Tamper-Resistant Prescription Pads Now Required

Section 7002(b) of the U.S. Troop Readiness, Veterans’ Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007 includes a provision requiring that all written and computer-generated prescriptions that are given to a Medicaid recipient to take to a pharmacy must be written or printed on tamper-resistant prescription pads or tamper-resistant computer paper. Refer to Attachment 1 (PDF, 63 KB) of this Wisconsin Medicaid and BadgerCare Update for a copy of the Centers for Medicare and Medicaid Services (CMS) guidance regarding this new requirement. Attachment 2 (PDF, 25 KB) is a Frequently Asked Questions (FAQ) document provided by the CMS. This requirement is effective October 1, 2007. All other Medicaid policies and procedures regarding prescriptions continue to apply.

Required Features for Tamper-Resistant Prescription Pads or Computer Paper

To be considered tamper-resistant as of October 1, 2007, prescription pads/paper must contain at least one of the following three characteristics:

• One or more industry-recognized features designed to prevent unauthorized copying of a completed or blank prescription form.
• One or more industry-recognized features designed to prevent the erasure or modification of information written on the prescription by the prescriber.
• One or more industry-recognized features designed to prevent the use of counterfeit prescription forms.

As of October 1, 2008, all three of the above-listed characteristics are required by federal law.

Exclusions to Tamper-Resistant Prescription Pad Requirement

Following are exclusions to the tamper-resistant prescription pad requirement:

• Refills of prescriptions presented at a pharmacy before October 1, 2007.
• Prescriptions faxed directly from the prescriber to the pharmacy.
• Prescriptions electronically transmitted directly from the prescriber to the pharmacy.
• Prescriptions telephoned directly from the prescriber to the pharmacy.
• Prescriptions paid for by a Medicaid Managed Care Organization (MCO).
• Prescriptions provided to recipients in nursing facilities, intermediate care facilities for the mentally retarded, and other specified institutional and clinical settings to the extent that drugs are part of their overall rate. However, written prescriptions filled by a pharmacy outside the walls of the facility are subject to the tamper-resistant requirement.

72-Hour Grace Period

Prescriptions presented by patients on non-tamper-resistant pads or paper may be dispensed and considered compliant if the pharmacy receives a compliant prescription order within 72 hours.

Coordination of Benefits

The federal law imposing these new requirements applies even when Wisconsin Medicaid is the secondary payer.

Retroactive Medicaid Eligibility

If a patient becomes retroactively eligible for Wisconsin Medicaid, the federal law presumes that prescriptions retroactively dispensed were compliant. However, prospective refills will require a tamper-resistant prescription.

Penalty for Noncompliance

Payment made to the pharmacy for a claim corresponding to a noncompliant order may be recouped, in full, by Wisconsin Medicaid.

Obtaining Tamper-Resistant Prescription Pads and Paper

Prescribing providers should begin acquiring tamper-resistant prescription pads and/or computer paper in order to meet the October 1, 2007, compliance deadline. Wisconsin Medicaid is planning to provide a limited supply of pads and paper to Wisconsin Medicaid/SeniorCare prescribing providers. However, this supply may not be available prior to October 1, and prescribers are not encouraged to wait for a Medicaid supply. Providers are not required to use the state-supplied pads to be compliant. Providers should refer to the Wisconsin Medicaid Web site in late September 2007 for information about this assistance.

Attachment 1 — Centers for Medicare and Medicaid Services (CMS) Guidance Regarding Tamper-Resistant Prescription Pads Requirement (PDF, 63 KB)
Attachment 2 — Centers for Medicare and Medicaid Services (CMS) “Frequently Asked Questions” Document (PDF, 25 KB)