Psychiatrists prescribe a wide variety of controlled substances. Controlled substances are medications and substances regulated under the Controlled Substances Act, which divides them into five “schedules,” generally based on how dangerous and addictive they are. They range from Schedule I drugs, “street drugs,” with the highest potential for abuse or dependency, either psychological or physical or both, and no federally approved medical use in the U.S.; to Schedule V drugs, which have the lowest potential for abuse or dependency.1
The controlled substances most prescribed by psychiatrists are:
- Benzodizepines prescribed to help reduce anxiety, including panic attacks and extreme fear or worry1
- Stimulants prescribed for the treatment of attention deficit hyperactivity disorder (ADHD)1
Benzodizepines are Schedule IV substances with a low potential for abuse. Stimulants are Schedule II substances and considered to have a high potential for abuse.1
Prescribing controlled substances is a much more complex process than writing a prescription for a non-controlled medication, including different legal requirements dependent upon location and situation.
Legislative requirements for electronic prescribing (e-prescribing)
Electronic prescribing (e-prescribing) is becoming a requirement for prescribing controlled substances in more states. Mandates for the Electronic Prescribing of Controlled Substances (EPCS) have been put in place with the goal of better monitoring prescriptions for controlled substances and, in the process, reducing opportunities for misuse of prescription medications.1,2 E-prescriptions are easier to track and monitor than paper prescriptions, making it easier to help prevent over-prescribing and easier to help prevent prescription drug abuse.
In 2018, Congress passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (or SUPPORT for Patients and Communities Act) to address the increasing rate of abuse of prescription drugs in the United States.3 This law requires Schedule II-V controlled substances that are covered under Medicare Part D or the Medicare Advantage Prescription drug plan to be electronically prescribed (e-prescribed) beginning January 1, 2021.3-5 In addition, all covered Part D medications that require prior authorization must be e-prescribed beginning January 1, 2021.2 E-prescribing is defined as transmitting a prescription electronically directly to the pharmacy, either through a practice’s EHR or through stand-alone e-prescribing technology.6,7
After the onset of COVID-19, the Centers for Medicare & Medicaid Services (CMS) pushed back the compliance date for this requirement to January 1, 2022. This extended the time before penalties would be enacted for non-compliance while still encouraging prescribers to implement e-prescribing of controlled substances as quickly as possible.3 However, many states have passed laws requiring e-prescribing for controlled substances immediately; other states require e-prescribing for all prescriptions, not just controlled substances; while still other states have legislation pending that will put requirements for e-prescribing in place:4
The specific requirements differ for each state. For instance, some states have penalties in place for non-compliance, whereas other have no penalties at all; some states allow exceptions and waivers for particular situations, while others do not. See your specific state legislation for guidance.4*
Simple e-Prescribing without an EHR
Although some electronic health records (EHR) systems have e-prescribing built into them, they may not meet the requirements for e-prescribing controlled substances.6 To satisfy the Drug Enforcement Agency’s (DEA’s) requirements for e-prescribing controlled substances, prescribers need to use EPCS-certified software. This has to meet DEA requirements for credentialing, software certification, dual factor authentication, and more.4 Not all EHR-integrated e-prescribing software is EPCS-certified.
