Home Forums Discussions General Discussion E-prescribing Ambien, Vicodin, etc.

Just wondering if anyone else is having the issue of pharmacies not accepting E-prescribed scripts for Ambien, Vicodin, Robitussin with Codeine, etc.? I'm a new resident to Florida and several of the pharmacies have not filled these scripts and said that they cannot be sent through E-prescribing. It just seems odd to me that the DEA will allow a verbal order for these medications yet not allow e-prescribed scripts. I moved from Iowa where we had been doing e-prescribing for years and this never was an issue. Plus, I've sent scripts for Xanax and Restoril before through Surescripts without an issue yet they are in the same class as Ambien. Has there been any change in policy that I am missing? Thanks for your help.

DEA says no scheduled meds even codeine. This is in public comment period so hopefully someday even Morphine can go e rx. I also think it is dumb.

http://tinyurl.com/eprescribe-CII

This is one of many, many articles about the DEA's now allowing ePrescribing for pretty much all controlled substances including Morphine, etc. It will require two of three of the following:

Password, token or biometric finger scan or eye scan. I am not sure when it goes into effect. This was the only article I found that had an unbroken link to the actual rule. It says it is interim, but I think it will stay.

Just in case the link is broken, I have uploaded the actual document:

http://www.box.net/shared/static/myq2jeuqaz.pdf

Wow! So when I call in the vicodin script, am I going to have to rub the receiver up against my finger or eyeball, or will they still just take my word for it?!

LOL. But, hey, just think of the good side. When that abuser comes in, you can just tell him that you just used Visine, and it will be hours before you can prescribe Oxycontin.

Excellent idea!!

Bert you are the best!

Thanks Martin. I can use that after this week.

There is an e-prescribe program for the Palm called BluefishRX that did not true e-prescribing but sent the prescription to a faxserver and stored a signature captured from the Palm pad. This program DID allow me to send schedule III-V meds electronically. It was not until I started using Shure-scripts that I learned of this problem. I have not tried AC for this yet but my current program even makes me print out Lyrica for some reason.

According to everything I have read - you can fax III-V with a signature on it - assume that is why the palm program worked the way it did. The rules for e prescribing where it sends DATA not a fax without a reproduction of your actual signature says that you cant even send Schedule V (lyrica) - royal pain, the new DEA regs for scrips look very onerous to be able to finally do scheduled - mention of fingerprint scanner, iris scan, first born child or something, but I hope that will eventually work.

At first blush, I was thinking what could be safer than sending Vicodin via ePrescribe. Currently we have the following alternatives:

1. Call it in (not optimal as anyone could do this -- one nurse of mine called it in, and the pharmacy didn't even get her name. They get names for Tylenol scripts (yes Tylenol -- free for Medicaid).
2. Sign the paper script and fax it.
3. Sign the paper script and hand to patient. (We do above because we aren't allowed to give a non Tamper-proof script to a medicaid patient. (You know how easy it is to change Amoxicillin 250/5 to 400/5. This is the same government changing our healthcare system)
4. Printing it out on tamper-proof paper.

Except for the call-in method, which does have some type of safety built in, the above methods do limit diversion to some degree.

But, while ePrescribe seems flawless, there would be no way of telling who did the ePrescribing unless there were extra precautions put in such as password and scans, etc.

One method would be for any CII through CV sent in via ePrescribe be automatically sent back to the physician prescriber on the secure site. He/She could then check daily to see if these indeed were legit.

Thoughts?

Personally,

I saw let's quit being so paranoid at the drug diversion level and worry more about the bigger things such as:

1. Healthcare
2. The deficit
3. Iraq
4. Iraq
5. Iraq
6. Food for the homeless
7. Etc.
8. GETTING GOVERNMENT OUT OF EMRs.

You know...when I have patients who talk to themselves without any answers I worry about their mental health......Bert seems to be fitting that today......LOL.

And, not to hijack the thread, where the hell was the government 15 years ago when all of the private developers were making EMRs and physicians like us were buying them?

Where were they in 2001 when Jon was rolling out AC?

It is always just like the government to wait until the private sector solves a problem and then jumps in and wants to regulate it.

Wow, I am getting political here. I haven't done that before.

Yes, usually you are so reserved and non-opinionated.....

Well, I am when it comes to politics, lol.

And, I am getting worried about you. I haven't even posted here today.

I think any of the above are a bit over the top.
I think ePrescribe combined with a token system (controlled substances) +/- password would work fine.
The token gives a four to six digit code every ten seconds, that you enter into the prescription module. Our hospital uses it, and if its good enough for them (to protect ALL hospital patient data), it's probably good enough for ePrescribe.
Remember, all I would have to do to allow another person to access the hospital data would be to give them my token or (as it now stands)my username and password.

I still think that forcing physicians to use tamper-proof paper for Medicaid patients for non CII to CV scripts such as a Z-pack is the single stupidest law this country has ever enacted.

Washington state decided the rule on special paper for Medicaid only just wasn't restrictive enough - as of July 1st we have to use SPECIFIC WA APPROVED paper for all scrips which are given to a pt. Right now there is a limited number of washington approved paper producers with each sheet having a State Seal....I guess you guys should be happy,.

Ecstatic.

We recently had a meeting with some people. That is all I can say. I just remember that with every sentence, I had to be careful or someone would jump down my throat for antitrust.

This stuff is going to continue to happen as long as we allow it to happen which, unfortunately, will probably be forever.

I suppose this post is even illegal.