Clarifying Requirements: Missouri Electronic Prescribing for Controlled Substances


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n the September/October 2020 Focus MDA issue an article was published titled, Surprising Ways e-prescribing Can Speed Up Your Workflow. The article


referred to a Missouri Statute that became effective August 2019 and states, “beginning January 1, 2021, no person shall issue any pre- scription in this state for any Schedule II, III, or IV controlled substance unless the prescription is made by electronic prescription from the person issuing the prescription to a pharmacy.” The article incorrectly stated, “beginning Janu- ary 1, 2021, all doctors are federally mandated to only use electronic prescriptions for any Schedule II, III or IV controlled substances.” While there is a state statute, the Missouri statute is different from the federal rule with the same start date. The Missouri statute requires the use of e-prescribing for Schedule II-IV controlled substances for all prescribers (but provides exceptions and waivers, which we will discuss following). In contrast, the federal e-prescribing final rule pertains only to Medicare Part D prescriptions per the electronic Real-Time Benefit Tool (RTBT). The following questions and answers seek to clarify current laws and how Missouri dentists can respond to those.


1) What does the Missouri Electronic Pre- scribing for Controlled Substances (EPCS) statute require? The Missouri statute states “beginning January 1, 2021, no person shall issue any prescription in this state for any Schedule II, III, or IV controlled substance unless the prescription is made by electronic prescription from the person issuing the prescription to a pharmacy.”1


2) What is electronic prescribing or e- prescribing?2


E-prescribing requires a special


software program, connected to a private, secure network that transmits directly to the pharmacy’s secure network. Prescribers ac- cess this special software through a computer device such as a desktop computer, laptop, tablet or phone. E-prescribing is a doctor’s


20 focus | NOV/DEC 2020 | ISSUE 6


ability to electronically send an accurate, error-free and understandable prescription directly to a pharmacy.


3) Does this include fax, phone, scanned or emailed prescriptions? No. As explained in #2, special software must be used to transmit an electronic prescription. Thus, e-prescribing meets an entirely different set of security regulations set forth by the Drug Enforcement Agency (DEA).3


Fax, phone,


scans and emails do not meet these require- ments.


4) Is the Missouri statute different from the federal rule with the same start date? Yes, they are different. The Missouri statute requires the use of e-prescribing only for Schedule II-IV controlled substances for all prescribers. The federal e-prescribing final rule pertains only to Medicare Part D prescriptions per the electronic Real-Time Benefit Tool (RTBT).4


5) Are there exceptions to the state statute? The exceptions outlined in the Missouri statute are as follows:5


(1) Issued by veterinarians; (2) Issued in circumstances where elec-


tronic prescribing is not available due to temporary technological or electrical failure; (3) Issued by a practitioner to be dispensed by a pharmacy located outside the state; (4) Issued when the prescriber and dis- penser are the same entity; (5) Issued that include elements that are not supported by the most recently imple- mented version of the National Council for Prescription Drug Programs Prescriber/ Pharmacist Interface SCRIPT Standard; (6) Issued by a practitioner for a drug that the federal Food and Drug Administration requires the prescription to contain certain elements that are not able to be accom- plished with electronic processing; (7) Issued by a practitioner allowing for the dispensing of a nonpatient specific prescription pursuant to a standing order, approved protocol for drug therapy, collab- orative drug management or comprehen- sive medication management, in response to a public health emergency, or other circumstances where the practitioner may issue a nonpatient specific prescription; (8) Issued by a practitioner prescribing a drug under a research protocol; (9) Issued by practitioners who have received an annual waiver, or a renewal thereof, from the requirement to use elec- tronic prescribing, pursuant to a process established in regulation by the depart- ment of health and senior services, due to economic hardship, technological limita- tions, or other exceptional circumstances demonstrated by the practitioner.6 (10) Issued by a practitioner under cir- cumstances where, notwithstanding the practitioner’s present ability to make an electronic prescription as required by this subsection, such practitioner reasonably determines that it would be impractical for the patient to obtain substances prescribed by electronic prescription in a timely manner, and such delay would adversely impact the patient’s medical condition; or


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