Opioid Electronic Prescribing
Opioid electronic prescribing laws have changed in the past few years. For example, prescriptions for controlled substances such as opioids moved to a paperless, e-prescription system in 2021 under a bill passed in the Arkansas Legislature.
According to data from the U.S. Centers for Disease Prevention and Control (CDC), Arkansas ranks second among all U.S. states in opioid prescription rates and opioid abuse by youths. The Attorney General’s office and a coalition of counties and cities across Arkansas filed lawsuits against drug makers, alleging that the companies’ actions contributed to the crisis.
Electronic prescribing provides many benefits, including the ability to conduct forensic reviews of historical data to identify drug-seeking behavior and out-of-compliance prescribers and pharmacies. There are challenges in rural areas where legitimate chronic pain patient needs may still need to be met. Rural areas with electronic prescribing and internet access may be able to receive and fill prescriptions.
These concerns were raised by several committee members about the effectiveness of an electronic system in rural areas and in the event of a natural disaster. Their concerns hinged on another set of statistics provided by Lane: While almost all pharmacists can receive electronic prescriptions, only 66 percent of healthcare providers are set up to use the system.
“I have a problem at this day and time with the technology,” said Sen. Terry Rice, R-Waldron. “It’s far from being complete for rural Arkansas.”
The National Association of Chain Drug Stores (NACDS) endorsed the enactment of an electronic prescribing bill (SB 174), for controlled substance prescriptions for Schedule II through Schedule VI, which will help prevent opioid abuse. Arkansas Gov. Asa Hutchinson (R) signed the bill into law on March 13, which will become effective January 1, 2021.
According to NACDS, State Sen. Kim Hammer (R), sponsor of the Senate bill; State Rep. Justin Boyd (R), a pharmacist and sponsor of the bill in the House; Kirk Lane, Arkansas drug director; and the Arkansas Pharmacists Association, were instrumental in getting the legislation passed.
The legislation enjoys popular and nonpartisan support in the state for mandatory e-prescribing. A January 2019 survey conducted by Morning Consult and commissioned by NACDS found that 64 percent of Arkansas registered voters support rules that all prescriptions must be handled electronically rather than by paper or fax to reduce the likelihood of fraud and abuse. Only 20 percent indicated opposition.
NACDS President and CEO Steven C. Anderson, IOM, CAE, said: “Fifteen states have enacted e-prescribing legislation as part of the opioid-abuse solution, and we congratulate Arkansas for helping to lead the way on this critical issue.”
President Trump signed into federal law in 2018—the SUPPORT for Patients and Communities Act (H.R. 6)—which includes provisions of the NACDS-backed Every Prescription Conveyed Securely Act. The new federal law requires electronic prescribing for Schedule II through V controlled substances prescriptions covered under Medicare Part D to help prevent fraud, abuse and waste – with limited exceptions to ensure patient access.
Reflective of the path toward greater use of electronic prescribing as a safeguard, NACDS was on the leading edge of working with the Drug Enforcement Administration to allow electronic prescribing of controlled substances. Until 2010, it was not allowed.
NACDS’ policy recommendations to help address the opioid-abuse epidemic reflect pharmacists’ firsthand experiences on the frontlines of care and extensive collaboration with law enforcement. In addition to e-prescribing, NACDS’ recommendations involve drug disposal, prescription drug monitoring plans(PDMP), and limits on initial fills of opioid prescriptions for acute pain.
The policy recommendations issued by NACDS are part of a strategy to improve adherence to the Controlled Substances Act provisions, including drug disposal; patient education; security initiatives; fostering naloxone access; stopping illegal online drug-sellers and providers who dispense improperly without cross-checking State prescribing databases.
Pain Management and Opioid Audit Protocol to identify drug-seeking behavior and prevent drug diversion