The Office of the National Coordinator for Health IT recently noted that although the percentage of clinicians who electronically prescribe controlled substances (EPCS) has increased, overall EPCS rates remain low. In 2017, 32 percent of office-based physicians who prescribed controlled substances did so electronically. That is one reason why the American Medical Association, the nation's largest physician organization, expressed concern when Walmart announced that starting Jan. 1, 2020, it would only accept electronic prescriptions for controlled substances.
James Madara, M.D., the AMA’s CEO, wrote a letter to Thomas Van Gilder, M.D., Walmart’s chief medical and analytics officer, saying the requirement could “lead to considerable disruption in patient care given the fact that only about 44 percent of physicians currently have the technology, hardware and certifications required for EPCS.”
The AMA said that if Walmart does not delay implementation, patients in every state will likely suffer negative consequences from not having their necessary medications dispensed. This includes patients receiving care for opioid use disorder, anxiety, depression, attention deficit hyperactivity disorder, auto- immune diseases, HIV/AIDS and painful conditions like sickle cell disease. Losing access to medications to help treat chronic disease could have devastating, potentially fatal consequences. In addition, data shows wide disparities in pain treatment for minorities, and Madara said Walmart’s policy could exacerbate those disparities.
The AMA said that although it supports EPCS, it sees regulatory barriers that have prevented widespread EPCS uptake. Madara said the organization has been urging the U.S. Drug Enforcement Administration (DEA) to update its requirements for the biometric component of multifactor authentication with respect to EPCS. “The SUPPORT Act requires the agency to modify these requirements, and the DEA is currently working to make these modifications. Requiring adoption of EPCS prior to these regulatory changes is likely to have many unintended consequences,” he said.
Madara also noted that Section 2003 of the federal SUPPORT Act requires, with certain exceptions, that covered drugs in Schedules II, III, IV and V prescribed to patients with Medicare Part D prescription drug coverage must be transmitted electronically in accordance with the DEA regulations for EPCS effective Jan. 1, 2021. “Not only has DEA not updated its regulations, but Walmart’s policy is not aligned with the timeframe of the federal law, which will likely lead to further market confusion and disruption,” he said.
He noted that many states have tied EPCS requirements to the Jan. 1, 2021, federal Medicare Part D requirement.
The AMA is urging Walmart to delay its decision to require EPCS until, at the very earliest, after DEA updates its regulations. “We further believe that Walmart should not require EPCS in a state unless the state legislature and/or regulatory boards have approved such policy,” Madara said.
The research from ONC found that EPCS varies across practice size and practice ownership. In 2017, 59 percent of physicians in practice groups of 100 or more physicians EPCS. In comparison, 23 percent of physicians in a solo practice EPCS. Physicians who practice in groups owned by a health plan, health maintenance organization, hospital, or other healthcare entity EPCS at higher rates than physicians in a private practice. Furthermore, physicians who participated in a Center for Medicare & Medicaid Services program, such as Accountable Care Organizations or Patient-Centered Medical Homes, were more likely to EPCS than non-participants.
ONC also reported that EPCS technology does not vary significantly between rural and urban areas; but it does vary between states. Some of this variation is explained by current state policies. The SUPPORT Act requires that all affected drugs covered by Medicare Part D be electronically prescribed starting in 2021. Some states, like New York, Maine, Minnesota, and Connecticut, have already mandated the use of EPCS technology while others are looking to implement similar plans.