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Electronic Prescribing of Controlled Substances

Public Act 17-131, Section 3, requires Electronic Prescribing of Controlled Substances (EPCS) starting on January 1, 2018 for all controlled substances. In addition to improving efficiency, this will help stop prescription fraud with fewer opportunities to duplicate or modify paper prescriptions.

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Verifying An Exemption

1. Verify EPCS Exemption Status - These instructions will help you find an individual prescriber's exemption status in real time from https://www.elicense.ct.gov/Lookup/LicenseLookup.aspx.
2. Waiver List - This list is can be searched or downloaded and is updated every 24 hours.

Frequently Asked Questions

Update: (Question 1 in the Pharmacists Section)

What is the pharmacist responsibility when receiving a written prescription for a controlled substance after January 1, 2018?

• A pharmacist has a duty to determine if a prescription is valid whether it was transmitted electronically or otherwise permitted by law.
• Prescribers are encouraged to place the reason for the written prescription on the prescription.
• Any prescriptions issued prior to January 1, 2018 with refills are still valid without an electronic prescription.
• NEW: A pharmacist is NOT required to verify that a prescriber has a waiver from the requirement to electronically prescribe, or properly falls under one of the other exceptions from the requirement to electronically prescribe. Pharmacists may continue to dispense medications from otherwise validwritten, oral, or fax prescriptions that are consistent with current laws and regulations.

Electronic Prescribing of Controlled Substances

Frequently Asked Questions

General

1. What is Electronic Prescribing of Controlled Substances (EPCS)?

• EPCS allows prescribers to use a software system to electronically transmit Schedule II-V controlled substance prescriptions to a pharmacy.

2. What is required for a prescriber to transmit an electronic Schedule II-V controlled substance prescription?

• Software used by prescribers to transmit an electronic Schedule II-V controlled substance prescription must meet the requirements set forth by the Drug Enforcement Administration (DEA).
• More information may be found on the DEA’s website.

• All Schedule II, III, IV, and V controlled substance medications
• For more information regarding controlled substances, see the Frequently Asked Questions.

1. How should a transmitted electronic Schedule II-V prescription be stored?

• Dispensed electronic Schedule II-V controlled substance prescriptions may be stored electronically or on paper using the software that created the prescription.
• All records must be maintained for a minimum of three (3) years and shall be made available for inspection at reasonable times.

2. What exceptions exist for Electronic Prescribing of Controlled Substance (EPCS)?

• Technological and/or electrical failure (temporary)
• Adverse impact on the patient’s medical condition or patient care (compounded prescriptions, complicated directions for use)
• The intended pharmacy is not located in the State of Connecticut
• Lack of technological capacity (requires a waiver)

3. What constitutes “technological failure” or “electrical failure”?

• A temporary failure of computer system, application, or device or the loss of electrical power to such system, application, or device or any other reasonable service interruption to such system, application, or device that reasonably prevents the prescriber from utilizing their EPSC system.
• Failure for a pharmacy to accept an electronic prescription would also be an appropriate use of this. In this case, you may want to let the pharmacy know that they are having an issue so that they may attempt to correct it.

4. What procedure must prescribers follow during a “technological failure” or “electrical failure”?

• Prescribers should attempt to correct any and all causes within one’s control.
• Prescribers must document in the patient’s medical record the reason why a paper, facsimile (fax), or telephone prescription was authorized during a “technological failure” or “electrical failure”.
• This must be done as soon as practicable, but no later than seventy-two hours following the end of the temporary “technological failure” or “electrical failure” that prevented the electronic transmission of prescriptions.
• Prescribers are encouraged to document the reason for a paper prescription on the paper, facsimile (fax), or telephone prescription provided to the patient.

5. What procedure must a prescriber follow when issuing an electronic prescription that adversely impacts the patient’s medical condition?

• A paper, facsimile (fax), or telephone prescription may be issued to the patient for up to a five (5) day supply of a Schedule II-V controlled substance.
• Prescribers issuing the paper, facsimile (fax), or telephone prescription must document the reason why the prescription was not electronically transmitted.
• Prescribers are encouraged to document the reason for a paper, facsimile (fax), or telephone prescription on the paper prescription provided to the patient.

6. What procedure must a prescriber follow when the patient’s pharmacy is located outside of Connecticut?

• A paper, facsimile (fax), or telephone prescription may be issued to the patient. The prescriber issuing the paper prescription must document the reason why the prescription was not electronically transmitted.
• The prescriber is encouraged to document the reason for a paper, facsimile (fax), or telephone prescription on the paper prescription provided to the patient.

7. What procedure must a prescriber follow when the issuance of an electronic Schedule II-V controlled substance prescription negatively impacts patient care?

