Required
Features on Tamper-Resistant Prescriptions
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Prescription Pad/Paper Requirements
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When Requirements Don't Apply
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Information for Pharmacists
As of October 1,
2008 only fully tamper-resistant prescriptions that meet ALL THREE REQUIREMENTS
listed below, are to be used for prescriptions for Maryland Medicaid recipients.
In 2007 Congress enacted federal legislation that requires State
Medicaid Program providers to use tamper-resistant prescription
pads/paper. The law requires all written Medicaid prescriptions
for outpatient drugs, whether handwritten or computer-generated,
to be tamper-resistant in order for them to be reimbursed by the
Medicaid Program. These requirements apply whether
Medicaid is the primary or secondary payer of the prescription.
Beginning this past April 1, 2008, Medicaid required that all
written prescriptions have at least one security feature from
the list below.
In order to eliminate confusion and to more narrowly define Maryland
requirements, the Maryland Medicaid Pharmacy Program (MMPP) has chosen the
security features that are most economical and reasonable to implement. We will
accept any of the features listed in the table below; however, the bolded
feature is preferred by the MMPP.
Providers who write prescriptions for Maryland Medicaid members are encouraged
to contact their printer to secure an appropriate supply of prescription pads or
paper that will meet the October 1, 2008 MMPP requirements and begin using this
paper or prescription pads no later than October 1, 2008 for all new written
prescriptions. Prescribers using computer-generated printed prescriptions
are advised to obtain software applications and printers that will generate
compliant prescriptions. Additionally, individual (not institutional) providers
should print their NPI numbers on the prescriptions.
Prescription Pads/Paper
Requirements
MMPP requires
that all prescription pads/paper for prescriptions written on or after October
1, 2008 must have at least one feature from each of the three categories listed
below:
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Category 1 - One or more
industry-recognized features designed to prevent unauthorized copying of
a completed or blank prescription form.
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FEATURES
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DESCRIPTION
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"Void" pantograph*
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The word "Void" appears when a document is
photocopied. Pharmacy must
note on prescription if received via fax.
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Watermarking
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Special paper containing "watermarking"
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Reverse
"RX" or white area on prescription
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"Rx"
symbol or white area disappears when photocopied at light setting.
This feature is normally paired with the "Void" pantograph to
prohibit copying.
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Micro
printing for computer-generated printed prescriptions.
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Very
small font (0.5 font or less) that is legible when viewed at 5x
magnification or greater, and illegible when copied.
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*Computer software and a color printer are needed
to produce this feature on plain paper.
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Category 2 - One or more
industry-recognized features designed to prevent the erasure or
modification of information written on the prescription by the
prescriber.
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FEATURES
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DESCRIPTION
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Uniform non-white background color- preferably
green
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Background that consists of a solid color or
consistent pattern that has been printed onto the paper.
This will inhibit a forger from physically erasing written or
printed information on a prescription form.
If someone tries to erase or copy, the consistent background
color will look altered and show the color of the underlying paper.
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Quantity
check-off boxes, or, for computer-generated printed prescriptions,
border characteristics
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In
addition to the written quantity on the prescription, quantities are
indicated in ranges. It is
recommended that ranges be 25's with the highest being "151 and over".
The range box corresponding to the quantity prescribed MUST be
checked for the prescription to be valid.
An example of a valid border characteristic is the use of
asterisks to surround the numeric quantity prescribed on a computer
generated printed prescription (Example: **50**).
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Refill
indicator or, for computer-generated printed prescriptions,
border characteristics
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Indicates
the number of refills on the prescription.
Circle or check number of refills or "NR".
Refill number MUST be used to be a valid prescription.
An example of a valid border characteristic is the use of
asterisks to surround the number of refills permitted, e.g. **5
refills**.
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Category 3 - One or more
industry-recognized features designed to prevent the use of counterfeit
prescription forms.
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FEATURES
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DESCRIPTION
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Security features and descriptions listed on the
front of the prescription
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Listing of the security features of the
prescription for compliance purposes.
This will assist the pharmacist and auditors on what security
features are included on the pads/paper.
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The Tamper-Resistant requirements
DO NOT APPLY:
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When a
prescription is communicated by the prescriber to the pharmacy
electronically, verbally, or by fax (please note that controlled substances
require a written prescription).
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When a
managed care organization pays for the prescription.
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To new or refills of written prescriptions presented to
the pharmacy before April 1 without one of the features, or before October
1, 2008 without all three features.
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When drugs
are provided in institutional settings where such drugs are not separately
reimbursed.
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When drugs
are provided in any situation, such as a long term care facility or a group
home for developmentally disabled persons, in which the patient does not
have the opportunity to physically handle the prescription.
Information for Pharmacists:
After the
respective dates, any pharmacist receiving a hard copy of a prescription for a
Medicaid recipient not in compliance with tamper-resistant standards must verify
the prescription order with the prescriber. Record on the original prescription
the person contacted and the date verified. If a prescriber continues to
use non-compliant prescription forms, the pharmacist should report the
prescriber to the Medicaid Pharmacy Program.
Maryland Medicaid will pay for a 72-hour emergency supply on a non-compliant
written prescription to allow the prescriber time to provide a verbal, faxed,
electronic or compliant written prescription.
Questions concerning this transmittal should be directed to the manager for
Pharmacy Services at 410-767-1455.
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