Beginning April 1, 2008, all written prescriptions for Medicaid recipients must be on paper with at least one tamper-resistant feature as outlined by CMS and defined by the State.  Beginning October 1, 2008 these same prescriptions must be on paper that meets all three baseline characteristics of tamper-resistant pads.  CMS has outlined the three baseline characteristics as those that: (1) prevent unauthorized copying of a completed or blank prescription form; (2) prevent the erasure or modification of information written on the prescription by the prescriber; or (3) prevent the use of counterfeit prescription forms.

States are responsible for defining specific features that meet the baseline characteristics in order for a prescription to be considered tamper-resistant in that State. The Rhode Island state Board of Pharmacy has selected a subcommittee to address state requirements. A meeting was held Wednesday, March 12 to meet with state Medicaid officials to discuss these issues. Some of the issues discussed are outlined below.  Please note that electronic prescriptions, faxed prescriptions and prescriptions sent over the telephone are exempt from this requirement.  Failure to comply could result in a withholding of Medicaid reimbursement.

The tamper proof paper must contain at least one of the following characteristics:
1. A watermark on the backside of the paper;
2. The word "VOID" will appear on the paper if copied;
3. The paper shall contain a feature that shows obvious tampering if exposed to chemical or through attempted erasure.

Exemptions to this rule also include refills on prescriptions written prior to April 1st, prescriptions not paid for by Medicaid as primary or secondary payer (cash, managed care, insurance, etc.), direct pharmacy-to-pharmacy transferred prescriptions, and prescriptions from Massachusetts prescribers.

If you receive a prescription on the wrong paper, some solutions for the prescriber include:
1. Call in the prescription;
2. Re-write on the proper, tamper-proof paper;
3. Fax or electronically send the prescription.

Additionally, the pharmacist can document on the prescription that she/he called the prescriber and verified the prescription's validity.

Effective December 17, 2007, a federal amendment by the DEA shall allow prescribers to write multiple Schedule II prescriptions for an individual patient. This final rule is entitled, "Issuance of Multiple Prescriptions for Schedule II Substances." This allows an individual patient to receive up to a 90-day supply of Schedule II medication with continuous therapy. Separate prescriptions must be written for each quantity of Schedule II substance on the same date to be filled sequentially.
 
However, under regulation 21-28-3.18. of the Rhode Island State Board of Pharmacy Drug Laws Manual, a prescription for a Schedule II, III, and IV substance must be dispensed within 30 days of the original date of the prescription . Because of the strict nature of the Rhode Island Controlled Substances Act, this supercedes federal regulation.
 
Thus, in Rhode Island, a practitioner licensed by law to prescribe these substances may:
 
Transcribe up to two multiple Schedule II prescriptions (each with a maximum of 30 day supplies) for an individual patient.
 
The original date must be transcribed on each prescription.
 
Both prescriptions must be dispensed sequentially within the 30 day window of expiration from the original date it was written

Contributed by: Lisa M. Rodriguez

• Medication Administration
  Issue Brief
  PDF of Senate Bill
  PDF of House Bill