• In these instances, a paper, facsimile (fax), or telephone prescription may be issued to the patient.
• • a prescription requiring a pharmacist to compound two or more products; a prescription for direct administration to a patient by parenteral, intravenous, intramuscular, subcutaneous, or intraspinal infusion;
  • a prescription bearing long or complicated directions;
  • a prescription in which the federal Food and Drug Administration requires the inclusion of certain elements;
  • a prescription transmitted orally to a pharmacist by a health care practitioner for a patient in a chronic and convalescent nursing home.
• The prescriber is encouraged to document the reason for a paper, facsimile (fax), or telephone prescription on the paper prescription provided to the patient or pharmacy.

8. What does “technological capacity” mean?

• Possession of a computer system, hardware or device that can be used to electronically transmit controlled substance prescriptions consistent with the requirements of the Drug Enforcement Administration.
• More information may be found on the DEA’s website.

9. What procedure must a prescriber follow when lacking the ability or “technological capacity” to comply with the requirements set forth for Electronic Prescribing of Controlled Substances (ECPS)?

• The prescriber must file an exemption with the Department of Consumer Protection’s Drug Control Division. The exemption process can be found at the top of the page under 'Exemption Instructions'.

10. What is the procedure for filing an Electronic Prescribing of Controlled Substances (ECPS) exemption with the Department of Consumer Protection’s Drug Control Division?

• The Department of Consumer Protection will send a brief questionnaire to each prescriber with an Active Controlled Substance Registration. This questionnaire will serve as the exemption. The questionnaire only needs to be completed by the prescriber if they are seeking the exemption.
• At this time, any prescriber that completes the exemption questionnaire and answers 'Yes' to questions 4 that asks about the waiver has successfully completed exemption.
• The prescriber is encouraged to document that they have completed the exemption with the Department of Consumer Protection on the paper, facsimile (fax), or telephone prescription prescriptions provided to the patient or pharmacy.

11. What procedure must a prescriber follow when one’s ability to comply with the requirements set forth for Electronic Prescribing of Controlled Substances (ECPS) exists in some, but not all, practice settings?

• Prescribers must comply with the requirements set forth for Electronic Prescribing of Controlled Substances (ECPS) in practice settings with “technological capacity”.
• Prescribers may issue a paper, facsimile (fax), or telephone prescription prescription in practice settings without “technological capacity”.

13. Can a prescriber change/update my questionnaire for Electronic Prescribing of Controlled Substances?

• Yes. If you log in to your account for your Controlled Substance Registration for Practitioner you can update your account at any time.

14. Can prescribers electronically prescribe controlled substances prior to January 1, 2018?

• If your software is compliant with the Drug Enforcement Administration requirement then you can electronically prescribe controlled substances prior to the January 1, 2018 mandate.

15. Is an electronic facsimile of a prescription considered an electronic prescription?

• No. A facsimile is a copy of an original prescription.

16. What should I do if my Electronic Health Record has temporary periods of “downtime” or temporary periods of time where Electronic Prescribing of Controlled Substances is unavailable?

• This is considered 'technological failure or electrical failure'. If your 'downtime' is scheduled, it is recommended that you share that information with pharmacies within your area if possible. Please see above.

17. Does an electronic prescription require a written follow-up prescription to be sent to the pharmacy?

18. Is it mandatory for pharmacies to receive electronic prescriptions for controlled substances?

• Yes.

• If the prescription is of an urgent nature, they can either locate another pharmacy or utilize a different exemption such as the exemption where Electronic Prescribing of Controlled Substances may negatively impact patient care.

20. How do prescribers know if their software is compliant with the requirements for Electronic Prescribing of Controlled Substances?

• You should contact your software vendor as they should be able to provide you with information.

21. Are oral prescriptions for controlled substances still permitted for Schedule II medications?

• Schedule II prescription can be communicated by a prescribing practitioner known to or confirmed by a pharmacist orally in an emergency.
• The filling pharmacist shall promptly reduce such oral order to writing on a prescription blank. Such oral order shall be confirmed by the proper completion and mailing or delivery of the prescription prepared by the prescribing registrant to the pharmacist filling such oral order within seventy-two hours.
• The pharmacist shall affix the temporary prescription to the properly completed prescription.
• The properly completed prescription can either be hand written or electronically transmitted but should indicated that it is part of the telephoned in prescription.

21. Are oral or facsimile (fax) prescriptions for controlled substances still permitted for Schedule III, IV, or V medications?

• Schedule III, IV or V prescriptions can be communicated orally or by facsimile by a prescribing practitioner known to or confirmed by a pharmacist orally if the prescriber is using a qualifying exemption.
• The filling pharmacist shall promptly reduce oral orders to writing on a prescription blank.

