(11) Issued where the patient specifically requests a written prescription.


6) Is there a waiver process? Yes. Prescrib- ers who meet certain “exceptional circum- stances” may be eligible for a waiver delaying implementation of an e-prescribing tool, as noted in #5, Sections 9, 10 and 11 of the Missouri statute. However, the Missouri Bureau of Narcotics and Dangerous Drugs (BNDD) has noted that no waiver process is established yet and that the Bureau has not received funding to implement the statute. Also, while the Bureau has been working on possible rules and fiscal notes, no rules have been filed at this time. In the interim, the Bureau expects the doctors to continue to prescribe as they have in the past.


7) Will pharmacies accept paper prescrip- tions for controlled substances after January 1? The law calls for pharmacies to follow e-prescribing protocol outside the statute exceptions listed in #5, but it is not possible to accurately predict which pharma- cies will and will not fill controlled substance prescriptions that are not transmitted elec- tronically.7


One of the exceptions noted in the state statute (Section 1.11) is when a script for a designate controlled substance is, “Issued where the patient specifically requests a writ- ten prescription”; another, under Section 2 states, “A pharmacist who receives a written, oral, or faxed prescription is not required to verify that the prescription properly falls un- der one of the exceptions from the require- ment to electronically prescribe. Pharmacists may continue to dispense medications from otherwise valid written, oral, or fax prescrip- tions that are consistent with state and federal laws and regulations.”


The MDA has communicated with the Missouri Pharmacy Association to ensure the association communicates with its member pharmacists about their ability to continue to accept paper scripts at the request of the patient, and therefore a universal rejec- tion of paper scripts—and requirement of e-prescribing for these listed controlled substances—is not allowed.


8) Does this law apply to non-controlled substances? No. The Missouri statute does not pertain to non-controlled substances.8 However, if you implement electronic prescribing for some medications, it may be faster and simpler to adapt a consistent workflow for all prescriptions. The law does not require nor preclude you from using the same technology for non-controlled substances.


9) Should I implement an EPCS program in my practice, what are the basic DEA guidelines for e-prescribing software? In order for an EPCS system to be considered in compliance with the DEA requirements, it must include:9


• Authentication: The system must enable a recipient to positively verify the signer without direct communication with the signer and subsequently demonstrate to a third party, if needed, that the sender’s identity was properly verified


• Nonrepudiation: The system must ensure that strong and substantial evidence is available to the recipient of the sender’s identity, sufficient to prevent the sender from successfully denying having sent the data. This criterion includes the ability of a third party to verify the ori- gin of the document


• Message integrity: The system must en- sure that the recipient, or a third party, can determine whether the contents of the document have been altered during transmission or after receipt


• Digital signatures using Public Key Infrastructure technology


• Two-factor authentication for providers who sign an EPCS prescription


• EHR/e-prescribing application certification


• ID proof to verify a provider has the authorization to prescribe controlled substances


• Detailed reporting that comprehensively shows compliance and identifies audit- able events and any incidents around breaches of security


10) How do I choose an e-prescribing soft- ware that adheres to the Missouri statute? Look for a software vendor that meets the DEA criteria for electronic prescriptions as outlined in #9 and that will personally assist


you in the registration and setup process. Additionally, some software companies have e-prescribing services that improve your workflow, such as e-prescribing all medica- tions, integrating with your practice manage- ment system and providing accessibility on any computer or device.


The MDA regrets that in its original publi- cation, it did not provide enough informa- tion for members about all aspects of the current statute. The MDA Board of Trustees is further researching this issue, including having discussions with other state health- care associations, to best advocate for our member dentists. We will provide updates and information as available. As stated previ- ously, while the statue is in effect, current rules have not been written to apply the statute, and thus the BNDD has stated that doctors can continue to prescribe as they have previously—including by paper or by e-prescribe, if it is a technology they already have implemented into their practice.


Should a doctor not currently use e-prescribe and/or EPCS technology, but wish to do so, they should inquire with their current dental practice software about built-in technology or software integration. Members can receive discounts through iCoreConnect, an MDA Perks Program participant that offers iCor- eRx which meets EPCS requirements and in- tegrates with popular practice management systems. The iCoreConnect team can discuss with members what iCoreRx interaction looks like with their particular PM software. You can learn more at icoreconnect.com/ modental-about. f


REFERENCES


1, 5-8) https://revisor.mo.gov/main/OneSection. aspx?section=195.550 (Missouri statute) 2) https://www.healthit.gov/faq/what-electronic- prescribing 3) https://ecfr.federalregister.gov/current/title-21/chapter- II/part-1311 (standards), https://ecfr.federalregister.gov/ current/title-21/chapter-II/part-1300/section-1300.03 (definitions) 4) https://www.cms.gov/newsroom/fact-sheets/ medicare-advantage-and-part-d-drug-pricing-final-rule- cms-4180-f 9) https://ecfr.federalregister.gov/current/title-21/ chapter-II/part-1311


ISSUE 6 | NOV/DEC 2020 | focus 21


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