E-prescribing hydrocodone drugs

Now that hydrocodone combination products, such as Vicodin and Norco, have been reclassified as Schedule II drugs, CDA Practice Support has been receiving inquiries about how to prescribe these drugs electronically. 

Dentists can no longer call or fax prescriptions for these drugs to pharmacies because Schedule II drugs have more restrictions.

There is a lot of e-prescribing software available, but not all are certified for use with controlled substance prescriptions.  A list of software with Electronic Prescriptions for Controlled Substances (EPCS) certification can be viewed on the Surescripts website, surescripts.com/certified (click the “EPCS” option under the “Products” list to the left side of the vendor listings). Surescripts is an e-prescription network connecting prescribers, pharmacies, payers and prescription benefit managers through the certification of software for the following services: prescription benefit, medication history and prescription routing. However, Surescripts does not certify for EPCS compliance. Currently, 30 companies have EPCS certification. Prescribers should verify certification with the company directly.

The U.S. Drug Enforcement Agency issued in 2010 regulations for e-prescribing of controlled substances. The basic rules are as follows:

  • Pharmacies and prescribers must use software that is certified compliant with Drug Enforcement Agency (DEA) regulations.
  • E-prescribing software are certified by DEA-approved entities.
  • Prescribers must go through an identity-proofing process conducted by a DEA-approved entity.
  • Following identity proofing, the software company issues a two-factor credential to a prescriber. A prescriber uses the two-factor credential to “sign” electronic prescriptions of controlled substances.
  • The hard token provided as part of the two-factor credential may not be in possession of anyone other than the prescriber.

E-prescribing is not mandatory in California (the state of New York will begin mandating it on March 27), and the state does not place limitations on it. E-prescribing is a meaningful use criterion for the federal electronic health record (EHR) incentive program. Prescription software can be used for noncontrolled substances and most are associated with an EHR. Prescribers and staff each get unique passwords. Staff may use software to add patient information, access information and queue up refill orders (except for controlled substances).

Software license fees range from $650 to $800 annually. There may be additional fees for identity proofing and patient data entry, for example. 

Additional information and a Q-and-A on e-prescribing controlled substances regulations are available on the DEA website.