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E-prescribing ramps up through federal and state mandates

By Amanda Riedell

The SUPPORT for Patients and Communities Act, passed in 2018 to help combat the nationwide opioid crisis, originally mandated that Medicare Part D prescribers use electronic prescribing for controlled substances (EPCS) technology by Jan. 1 ,2021. Under Section 2003 of the SUPPORT Act, the Centers for Medicare & Medicaid Services (CMS) has authority to enforce and specify penalties for noncompliance with the EPCS requirement. Accordingly, due to the COVID pandemic’s impact on healthcare entities, CMS has delayed the e-prescribing compliance deadline to Jan. 1, 2023.

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Nonetheless, CMS’s Calendar Year 2022 Medicare Physician Fee Schedule puts the EPCS requirement into effect and the agency encourages “all prescribers to conduct EPCS as soon as feasible.” As things stand today, CMS considers prescribers to be compliant with the EPCS mandate if they electronically prescribe at least 70 percent of their Part D controlled substance prescriptions per calendar year.

Although CMS has not proposed penalties for noncompliance, it may do so in the future. Hospices need to be prepared to make this adjustment. In the meantime, the agency points out several advantages of EPCS over the traditional processing of paper prescriptions:

Improved workflow efficiencies;

Deterrence and detection of prescription fraud and irregularities;

Enhanced patient safety through identity checks, safety alerts, medication menus, electronic history files, and medication recommendations that lower the risk of errors and potentially harmful interactions; and

Avoidance of data-entry errors and calls to clarify written instructions.

Hospice provisions

Through its rulemaking, CMS finalized exemptions from the e-prescribing mandate for low-volume prescribers, as well as during recognized emergencies (e.g., pandemic, natural disaster) and for entities facing extraordinary circumstances, such as lack of broadband access.

Additionally, CMS was asked to consider whether Part D prescriptions for individuals enrolled in a Medicare Part A hospice benefit should be exempt from the EPCS requirement. According to CMS, “an exception for a prescription made for an individual enrolled in hospice would be inappropriate.” The agency stated that only in a very few instances would it cover a controlled substance prescribed for a Part D enrollee who has elected hospice. Further, an exception applicable to those rare instances could be confusing and burdensome for prescribers who furnish care to hospice-enrolled Part D beneficiaries. “[It] would pose an operational challenge to accurately match prescription data records with hospice enrollment data,” which can be fluid, CMS stated.

State landscape

Besides the federal mandate for e-prescribing controlled medications, 33 states have EPCS legislation either in effect or scheduled for future implementation, according to research compiled by medical software firm RxNT. California, Indiana, Maryland, Michigan, Nebraska, New Hampshire, Utah and Washington all passed EPCS legislation effective as of Jan. 1, 2022. Michigan and Colorado are expected to follow suit in 2023. Click here to view e-prescribing legislative status in your state.

Compliance advocates note that broad adoption of e-prescribing will bring important benefits to providers and patients. Systems that prompt the prescriber to choose the drug and select available dosages will speed up the prescribing and dispensing processes while reducing opportunities for error. What’s more, e-prescribing lessens the risk of prescriptions being altered and provides a wealth of data points that can be used to improve operational efficiencies.

If your hospice is looking for an e-prescribing solution to help improve day-to-day operations, please visit Hospice Pharmacy Connect to learn more.




U.S. Department of Health and Human Services. CY 2022 Physician Fee Schedule Final Rule.

Holland & Knight. CMS Issues 2022 Medicare Physician Fee Schedule Final Rule.

RxNT. The Ultimate Guide to EPCS Mandates.

Centers for Medicare & Medicaid Services. CY 2022 Medicare Physician Fee Schedule Final Rule Fact Sheet.