Jul 17 2018

Pharmacies Stand Ready with EPCS Technology in Place

As federal and state legislators consider options for addressing the nation’s growing opioid and prescription drug abuse crisis, it seems that one tool already in the arsenal is being largely overlooked:  Electronic Prescribing of Controlled Substance (EPCS) technology.

According to the 2017 National Progress Report, a report generated annually by pharmacy technology certification specialist Surescripts, 93 percent of the nation’s pharmacies are EPCS-enabled,  but so far, only four states – Connecticut, Maine, Minnesota and New York – have laws in place mandating electronic prescribing for controlled substances or opioids.  An additional seven states – Arizona, Iowa, North Carolina, Oklahoma, Rhode Island, Tennessee, and Virginia --  have enacted laws, but implementation dates are pending.

Important to note is that electronic prescribing of controlled substances is permitted in all 50 states, but is currently only mandated in four.

Legislation has also been introduced in the U.S. Congress.  The “Every Prescription Conveyed Securely Act” would require e-prescribing for coverage under Medicare Part D for controlled substances.

A letter submitted in support of the federal legislation, and signed by pharmacy representatives including the National Association of Chain Drug Stores, Express Scripts, Surescripts, Walgreens and CVS Health, among others, affirmed support for EPCS technology.  “A number of approaches have been summoned to attack this epidemic,” the group wrote,  “but we believe that the use of already-existing electronic prescribing of controlled substances (EPCS) technology is going woefully underutilized.”

The letter noted several benefits of existing technology including:

  • Reduced opportunities for diversion, since the DEA-approved technology offers more protection than “the current system of paper and oral prescriptions;”
  • Inability to alter or copy prescriptions;
  • Electronic tracking capability; and
  • Security measures including two-factor authentication that reduce the likelihood of fraudulent prescribing

The group also pointed out, that while 90 percent of prescriptions for non-controlled substances were filled electronically during 2017, that figure fell to just 21 percent for controlled substances.

It seems though, that reluctance among physicians and hospitals is at least partly to blame for the lag in broader implementation.  For one thing, the SureScripts report found only 22 percent of prescribers were enabled for EPCS during 2017.  While that marked an almost 60 percent increase over 2016 levels, it is indicative of the number of providers that have yet to adopt this important technology.

Cost is an important factor.  U.S. Representatives Markwayne Mullin (R-OK) and Katherine Clark (D-MA), House sponsors of the federal EPCS legislation told Medscape they have received negative feedback from healthcare providers, since the technology will come at a cost.  “It will cost money,” Rep. Clark said.  “The burden will fall on doctors and hospitals, and that’s where we are getting some resistance.  But this is worth it,” she added.

Meanwhile, states with EPCS mandates in place are already reporting positive benefits.  “It has been incredibly effective,” Andrew J. DiLuca, R.Ph, director of pharmacy services at Kaleida Health in Buffalo, NY  told Decision Resources Group.  “We have seen a dramatic drop in opioid scripts, in general, because prescribers can see in real time what the patient has at home, and they don’t feel obligated to just give them a small script.”

Positive feedback like this will likely help fuel legislative efforts in additional states for mandatory e-prescribing for controlled substances.  For the 93 percent of pharmacies with EPCS technology already installed,  this will be a welcome development.