Make EPCS Compliance Easier, Protect Yourself and Your Patients

Make EPCS Compliance Easier, Protect Yourself and Your Patients

By Jerry Cox, CISSP

The ongoing rise in opioid addiction rates and the resulting overdoses make headlines daily. This isn’t a surprise, as forecasts predict that opioids could kill nearly 500,000 Americans in the next decade1.  Opioid overdoses will also cost the US economy hundreds of billions of dollars in the same timeframe. New regulations, such as the Electronic Prescription of Controlled Substances (EPCS), aim to reduce these trends by assisting doctors and pharmacies in recognizing both legitimate and concerning behaviors.

EPCS is a rule established by the Drug Enforcement Administration (DEA) that allows pharmacies and practitioners to process prescriptions for controlled substances electronically. EPCS was first made legal at the federal level in 2010, with the last of the states legalizing EPCS in 2015. Several states, seeing the potential for EPCS to help manage the opioid epidemic, have made EPCS mandatory by law. There are six (6) states, including New York, Maine, Connecticut, Rhode Island, Virginia and North Carolina, that have enacted laws or soon will to require EPCS use.  Similar legislation in other states has been introduced. 

Federal law requires that electronically prescribed prescriptions for controlled drugs be digitally signed with a certificate issued from a trusted Certification Authority (CA). This CA must prove the provider’s identity, ensuring they are who they say they are, before they issue the credential. To further ensure transactions are legitimate, EPCS regulations also require the prescriber to use two-factor authentication at the time they “write” the prescription.  While all this may sound complicated, the benefits greatly outweigh those concerns.     

Reduce the risk of patient fraud and pharmacy errors

The vast majority of doctors want to protect addicts from themselves, but also recognize that some patients have a legitimate need for pain relief. By leveraging electronic prescriptions, it is less likely that the physician ends up a victim of fraud through fake prescription pads or forged signatures. Not only that, but using EPCS  can be more efficient overall for time-starved providers, reducing time spent writing prescriptions and re-writing prescriptions in the event of “lost” prescriptions and eliminating the need for call-backs from pharmacies needing clarification.

Ease compliance burden for doctors

Using EPCS from within an EHR application ensures prescription records are in electronic format and are tied to patient records. In most states, this also simplifies processes associated with record keeping requirements. In some states where EPCS laws have been enacted, electronic processes have eliminated the need for previous procedural requirements to fill out prescriptions in triplicate and then submit and store prescription records into state Prescription Monitoring Programs (PMPs).

EHR applications are also starting to include automated checks of PMP data at the time prescriptions are written from within the EHR application, providing doctors with information needed to provide quality patient care while at the same time providing visibility into patients that may be chronic abusers or doctor hoppers.

Pharmacists also benefit

That same reduction in call-backs benefits the pharmacy as well. In addition to electronic prescriptions that remove any doubt as to the authenticity of the prescription request, the potential for the prescription to be tampered with or altered is eliminated.

Patients with a legitimate need for these drugs get a better experience

Though opioid abuse is rampant, some patients do need these prescriptions to manage their pain; it is important to support them without undue burden. With electronic prescriptions, medications can be ready when the patient arrives at the pharmacy, with the necessary compliance check already complete.  This is much more convenient for the patient, and can foster loyalty to both the doctor and pharmacy. 

Understanding e-prescribing

With all these benefits, and the U.S. Department of Justice research estimating that e-prescribing could result in an annualized cost savings potential of $700 million in healthcare expenses, it might be surprising to hear that EPCS adoption is moving slower than anticipated. Or maybe it’s not. Pharmacies have led the way in becoming EPCS compliant, mostly driven by large chain adoption, but doctors have lagged behind. One driver behind this is lack of awareness. Surprisingly, many doctors don’t realize they can now prescribe controlled substances electronically. Outside of that, the most common concerns include cost, potential disruption to existing process and uncertainty about EHR capabilities. The identity proofing requirement is often cited as a primary inhibitor to adoption, with the perception that it is time-consuming and confusing. In addition, concepts like digital certificates and digital signature verification can be intimidating. Most practices don’t have enough resources to research and implement these types of technical solutions. Outside of states that have mandated or are mandating EPCS adoption, it may not be at the top of many to do lists.       

Practices should look for an EHR that incorporates most of the functionality required to maintain EPCS compliance 

When this functionality is built in EPCS compliance is greatly simplified for practices and doctors. Aprima has worked very hard to simplify the two-factor authentication process in support of provider adoption of EPCS, making it quick and secure. Patients no longer handle or lose scripts and the practice is able to track each prescription in Aprima and know immediately that it has been received by the pharmacy, or if there is an issue that needs to be addressed.

Using EPCS is as easy as 1-2-3!

By implementing EPCS, you can offer an important service that can help patients, possibly even save lives, and can protect your practice. Please reach out if you have questions about how to implement an EPCS-compliant solution for your practice at or 844-4APRIMA.   

1STAT Forecast:

Jerry Cox, CISSP, is Director of Business Development for IdenTrust, part of HID Global. Jerry has been instrumental in gaining widespread support for the use of EPCS and digital certificates to help combat opioid abuse.

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