Tamper-Resistant Prescriptions
(updated 4/11/2008)

Resources:

For more information, contact:
Michigan Department of Human Services (MDHS) Provider Hotline, (800) 292-2550
Michigan Pharmacists Association (MPA), (517) 484-1466

 

Tamper-Resistant Prescription Law Takes Effect April 1
Pharmacists must be aware of the implementation date of April 1, 2008, for the tamper-resistant prescription law, as well as the provisions relating to what security features must be contained on tamper-resistant prescriptions.

Tamper-Resistant Characteristics
To be considered tamper-resistant on April 1, a prescription must contain at least one of the following three industry-recognized security features. The prescription features must prevent unauthorized copying of a completed or blank prescription form, prevent the erasure or modification of information written on the prescription by the prescriber and/or prevent the use of counterfeit prescription forms. By October 1, 2008, a prescription must contain all three characteristics to be considered tamper-resistant.

According to tamper-resistant prescription regulations, outpatient drugs paid in any part by Medicaid (primary, or through secondary or tertiary coverage) will only be reimbursable if "nonelectronic written prescriptions are executed on a tamper-resistant pad." Tamper-resistant prescriptions will be auditable, and Medicaid will recover inappropriate payments for noncompliance with the tamper-resistant prescription law. Prescriptions communicated verbally to the pharmacy, transmitted via facsimile or electronically prescribed will not be affected by the tamper-resistant prescription law.

Prescriptions That Must Be Tamper-Resistant
Whenever Medicaid pays any portion of the cost of a prescription, the written prescription must be on tamper-resistant paper. The tamper-resistant prescription policy applies for the following:

  • Fee-for-service Medicaid prescriptions that are not transmitted via facsimile, electronically prescribed or verbally communicated to the pharmacy
  • Prescriptions for carve-out drugs that are reimbursed by the Michigan Department of Community Health (MDCH) through its pharmacy benefits manager (PBM) even if these beneficiaries are enrollees of a Medicaid health plan, county health plan or in a Medicare Part D program. These carve-out drugs include antipsychotics, antidepressants, anxiolytics, HIV medications, etc.
  • Prescriptions for beneficiaries who have Medicaid coverage in addition to other primary healthcare coverage (e.g., BCBSM, Aetna, PHP) and who have a portion of the costs of the prescription, such as the copay, billed to Medicaid
  • Prescriptions for Medicare Part D beneficiaries residing in nursing facilities, intermediate care facilities for the mentally retarded or other clinical centers that have prescription drugs billed to Medicaid (e.g., benzodiazepines)
  • Computer-generated prescriptions from the hospital emergency room or a prescriber that are printed out and handed to the patient or caregiver
  • Prescriptions for beneficiaries who are retroactively enrolled in the Medicaid program

Noncompliant Prescriptions
In the event that a pharmacist cannot verbally confirm a noncompliant prescription order because the prescriber is not available, the noncompliant prescription should be filled on an "emergency basis" and within 72 hours after the date the prescription was written, obtain a compliant order from the prescriber (either verbal, facsimile or e-prescribed order). Pharmacists in doubt about the authenticity of a prescription order for any patient presented to the pharmacy should verify the prescription with the prescriber and document information (date verified, name of person verifying information both at the prescriber's office and the pharmacy and time of call) on the prescription, consistent with Board of Pharmacy Rule 338.3162 (5).