***At press time, the U.S. House of Representatives had passed a bill that would postpone the implentation of the new security prescription rules for 6 months. The Senate is expected to vote on the bill by the end of the week. Stay tuned for details.

As reported last week in CMA Alert, prescriptions paid for by Medi-Cal managed care plans are exempt from the new federal security prescription rules that take effect next week. We have just learned, however, that with the exception of the Health Plan of San Mateo, drugs dispensed within a County-Organized Health System are defined under the law as “covered outpatient drugs” and must be written on tamper-resistant prescription pads. Therefore, prescriptions for patients enrolled in CalOPTIMA, Santa Barbara Health Initiative, Partnership Health Plans, and Central Coast Alliance for Health must be written on tamper-proof pads.

Also exempt from the new federal law are nursing homes and some other institutional settings and phoned, faxed, or electronically transmitted prescriptions. Of course, all prescriptions for controlled substances, regardless of the payor, must be written on secure tamper-proof pads under California Law.  

There has also been confusion about dual-eligible (Medicare/Medi-Cal) patients. If the drugs being prescribed are covered by Medicare Part D, then physicians do not need to write the prescriptions on secure pads. However, if the drugs are not covered by Part D, physicians do need to use a secure pad. Of course, if patients are enrolled in a managed care plan or are in an institutional setting, they are exempt from the law and physicians do not need to use a secure pad.

Recognizing that this new law is very confusing, and physicians may not be able to easily determine when Medi-Cal fee-for-service is the secondary payor to private insurance, or if a prescribed drug is carved out of managed care, the California Department of Health Services is recommending that prescribers use tamper-proof prescription pads for all Medi-Cal beneficiaries.

For more information on this new law, see CMA ON-CALL documents #0510, Drug Prescribing (Not Schedule II-V Drugs) and #0509, Controlled Substance Prescribing. ON-CALL documents are free to members at the members-only website. Nonmembers can purchase ON-CALL documents for $2 per page in the CMA Bookstore.

CMA is extremely concerned that confusion among physicians and pharmacists will negatively impact patient care and access to prescription drugs. We are also concerned that the additional hassle and cost involved will force physicians to leave the Medi-Cal program, where access to care is already a problem. CMA is working on federal urgency legislation to reverse the law or at least make it consistent with current state law. At press time, the U.S. House of Representatives had passed a bill that would postpone the implentation of the new security prescription rules for 6 months. The Senate is expected to vote on the bill by the end of the week.

To help ease the burden of this new requirement, especially for physicians with a high volume of Medi-Cal patients, CMA has negotiated a 20 percent member discount on tamper-proof pads and printer paper that meet both federal and state security prescription requirements.

This special discount from CMA’s security prescription partner RxSecurity is available through Wednesday, November 7. After that date, members will receive the normal member discount of 15 percent.

Place your order online at http://www.rxsecurity.com/cma.php or by phone at 800/667-9723.

Contact: Elizabeth McNeil, 415/882-3376 or emcneil@cmanet.org.