What does the STOP Act e-prescribing provision mandate, with respect to controlled substances prescriptions?
The STOP Act mandates that all prescriptions for targeted controlled substances – a designation that includes all Schedule II and Schedule III opioids and narcotics – that are issued on or after Jan. 1, 2020, be e-prescribed.
What specific medications must be e-prescribed, per the STOP Act of 2017?
All “targeted controlled substances” – a category created by the STOP Act – must be e-prescribed, effective Jan. 1, 2020. All Schedule II and Schedule III opioids and narcotics are in this group. A complete list can be found here.
Is anyone exempt from the STOP Act e-prescribing mandate?
The law specifies the following exemptions:
- A practitioner, other than a pharmacist, who dispenses directly to an ultimate user.
- A practitioner who orders a controlled substance to be administered in a hospital, nursing home, hospice facility, outpatient dialysis facility, or residential care facility
- A practitioner who experiences temporary technological or electrical failure or other extenuating circumstance that prevents the prescription from being transmitted electronically; provided, however, that the practitioner documents the reason for this exception in the patient’s medical record.
- A practitioner who writes a prescription to be dispensed by a pharmacy located on federal property; provided, however, that the practitioner documents the reason for this exception in the patient’s medical record.
- A person licensed to practice veterinary medicine.
I do not e-prescribe and would prefer not to start, due to the cost and administrative burden. Does lacking e-prescribing capability constitute an “extenuating circumstance” that would exempt me from e-prescribing?
No. Choosing not to develop e-prescribing capability, whatever the reason, does not qualify as an “extenuating circumstance” in the Board’s view and would not exempt a licensee from the STOP Act e-prescribing requirement.
I do not e-prescribe but I occasionally write Schedule II and Schedule III drugs to patients with acute pain. Is it acceptable to divert patients who contact my practice for acute pain relief to a hospital emergency room after Jan. 1, 2020, if I still do not have e-prescribing at that time?
No, the Board would not consider this an acceptable practice. Directing established patients to a hospital emergency room or other medical provider for treatment could constitute patient abandonment, depending on the circumstances. Licensees are strongly encouraged to develop e-prescribing capability if they will continue to prescribe Schedule II and Schedule III opioids and narcotics after Jan. 1, 2020.
Will my patients be able to fill prescriptions for Schedule II or Schedule III opioids and narcotics if I continue to issue paper prescriptions for these medications after Jan. 1, 2020?
The STOP Act specifically exempts pharmacies and pharmacists from having to determine whether individual prescriptions are valid or comply with the e-prescribing mandate, and states at § 90-106 (a2), “A dispenser may continue to dispense targeted controlled substances from valid written, oral, or facsimile prescriptions that are otherwise consistent with applicable laws.” Therefore, if presented with a paper prescription for a targeted controlled substance after Jan. 1, 2020, a pharmacy may lawfully fill it. Per the NC Board of Pharmacy, repeated instances of noncompliance (e.g. continued use of paper prescriptions for Schedule II and Schedule III opioids and narcotics) could lead a pharmacist to address the issue. This could include reaching out to the prescriber to ensure he or she is aware of the e-prescribing mandate. Alternatively, pharmacists could report prescribers who persist in writing paper prescriptions to NCMB, which would investigate.
What are the potential consequences of failing to comply with the STOP Act e-prescribing mandate?
There is no specific consequence established by the STOP Act. NCMB would evaluate each situation and determine an appropriate resolution based on the individual circumstances of each case.
What can prescribers who currently lack e-prescribing capability do to comply with the STOP Act e-prescribing requirement?
The Board cannot provide specific advice or recommendations to its licensees. Prescribers who do not currently have e-prescribing capability are strongly encouraged to identify an e-prescribing solution that complies with the law. Commercial products, such as an e-prescribing app for your smartphone or standalone e-prescribing software, may be an option (provided the product selected meets applicable privacy and security standards). Again, NCMB cannot recommend specific vendors or products, but the Board is aware that free and low-cost e-prescribing tools are available.
Professional and specialty organizations (NC Medical Society, Old North State Medical Society, NC Academy of Family Physicians, NC Academy of Physician Assistants, NC Osteopathic Medical Association, etc.) may be able to offer additional information or guidance.
How can I determine whether a specific vendor or e-prescribing tool meets applicable standards for privacy and security?
Prescribers may select any tool that meets security requirements set by the federal Drug Enforcement Administration (DEA). Visit DEA’s e-prescribing page for more information.
What should I do if I send an electronic prescription to a pharmacy, but they do not have the medicine in stock? I can’t cancel an e-prescription and I don’t feel comfortable allowing patients access to multiple valid prescriptions of pain meds.
The prescriber or a member of the practice support staff can contact the pharmacy to ask them to cancel the prescription. Then, the prescriber may reissue the prescription to another pharmacy.
Is it possible to use e-prescribing to provide multiple dated one-month prescriptions for controlled substances to patients with chronic conditions? This is my typical practice.
Yes. To provide multiple one-month prescriptions to a patient, the prescriber may issue a separate e-prescription for each month and indicate a “do not fill” until date on each prescription to indicate the appropriate fill date.