However, an EHR is not essential for e-prescribing. Veradigms ePrescribe is a comprehensive, standalone, EPCS-certified solution for electronic prescribing.8 It is cloud-based, allowing you to access Veradigm ePrescribe from any location with internet access, including your mobile device.8,9
Advantages of e-prescribing
ePrescribe’s EPCS certification enables you to electronically prescribe and monitor prescriptions for controlled substances that come from your practice. It helps you prevent overprescribing and delivers your patient’s prescription directly—and electronically—to their chosen pharmacy.8
ePrescribe is also integrated with the Prescription Drug Monitoring Program (PDMP) database, a tool that can help you to spot prescription drug abuse early in your patients.2,7,8
However, ePrescribe does not just allow you to meet the legal requirements for prescribing controlled substances. ePrescribe also streamlines the prescription-writing process, helping to make your workflow more efficient. ePrescribe enables you to e-prescribe from within your existing clinical workflow. It helps you save time by decreasing the number of calls and faxes you and your staff need to make to the pharmacy when ordering a prescription.8 It also enables you and your staff to spend less time on the phone with the pharmacist, calling in prescriptions or clarifying a difficult-to-read handwritten prescription.6,7
E-prescriptions tend to be more efficient for patients as well, as they no longer must take a paper prescription to the pharmacy and wait while it’s filled. Instead, the prescription is delivered to the pharmacy electronically, while the patient is still at the point-of-care. It can be filled before the patient arrives at the pharmacy.7
ePrescribe also helps you to prescribe medications more safely. Although prescribing errors are still possible, electronic prescriptions are generally more accurate than handwritten ones. E-prescriptions eliminate illegible scripts, increasing the likelihood that scripts will be filled correctly.6,7 As an added safety feature, it delivers your patient’s medication histories and formularies directly to your clinical workflow, including drug interaction details, allergy alerts, and other information to help you avoid prescription drug errors. ePrescribe helps you help keep your patients safe.6-9
Many controlled substances require prior authorization before they can be filled. ePrescribe includes eAuth, an integrated electronic prior authorization tool. eAuth automates submission of your prior authorization request within your e-prescribing workflow, reducing the wait time for payer approvals from days or weeks to minutes. eAuth notifies the prescriber if a medication requires prior authorization when they select the medication to prescribe, while the patient is still at the point-of-care.8,10 You and your staff can spend less time on the phone with insurance companies and pharmacy benefit managers by automating the prior authorization process; help your patients receive their medications quickly, without the treatment delays that often accompany the need for prior authorizations.8,10
ePrescribe also includes Veradigm RxTruePrice™, an integrated prescription price transparency solution that allows you to verify your patient’s pharmacy benefit more easily. This makes it easier for you to choose medications that will be covered by the patient’s prescription drug benefits. It also makes it easier to identify financial assistance for patients who are paying out of pocket.8,9 RxTruePrice even provides competitive pricing from different pharmacies. All these, in turn, make it more likely that your patient will pick up their medication and adhere to their care plan.2
Improve patient satisfaction
Regulatory mandates on electronic prescribing are becoming more common and more stringent, with more and more states requiring e-prescribing for controlled medications. ePrescribe will allow you to meet state requirements for prescribing controlled substances. It will also help you provide your patients with speedier PA. Speedier PA for controlled medications means speedier time-to-therapy; faster time-to-therapy leads to better odds for medication adherence and better patient satisfaction.8
To learn more about ePrescribe and using it to prescribe controlled medications for your patients, click here.
*Please note that this is not intended as legal advice. Please see your state legislation to determine the requirements for your particular practice.
- TheraNest Team. Most Common Psychiatric Controlled Substances. TheraNest. Updated November 23, 2020. Accessed June 15, 2021, https://theranest.com/blog/most-common-psychiatric-controlled-substances/.
- Pasquariello T. Electronic Prescribing Regulations Expand in 2019.4. 2019. https://veradigm.com/img/resource-erx-regulation-report.pdf
- California Medical Association. CMS delays enforcement of e-prescribing requirement for controlled substances. California Medical Association. Updated December 15, 2020. Accessed June 15, 2021, https://www.cmadocs.org/newsroom/news/view/ArticleId/49150/CMS-delays-enforcement-of-e-prescribing-requirement-for-controlled-substances.
- Mazina N. Are you ready for E-Prescribing? MazinaLaw. Updated May 1, 2019. Accessed June 14, 2021, https://www.pharmhealthlaw.com/single-post/2019/05/01/are-you-ready-for-e-prescribing/.
- OptumRx home delivery pharmacy to require e-prescribing for controlled substances effective January 1, 2020. Updated December 11, 2019. Accessed June 14, 2021, https://www.cmadocs.org/newsroom/news/view/ArticleId/28223.
- American Psychiatric Association. e-Prescribing (eRx). American Psychiatric Association. Accessed June 14, 2021, https://www.psychiatry.org/psychiatrists/practice/practice-management/health-information-technology/e-prescribing.
- TheraNest Team. How Do Electronic Prescriptions Work for Psychiatrists? TheraNest. Updated October 26, 2020. Accessed June 11, 2021, https://theranest.com/blog/how-do-electronic-prescriptions-work-for-psychiatrists/.
- Veradigm. ePrescribe–Automate and Empower Your Prescribing Success. Veradigm. Accessed June 15, 2021, https://veradigm.com/eprescribe/.
- Pasquariello T. The Importance of e-Prescribing for Dentists. Veradigm. Updated August 16, 2019. Accessed June 15, 2021, https://veradigm.com/veradigm-news/e-prescribing-software-for-dentists/.
- Health Plan and Payer Solutions. Veradigm. Accessed June 17, 2021, https://veradigm.com/health-plan-payer-solutions/.