22. What if I am a prescriber and I work at multiple locations that don't all have the ability to comply with Electronic Prescribing of Controlled Substances?

• Please complete the questionnaire for an exemption. In the locations where you can comply with Electronic Prescribing of Controlled Substance you will be required to do so.

• If your computer system can comply with Electronic Prescribing of Controlled Substances then you do not need to do anything. If your software cannot comply with Electronic Prescribing of Controlled Substances then you should complete the questionnaire for a waiver.

• Your software vendor may charge you for the ability to comply with Electronic Prescribing of Controlled Substances. At this time, you are not required to purchase any software because you can apply for the exemption.

• If you practice with a software system that can comply with Electronic Prescribing of Controlled Substances then you do not need to do anything. If your software cannot comply with Electronic Prescribing of Controlled Substances then you should complete the questionnaire for a waiver.

• A paper, facsimile (fax), or telephone prescription would still be permitted.

• Yes. They are also eligible for all of the exemptions that are available as well.

• The prescribers should apply for the waiver until they are fully compliant with Electronic Prescribing of Controlled Substances.

Pharmacy/Pharmacist

1. What is the pharmacist responsibility when receiving a written prescription for a controlled substance in Schedule II-V after January 1, 2018?

• A pharmacist has a duty to determine if a prescription is valid whether it was transmitted electronically or otherwise permitted by law.
• Prescribers are encouraged to place the reason for the written prescription on the prescription.
• Any prescriptions issued prior to January 1, 2018 with refills are still valid without an electronic prescription.
• NEW: A pharmacist is NOT required to verify that a prescriber has a waiver from the requirement to electronically prescribe, or properly falls under one of the other exceptions from the requirement to electronically prescribe. Pharmacists may continue to dispense medications from otherwise validwritten, oral, or fax prescriptions that are consistent with current laws and regulations.

• The law does not specifically require a pharmacist to verify the prescribing practitioner's exemption status for every written prescription. It is the pharmacists responsibility to determine the validity of a prescription prior to dispensing it using their professional judgment.

• Yes. It is recommended that the verification is performed that it is documented. Please see the list of providers who have successfully completed the exemption process at the top of the page or the instructions for looking up individual providers.

• All records are required to be maintained on file for three (3) years at the premises of the pharmacy and maintained current and separate from other business records.
• All records must be stored in a manner that is readily available for inspection by the Department of Consumer Protection, or authorized agents at reasonable times.
• Prescription records that have been received electronically may be stored electronically, provided the files are maintained in the pharmacy computer system for not less than three (3) years. If an electronically transmitted prescription is printed, it shall be filed along with written and telephone prescriptions chronologically and sequentially.

• Technological and/or electrical failure (see prescriber area above for more information)
• Adverse impact on the patient’s medical condition or patient care (compounded prescriptions, complicated directions for use)
• The intended pharmacy is not located in the State of Connecticut

8. As a pharmacist, how do I know if a prescriber has applied for the exemption from the EPCS requirement?

• All exemption information will be available on our website at www.elicense.ct.gov by prescriber. There is also a list available at the top of the page. NEW: There is no specific number issued to a prescriber when a waiver is requested.

• If the pharmacist, in their professional judgment believes that the prescription is appropriate they should fill the prescription. If the pharmacist decides to fill the prescription, they may document their rationale in a manner that would be readily retrievable.

10. Are oral prescriptions for controlled substances still permitted?

• Schedule II prescription can be communicated by a prescribing practitioner known to or confirmed by a pharmacist orally in an emergency.
• The filling pharmacist shall promptly reduce such oral order to writing on a prescription blank. Such oral order shall be confirmed by the proper completion and mailing or delivery of the prescription prepared by the prescribing registrant to the pharmacist filling such oral order within seventy-two hours.
• The pharmacist shall affix the temporary prescription to the properly completed prescription.
• The properly completed prescription can either be hand written or electronically transmitted but should indicated that it is part of the telephoned in prescription.

Kabhi khushi kabhie gham full synopsis. 11. Are oral or facsimile (fax) prescriptions for controlled substances still permitted for Schedule III, IV, or V medications?

• Schedule III, IV or V prescriptions can be communicated orally or by facsimile by a prescribing practitioner known to or confirmed by a pharmacist orally if the prescriber is using a qualifying exemption.
• The filling pharmacist shall promptly reduce oral orders to writing on a prescription blank.

• Pharmacists may dispense a controlled substance medication pursuant to an out-of-state written or electronic prescription provided they meet all of the requirements, state and federal, for issuing a prescription. It is the pharmacists responsibility to determine the validity of a prescription prior to dispensing it using their professional judgment.