• Deadline Approaching For Tamper-Resistant Prescription Pads
  • February 19, 2008
  • Law Firm: Jackson Walker L.L.P. - Austin Office
  • Effective April 1, 2008, the federal Centers for Medicare & Medicaid Services (CMS) and the Texas Health & Human Services Commission (HHSC) will require providers to begin using tamper-resistant prescription pads for all written prescriptions submitted for payment to the Vendor Drug Program (VDP) for all Texas Medicaid beneficiaries.  Congress mandated the measure last year in an attempt to reduce the number of unauthorized, altered, and counterfeit prescriptions submitted for payment.  The implementation deadline for tamper-resistant pads was initially set for October 1, 2007, but Congress extended it to April 1 in order to give state Medicaid programs more time to respond.

    To be considered tamper-resistant, a prescription pad must satisfy the following criteria:

    • Prevent unauthorized copying of completed or blank prescription forms;
    • Prevent erasure or modification of information written on the prescription form; and
    • Prevent the use of counterfeit prescription forms.

    CMS has established a “grace period” from April 1 to October 1, 2008, during which time prescription pads must meet at least one of the criteria listed above.  After October 1, prescription pads must meet all three criteria to be in compliance with the law.  Currently, the Texas Medicaid Program maintains this two-stage implementation process, but industry groups such as the American Medical Association, the Texas Medical Association, and pharmacist groups are encouraging state programs to require pads to meet all three criteria by April 1 to avoid potential confusion.  Industry groups are also encouraging prescribers to use tamper-resistant pads for all their patients and not just Medicaid beneficiaries.

    The new requirements do not apply to prescriptions submitted to a pharmacy electronically, by telephone, or by fax machine.  Nor do they apply to inpatient prescriptions within hospitals, long-term care facilities, and other institutions.  The entities are, however, subject to the tamper-resistant prescription requirements for outpatient medications if the Medicaid reimbursement for the prescribed drugs is made directly to the facility and not included in capitation payments.

    The new law does not affect the state requirement that prescriptions for Schedule II drugs be written on pads approved by the Texas Department of Public Safety (DPS).  However, CMS has determined that pads that meet the current DPS criteria for tamper-resistance should also meet the new standards set out by CMS and HHSC.

    Providers are responsible for obtaining their own tamper-resistant prescription pads from private suppliers and any associated costs are not reimbursable by Medicaid.  Additionally, HHSC has not certified specific private suppliers as Medicaid-complaint, but others states (e.g., California, Florida, Indiana, Kentucky, Maine, West Virginia, and Wyoming) have done so.  Texas prescribers may want to look to these states’ certified lists for guidance when choosing a supplier.  HHSC expects pharmacists to use their best professional judgment in determining whether a written prescription meets the tamper-resistant criteria outlined above.