What is EPCS?
Electronic Prescribing of Controlled Substances (EPCS): Facts and FAQs
Electronic prescribing of controlled substances, or EPCS, electronically transmits prescriptions for controlled substances to the pharmacy. Prescribers are encouraged to write and send prescriptions for controlled substances electronically to increase safety and security and reduce fraud and diversion risks. Pharmacists are then permitted to receive, dispense, and archive the prescriber's electronic prescriptions.
What constitutes a controlled substance?
A drug or other substance that the government tightly controls because it may be abused or cause addiction. The control applies to how the substance is manufactured, used, handled, stored, and distributed. Controlled substances include opioids, stimulants, depressants, hallucinogens, and anabolic steroids.
Electronic Prescribing for Controlled Substances (EPCS) eliminates paper prescriptions by allowing clinical prescribers to write prescriptions for controlled substances electronically. It also permits pharmacies to receive, dispense and archive these e-prescriptions.
Schedule I
Schedule I drugs are defined as those with no currently accepted medical use and a high potential for abuse. Examples include heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), 3,4-methylenedioxymethamphetamine (ecstasy), methaqualone, and peyote.
Schedule II
Schedule II drugs carry serious potential for abuse leading to severe psychological or physical dependence. These drugs are also considered dangerous. Examples are combination products with less than 15 milligrams of hydrocodone per dosage unit (Vicodin), cocaine, methamphetamine, methadone, hydromorphone (Dilaudid), meperidine (Demerol), oxycodone (OxyContin), fentanyl, Dexedrine, Adderall, and Ritalin.
Schedule III
Schedule III drugs have low-to-moderate potential for physical and psychological dependence. Examples include drugs containing less than 90 milligrams of codeine per dosage unit (Tylenol with codeine), ketamine, anabolic steroids, and testosterone.
Schedule IV
Schedule IV drugs have a low potential for abuse and carry little risk of dependence. Some examples include Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin, Ambien, and Tramadol.
Schedule V
Schedule V drugs have less potential for abuse than Schedule IV and consist of preparations containing limited quantities of certain narcotics. This class of drugs is generally prescribed for antidiarrheal, antitussive, and analgesic purposes. Examples include cough preparations with less than 200 milligrams of codeine or per 100 milliliters (Robitussin AC), Lomotil, Motofen, Lyrica, and Parepectolin.
DrFirst: An EPCS Pioneer
DrFirst is proud to have developed and introduced the first-ever EPCS technology in 2010, working with the Massachusetts Department of Health under a waiver from the U.S. Drug Enforcement Administration (DEA). Today, iPrescribe meets DEA requirements and Surescripts' strict certification processes. We are committed to further leading the industry in best practices for the quality, usability, and security of controlled substance e-prescribing.
What are EPCS technology requirements?
EPCS creates "identity proofing" responsibilities for EHR vendors, prescribers, and pharmacies by requiring two-factor authentication, more robust audit trails, and strict auditing procedures to comply with the DEA's Interim Final Rule regulating EPCS.
Federal EPCS Mandates
The federal government passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act – better known as the SUPPORT Act – in 2018 with the intention of enforcing EPCS for every provider in the nation whose patients are enrolled in Medicare Part D and Medicare Advantage prescription drug plans. The Centers for Medicare & Medicaid Services (CMS) delayed the mandate deadline to January 1, 2023. The Long-Term Care facilities have until January 1, 2025 to comply.
State EPCS Mandates
E-prescribing is now the rule rather than the exception in all 50 U.S. states and the District of Columbia. With state mandates as the impetus, most U.S. pharmacies today are fully up to speed on e-prescribing processes.
Prescription Drug Monitoring Programs (PDMPs)
A PDMP collects, monitors, and analyzes prescriptions and dispensing data submitted by pharmacies or dispensing practitioners, helping to identify patients who are addicted, or are at risk of becoming addicted, to dangerous drugs.
Each state maintains its own database of controlled substances. State-mandated PDMPs are a vital resource in the effort to curb the nation’s opioid epidemic; keeping providers informed so they, in turn, can protect patients.
The benefit of iPrescribe by DrFirst is access to EPCS with in-workflow PDMP; enabling providers to prescribe Schedule II-V controlled substances and non-controlled prescriptions in one simple mobile workflow—for added convenience and improved safety.
Why is EPCS necessary?
Deaths from prescription painkillers have reached epidemic levels. According to the Centers for Disease Control (CDD), 15,000 Americans die each year from overdoses involving prescription painkillers. The regulation aims to quell opioid-related addiction, abuse, diversion, and death rates by making it more difficult for drug-seekers to doctor-shop and alter prescriptions.
Get Started with iPrescribe Today
Here’s what you’ll need:
NPI Number
You’ll need an NPI account to set up your e-prescribing profile as part of the identity verification process. You will need to upgrade your account to begin e-prescribing controlled substances (EPCS).
Identity Proofing
Identity proofing can be done in person or online through companies that work with your EHR. For online identity proofing, you may need to answer a security question and email scanned copies of government-issued documents along with your photo and medical license.
Two-Factor Authentication
This two-step process ensures that only you can sign and send the controlled substance prescription to the pharmacy. The process includes something you have (e.g., a fob token generated one-time password) and something you know (e.g., a password). There are various options for two-factor authentication: mobile phones, smart cards, fob tokens, USB thumb drives, and biometrics such as fingerprint scanners.
References
https://www.congress.gov/bill/115th-congress/house-bill/6/text
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/controlled-substance
https://www.dea.gov/drug-information/drug-scheduling#:~:text=Schedule%20I%20drugs%2C%20substances%2C%20or,)%2C%20methaqualone%2C%20and%20peyote.
https://drfirst.com/resources/regulatory-mandates/
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/NPI-What-You-Need-To-Know.pdf