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Deadline to comply with federal law is near
By Rebecca Trela
For Aftab “AJ” Jiwani, California’s Medicaid secure prescription pad requirements “saved the business,” when they were first enacted in 2004, he says. The Buena Park, Calif.-based distributor, who has about 4,500 clients in the health care market, has been aggressively marketing the pads with each order of related products—from billing forms to envelopes—since the legislation passed.
A lot of his sales success, he says, has been over the phone. “It’s really a no-brainer for clients,” he says, revealing that they rely on him to ensure they’re compliant with the law. “In the beginning, the sale was all about informing them, but they’re aware of the law by now and what’s important is turnaround. They don’t really care which security features we use.” The VOID pantograph is popular because of its price and covert nature.
The pads used to be more expensive, he says, but what once sold wholesale for $20 can now be had for $6, especially from Canadian sellers as the dollar continues to drop. “Hundreds of approved printers have just sprung up,” Jiwani says. “The margins on these things are wonderful; they can be as high as 100 percent, but the sale is still very, very small,” which is one of the reasons the critical mass of his customer base is so important. The pads make a nice add-on sale to other health care market items, he says, but mostly to small and medium-size offices with fewer than five locations.
“Any bigger than that, say more than 20 employees, and they’re probably with another provider, and they’re definitely looking at or already doing an EMR or electronic medical records program,” Jiwani says.
While California is a little ahead of the rest of the country, the most recent wave of Medicare/Medicaid standards went into effect April 1, requiring at least one of a select list of security features to be present on each prescription pad. The features can include thermochromic ink, VOID pantographs, chemically sensitive paper, micro print or a watermark. Several states—Florida, Kentucky, Indiana, Maine, West Virginia and Wyoming—have additional requirements.
On October 1, the pads will be required to have at least three security measures—one aimed at deterring counterfeiting, one to deter copying and one to deter erasure. Prescriptions for hospital in-patients or long-term-care facility patients will not be required to meet the standards, but computer-generated prescriptions will.
It’s not too late to start selling prescription pads, Jiwani says, but only if you’re already in the medical business. “This is not a new reason to go out and get a health care market account, but if you’re already there and not selling them, you’re missing out.” One of the nice things about prescription pads, he says, is that pharmaceutical companies are reluctant to give away branded ones (unlike pens or notepads) because of the possible connection of the brand to the actual prescription and allegations of bribery. “This is one of those areas where pharma giveaways aren’t hurting our business,” he says.
Prescription Pad FAQs
The requirements governing tamper-resistant prescription pads were passed as part of the U.S. Troop Readiness, Veterans’ Care, Katrina Recovery and Iraq Accountability Appropriations Act of 2007 (Section 7002(b)).
The Center for Medicare and Medicaid Services issued a letter to State Medicaid directors (SMDs) in August 2007, offering guidance regarding interpretation of the law. Following response to the SMD letter, the Center for Medicare and Medicaid Services generated answers to frequently asked questions and issued the following:
Will CMS provide examples of existing state practices that meet
CMS requirements?
The tamper-resistant prescription pad characteristics set forth by the several states that currently have tamper-resistant prescription laws and/or regulations in effect are all acceptable examples of all three of the characteristics set forth on page two of the SMD letter. These states are California, Florida, Indiana, Kentucky, Maine, New Jersey, New York, Texas and Wyoming. (Idaho’s regulations currently require one tamper-resistant feature; therefore, Idaho’s law is compliant with the guidance given in the SMD Letter through September 30, 2008, but not thereafter.)
What are the “industry-recognized features” that CMS recognizes for the prevention of copying, erasure, or counterfeiting?
The tamper-resistant prescription pad characteristics set forth by each of the states that currently have tamper-resistant prescription laws and/or regulations in effect are all acceptable examples of existing state practices that meet the requirements set forth by the SMD letter.
Does the requirement of the use of an ink pen satisfy the second characteristic set forth on page two of the SMD letter (i.e., a feature that “prevent[s] the erasure or modification” of information on a prescription)?
No, it does not. Ink can be erased and modified, and partly for those reasons, the use of an ink pen is not an industry-recognized standard.
How do the characteristics set forth on page two of the SMD letter apply to computer-generated prescriptions that are printed on plain paper and are then signed by the prescriber? Is there an industry-recognized feature to address computer printer paper?
A computer-generated prescription that is given to the patient to take to the pharmacy must be printed on compliant, tamper-resistant paper. Such compliant paper is available in the marketplace.
Will CMS publish a list of approved vendors that print prescription pads on compliant, tamper-resistant paper?
No. As long as the prescription pads meet the requirements of the guidance in the SMD letter, providers are free to choose whatever vendor they wish.
Is there any restriction on who may supply prescribers with compliant
tamper-resistant prescription pads?
Each state may determine the vendors from which a prescriber may obtain tamper-resistant prescription pads.
Source: Centers for Medicare and Medicaid Services, cms.hhs.gov
Rebecca Trela is assistant editor of Print Solutions Magazine. Email comments to rtrela@psda.org.