is set to publish final EPCS rules and waiver forms in the coming weeks.

Learn More About EPCS Requirements  

How to Prescribe Controlled Substances Under COVID-19 Waivers

 

If you treat patients with chronic pain, you can temporarily prescribe certain controlled substances during a telemedicine visit under state and federal waivers issued in response to the COVID-19 pandemic.

Get the Specifics  

You Don't Have to Use an EHR to E-Prescribe

E-Prescribing Basics

Certified E-Prescribing Software - SureScripts

E-Prescribing Quality Guidelines - SureScripts

Electronic Signatures

Practice Operations

Quick Reference Guide: Prescriptions Which May Be Dispensed In Texas (Texas State Board of Pharmacy)

Delegation of Prescriptive Authority to Physician Assistants and Advanced Practice Registered Nurses

Order Texas’ New Prescription Forms Soon To Stay Compliant

Dispensing Drugs From a Medical Practice

Bypassing the Middle Man: Should Texas Allow Physician Dispensing?

• Reminder: Physicians No Longer Need Controlled Substances Registration

Cut E-Prescribing Hassles for Physicians, TMA Tells Feds

 

On April 21, DEA and the Department of Justice posted an interim final rule and asked for comments on specific issues related to the technology and use of e-prescribing.

The Texas Medical Association in June submitted comments urging DEA to consider physician workflow and widely available technologies when exploring any changes to the program.

Read What TMA Has to Say  

E-Prescribing Controlled Substances

New Laws Improve Texas' Opioid Prescription Process (Texas Medicine Today, Aug. 6, 2019)

When Do New Opioid Prescribing Requirements Take Effect? (Texas Medicine Today, Aug. 2, 2019)

Prescribing Changes in Texas: Know What You Need to Know (Texas Medicine Today, June 28, 2019)

Prescribers: Register With the State's Monitoring Program (Texas Medicine Today, Jan. 25, 2018)

EPCS Permitted in Texas (Action, 2016)

E-prescribing Controlled Substances Is Worth It (Texas Medicine, July 2014)

What is the status of electronic prescribing for controlled substances? - SureScripts

Electronic Prescriptions for Controlled Substances – DEA

FAQs on E-Prescribing Controlled Substances - DEA

DEA Modifies Electronic Rx Rules (Action, 2010)

DPS Tracks Drug Shoppers (Action, 2012)

Advocacy

TMA Comment Letter to the DEA Re: Interim Final Rule on E-Prescribing of Controlled Substances (EPCS) (June 22, 2020)

Texas Official Schedule II Prescription Forms Update

If you are not yet e-prescribing controlled substances (EPCS), you can still use official Schedule II prescription forms in Texas. But be aware, on Sept. 1, 2018, the official forms began including additional security features to prevent fraud.

Effective June 1, 2019, ALL official prescription forms ordered prior to Sept. 1, 2018, are no longer valid.

Order prescription forms early to avoid running out.

The following information must be accurate and included with your order:

• Current DEA Registration (To update a DEA registration address, contact the DEA at https://www.deadiversion.usdoj.gov/)
• State License Information
• Office Phone Number
• Texas Driver License (If shipping to a Texas driver license (DL) address, send a copy of the DL to texaspmp[at]pharmacy[dot]texas[dot]gov)
• E-mail Address
• Shipping Address (Orders require a signature at delivery)
  
  

Be sure to e-mail a copy of your driver's license to texaspmp[at]pharmacy[dot]texas[dot]gov as soon as you submit your order!

Due to the volume of orders, fulfillment for orders for new Schedule II prescription pads can exceed 8 weeks for delivery by the Texas State Board of Pharmacy. 
 

Consider EPCS

If you anticipate running out of prescription forms, check with your electronic health record (EHR) vendor to see how you can get set up to e-prescribe controlled substances (EPCS). Sometimes the EPCS functionality can be set up within a day (depending on the vendor).

If you don't have an EHR vendor, search for standalone e-prescribing software. The vendor can assist you with EPCS setup.

