Category Archives: Medical Coverage Care

New Rule Allows for Electronic Transmission of Controlled Substance Prescriptions

Controlled Substance PrescriptionsA new Drug Enforcement Agency (DEA) rule could substantially impact the way prescriptions for controlled substances can be transmitted from a physician to a pharmacy.

As physicians and pharmacies seek to cut costs and maximize efficiency, electronic record keeping and prescription filing has become more commonplace.

In response, the DEA has relaxed previous restrictions on electronically filing controlled substance prescriptions. However, recognizing the high risks posed by abusing or forging controlled substance prescriptions, the DEA has created a system of requirements which must be met before a physician is able to take advantage of the new rule.

The DEA defines controlled substances as drugs and other substances that have a potential for abuse and psychological and physical dependence; these include opioids, stimulants, depressants, hallucinogens, anabolic steroids, and drugs that are immediate precursors of these classes of substances.

Once classified as a controlled substance, drugs are then broken down into one of five categories depending on the potential for abuse and risk of dependance. Today, controlled substances account for between 11% and 12% of prescriptions written in the United States.

Under the previous rule, physicians were prohibited from electronically sending prescriptions for schedule II-V controlled substances to pharmacies. However, under the current rule, which was published March 31, 2010 in the Federal Register, physicians who meet certain requirements will be permitted to e-file those prescriptions beginning June 1, 2010.

To be eligible to e-file controlled substance prescriptions, physicians must meet two of three factors. The “two-factor authentication protocol,” which seek to guard against fraudulent prescription filings by confirming the prescribers true identity includes:

  • A password or PIN number
  • biometric data- either a fingerprint or iris scan, or
  • a “hard token”- a secured device separate from a computer that can provide a password to a physician at the time of e-filing.

To be eligible to e-file controlled substance prescriptions, physicians must validate their identity with a designated agency. When applying for the proper credentials to utilize e-filing programs, physicians must supply verifiable information such as government issued identification or financial account information.

Currently, Michigan laws vaguely address the current state of e-filing prescriptions for controlled substances. MCL 333.7333(7) states that physicians may electronically transmit prescriptions as long as they do not conflict with federal law.

The law does not differentiate between controlled substance and non-controlled substance prescriptions. As a result, we may see future clarification from the Michigan legislature or the Board of Pharmacy regarding this issue.

Importantly, physicians and pharmacies that currently possess the technology to e-file prescriptions must ensure that their systems comply with the new DEA “two-factor authentication protocol” requirements for controlled substances.

Licensed physicians who cannot afford to implement the required technology or simply wish to opt out of the program are still able to produce physical prescriptions which can be presented at a pharmacy.

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New Michigan Law Related to Billing Sexual Assault Survivors for Costs of Forensic Exam

Billing Sexual Assault Survivors for Costs of Forensic ExamHealth care providers may no longer seek payment directly from sexual assault survivors for any portion of the costs of a sexual assault medical forensic examination, including any insurance deductible, co-pay, denial of claim or other out-of-pocket expenses, if the survivors do not have insurance, or if they refuse to have the claim submitted to their insurance carrier. Instead, effective December 29, 2008, health care providers are eligible to seek reimbursement for these costs directly from the state Crime Victims Services Commission (formerly the Crime Victims Compensation Board).

Prior to seeking reimbursement from the Crime Victims Services Commission, health care providers must advise the patient, either orally or in writing, that a claim will not be submitted to their insurance carrier without their express written consent and that they may decline to consent if they believe that submitting the claim would substantially interfere with their personal privacy or safety. If the patient declines to have the claim submitted to his or her insurance carrier or if the patient is uninsured, the provider may then seek reimbursement from the Crime Victims Services Commission. The provider may not bill the patient directly.

If the patient consents to have the claim submitted to his or her insurance carrier, the health care provider must submit the claim to the patient’s insurance carrier, including Medicare or Medicaid. If reimbursement cannot be obtained from the patient’s insurance carrier, the health care provider may then submit the claim for reimbursement to the Crime Victims Services Commission. If reimbursed by the patient’s insurance carrier for any portion of the claim, the health care provider may not also seek reimbursement from the Crime Victims Services Commission or the patient for the balance of the claim.

In order to be eligible for reimbursement, the examination must include all of the following: collection of a medical history, a general medical examination, a detailed oral, anal, or genital examination, and administration of a sexual assault evidence kit and related medical procedures and laboratory and pharmacological services.

The Crime Victims Services Commission will not pay more than $600 for the cost of performing a sexual assault medical forensic examination. This includes payments up to $400 for the use of an emergency room, clinic, or examination room and the sexual assault medical forensic examination, up to $125 for laboratory services, and up to $75 for dispensing pharmaceutical items related to the sexual assault.…

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