ONC Report: States with High Proportion of EPCS Users Have Fewer Opioids Claims Per Prescriber

April 10, 2019
Electronic prescribing of controlled substances to be mandated in Medicare Part D in 2021

The SUPPORT for Patients and Communities Act, passed in 2018, includes a provision requiring prescriptions for controlled substances covered by Medicare Part D to be transmitted electronically starting in 2021. A recent analysis by the Office of the National Coordinator for Health IT found a significant association between the use of electronic prescribing of controlled substances (EPCS) technology and rates of opioid prescribing among Part D prescribers. States with a high proportion of EPCS users tend to have fewer opioids claims per prescriber.

In 2010, the United States Drug Enforcement Administration revised its regulations to allow pharmacies, hospitals, and healthcare providers to use EPCS technology in all 50 states. The use of EPCS technology can help providers integrate prescription information into electronic health records (EHRs) more directly, while improving patient safety and reducing diversion and fraud.

ONC prepared a data brief that explores the use of EPCS among Medicare Part D providers on the Surescripts Network from 2015 to 2016. It also presented data on variations in EPCS use and the number of opioid claims prescribed by prescriber specialty and state. Here are some of the highlights of ONC’s report:

• The proportion of Part D prescribers who used EPCS increased by nearly three-fold between 2015 and 2016. About one in 10 Part D prescribers used EPCS in 2016. In 2015 and 2016, Part D opioid prescribers used EPCS at similar rates to all Part D prescribers. Part D prescribers with more than 100 opioid claims are twice as likely to use EPCS compared to prescribers that did not have any opioid claims. In 2016, about one in seven Part D prescribers (14 percent) had more than 100 Part D opioid claims – about 15 percent of these providers used EPCS. Nearly six in 10 Part D prescribers (56 percent) had 10 or fewer Part D opioid claims in 2016.

• The number of Part D opioid claims per prescriber decreased between 2015 and 2016, regardless of EPCS use. On average, EPCS prescribers had 180 Part D opioid claims per prescriber in 2016 – a 6 percent reduction from 2015. On average, non-EPCS prescribers had 152 Part D opioid claims per prescriber in 2016 – a less than 3 percent reduction from 2015.

• Pain management specialists had the largest proportion of Part D prescribers using EPCS as well as the highest number of Part D opioid claims per prescriber. Specialties with the highest proportion of Part D opioid prescribers using EPCS include pain management, behavioral health, geriatric medicine, physician assistants, and physical medicine and rehabilitation. About one in six general/family practitioners and internists who prescribed opioids used EPCS – these specialties represent a large number of providers and the highest total opioid claim count. Only 1 in 20 dentists who prescribed opioids in Part D used EPCS.

In 2016, 18 states had fewer than 5 percent of their Part D prescribers using EPCS. New York, North Dakota, Nebraska, South Dakota and Rhode Island have the highest proportion of Part D prescribers who use EPCS. Alabama, Mississippi, Hawaii, Montana, and West Virginia have the lowest proportion of Part D prescribers who use EPCS. In 2016, Minnesota and New York were the only states with a mandatory EPCS requirement. In New York, more than six in 10 Part D prescribers used EPCS in 2016.

• States with a higher proportion of Part D prescribers using EPCS also had a lower average number of Part D opioid claims per prescriber. New York had the highest proportion of Part D prescribers using EPCS (62 percent) and the second lowest average number of opioid claims per prescriber. Alabama had the lowest proportion of Part D prescribers using EPCS (2 percent) and the highest average number of opioid claims per prescriber. Washington D.C. had the lowest average number of opioid claims per prescriber (17) and one of the lowest proportions of Part D prescribers using EPCS (3 percent).

The ONC report noted that while additional factors besides EPCS use may affect the prescription of opioids, these results highlight the importance of EPCS policies on managing opioid prescriptions. “As the SUPPORT for Patients and Communities Act is implemented,” the report said, “we should expect to see an increase in the number of Part D prescribers using EPCS, which will help healthcare providers integrate prescription information into EHRs, while improving patient safety and reducing diversion and fraud.”

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