See FAQs About Prescription Pad Orders

Opiates and Other Controlled Substances 

Articles

Opioids: The Forgotten Epidemic? (Texas Medicine, Oct. 2020)

Same Old Hurdles: Pharmacy-Mandated Obstacles to Filling Opioid Scrips (Texas Medicine Today, Sept. 18, 2020)

Medicaid Changing Prior Authorization Criteria for Certain Opioid Prescriptions (Texas Medicine Today, Aug. 28, 2020)

TMB Sets Rules on Acute-Pain Scrip Limit, Opioid CME (Texas Medicine Today, July 31, 2020)

Pharmacy Board Limits Chloroquine Prescriptions (Texas Medicine Today, Mar. 30, 2020)

TMA to TMB: Let Docs Decide Whether In-Person Visit Needed For Subsequent Opioid Scrips (Texas Medicine Today, Mar. 6, 2020)

Removing the Pain from Prescribing Pain Meds (Texas Medicine Today, Nov. 7, 2019)

Easing the Pain? Opioid Settlement Brings Valuable Funding to Fight Crisis (Texas Medicine, Nov. 2019)

Tapering a Patient’s Opioid Dosage? Follow This Guide (Texas Medicine Today, Oct. 17, 2019)

Physicians Need to Prepare for New Opioid Rules and Best Practices (Texas Medicine Today, Oct. 9, 2019)

The Changing Face of the Opioid Epidemic (Texas Medicine Today, Sept. 27, 2019)

Doctors Drive New Opioid Laws - A 10-day limit and integration of state's PMP among new changes (Texas Medicine, Sept. 2019)

New Laws Improve Opioid Prescription Process in Texas (Texas Medicine Today, Aug. 6, 2019)

When Do New Opioid Prescribing Requirements Take Effect? (Texas Medicine Today, Aug. 2, 2019)

Prescribing Changes in Texas: Know What You Need to Know (Texas Medicine Today, June 28, 2019)

Despite Deadline, New Prescription Forms Still Not Received (Texas Medicine Today, June 11, 2019)

TMA Pushing To Delay PMP Mandate, Buy Time for Integration With EHRs (Texas Medicine Today, Apr. 9, 2019)

Keep Your Patients and Practice Safe from Opioid Prescription Fraud (Texas Medicine Today, Mar. 19, 2019)

Website Glitches Hinder New Opioid Prescription Order Forms (Texas Medicine Today, Sept. 18, 2018)

Are You Ready for Changes to Opioid Prescribing in Texas? (Texas Medicine Today, Aug. 22, 2018)

FDA Says No to Prescription Opioid Cough Meds for Children (Texas Medicine Today, Jan. 17, 2018)

Three Organizations Get Early Approval to Prescribe Cannabis (Action, May 12, 2017)

Opioids: Resources for Prescribing and Addiction Treatment (TMA Practice E-Tips, Jan. 10, 2017)

New Law Expands Access to Naloxone (Action, Sept. 1, 2015)

Guidance on Prescribing Schedule II Hydrocodone Products (Action, Sept. 15, 2014)

Hydrocodone Products Reclassified as Schedule II (Aug. 29, 2014) 

Resources

Sample Opioid Treatment Agreement (Texas Pain Society)
An informed consent and opioid treatment agreement is a contract between a doctor and a patient. The goal of the agreement is to ensure that patients who are taking opioid drugs do so exactly as their doctor has prescribed. This sample agreement can be used as a template for your practice. Once it is signed, be sure to incorporate it into the patient’s record in the EHR. Thank you to the Texas Pain Society for allowing TMA to link to the sample agreement.

Training to Focus on Opioid Prescribing Guidelines (CDC)

• Dose of Reality 
  This website includes details on approaches to preventing opioid misuse and addiction, proper pain management, safe storage of prescription painkillers, and guidelines on responding to an opioid overdose. It also features a statewide take back map of locations that accept prescription opioids for safe disposal.

Quality

Four Tips To Improve Your Practice’s E-Prescribing

e-Prescribing Quality: Getting It Right the First Time  - TMA Webinar (free to members)

The Perfect Prescription: Obstacles and Opportunities on the Path to Higher Quality and Lower Costs - Surescripts

E-Prescribing Quality Guidelines - Surescripts

Improving Patient Directions by Optimizing E-Prescribing - Surescripts

Vendor Spotlight

TMA members are now eligible to receive 15 percent off of tamper-resistant prescription pads and forms from Rx Security. Pads can be used for schedule III, IV, and V controlled substances as well as non-controlled substances. Remember, orders for schedule II prescription forms must go through the Texas State Board of Pharmacy.

Learn More About Rx Security

Resources

Use the following e-prescribing resources:

• Surescripts
  Information and guidance on how to get connected for e-prescribing 
• Texas Prescription Monitoring Program - Online Registration
• Texas PMP Prescriber Toolkit
  This toolkit is designed to assist you in having productive conversations with patients about the Texas PMP and the safe and effective alleviation of pain.
• Dose of Reality
  This website includes details on approaches to preventing opioid misuse and addiction, proper pain management, safe storage of prescription painkillers, and guidelines on responding to an opioid overdose. It also features a statewide take back map of locations that accept prescription opioids for safe disposal.
• Technology and Patient Safety
  This TMA webpage is dedicated to providing resources and education designed to improve the safe and effective use of technology for better health outcomes.