Tamper-Resistant Prescription Frequently Asked Questions - AAPPN Newsletter


A new state law passed in 2009 to combat unauthorized, improperly altered and counterfeit prescriptions. (RCW 18.64.500) Starting July 1, 2010, all prescriptions written in Washington State must be on board-approved, tamper-resistant prescription paper or pads. (TRPP).

http://www.doh.wa.gov/hsqa/Professio...perResFAQs.htm

What is tamper-resistant prescription paper or pads?

Tamper-resistant prescription paper or pad means a prescription pad or paper that has been approved by the board for use and contains one or more industry-recognized feature to prevent:

* Unauthorized copying of a completed or blank prescription form.
* Erasure or modification of information written on the prescription by the prescriber.
* Use of counterfeit prescription forms.

What are industry-recognized features?

Examples of industry-recognized features include:

* The word ?Void,? ?Illegal,? or ?Copy? appearing when the prescription is photocopied or faxed.
* A background consisting of a solid color or pattern that is printed on the paper. This stops a forger from physically erasing written or printed information on a prescription form.
* A complete list of the security features on the prescription paper. This aids pharmacists in identifying features and determining compliance.

Is the Washington State law different than the Medicaid Tamper-Resistant Prescription Law?

Yes and no. The federal law implemented in 2009 requires that all written prescriptions for covered outpatient drugs that are paid for by Medicaid be written on tamper-resistant prescriptions.

The new law RCW 18.64.500, states that beginning on July 1, 2010 all prescriptions written in Washington must be written on tamper-resistant prescription paper or pads approved by the Board of Pharmacy. Tamper-resistant prescription paper or pads meeting the requirements of this law will also meet the federal requirements for Medicaid prescriptions.

The new law applies to prescriptions written for delivery/dispensing by a pharmacist/pharmacy. It does not apply to prescriptions such as those written for corrective lenses, custom orthotics/prosthetics, etc.

Who must comply?

All practitioners with prescriptive and dispensing authority must comply with this law.

How must they comply?

Beginning July 1, 2010, all prescriptions must be written on tamper-resistant paper approved by the Board of Pharmacy.

Pharmacists cannot dispense a written prescription unless it is written on board approved prescription paper. A pharmacist may provide emergency medications in compliance with federal and state laws and rules, and any applicable health care plan restrictions and procedures.

There are exceptions included in the law when tamper-resistant prescription paper is not required. RCW 18.64.500

Are there exceptions in the law when tamper-resistant prescription paper or pads are not required?

Yes. Tamper-resistant prescription pads or paper are not required when:

* Prescriptions are transmitted to the pharmacy electronically, by telephone or by facsimile.
* Prescriptions are written for patients in hospitals (whether in patient or as out-patients, residents of nursing homes, or inpatient or residents of a mental health or correctional facilities, if the prescriber writes the order into the patient?s medical or clinical record, the order or prescription is given directly to the pharmacy, and the patient never has the opportunity to handle the written order or prescription.

If at any time the patient or patient?s designee handles the written order or prescription, the prescription must be on approved tamper-resistant paper or pad.

Does the July 1, 2010 date refer to the date the prescription is filled or written?

The effective date refers to the date the prescription is written.

What if I am dispensing a refill on or after the effective date, but the original prescription was filled before July 1, 2010?

The law applies to prescriptions written on or after July 1, 2010. It does not apply to refills for prescriptions written before July 1, 2010.

Can the prescriber add features to the prescription to make it compliant with the requirements such as writing out the drug quantities rather than just the number; using indelible or gel ink; or using an embossed logo?

No. The law requires all written prescriptions to be on tamper-resistant paper or pads (TRPP) approved by the board. Features added to the prescription after it is printed such as a stamp, sticker or indelible ink do not meet the requirements of the law. All board-approved TRPP will have the Board of Pharmacy ?seal of approval.?

Will prescriptions printed from a computer need to be on board approved tamper-resistant prescription paper or pads?

If a hard copy of an electronic prescription is printed and given to the patient or patient?s designee, the manually-signed hard copy prescription must be on approved tamper-resistant paper.

The law does not require prescriptions transmitted to the pharmacy electronically, by telephone or by facsimile to be on board-approved tamper-resistant paper or pad.

Are tamper-resistant prescription pads or paper required when over-the-counter products are prescribed?

Yes. Over-the-counter products written as prescriptions must comply with the tamper-resistant requirements.

Do transferred prescriptions need to be on tamper-resistant pads or paper?

The pharmacy needs to receive a phone call or fax from the other pharmacy that originally received the prescription to confirm its authenticity. The receiving pharmacist is not required to get confirmation of the original prescription from the prescriber.

Can a pharmacist dispense a prescription written on faxed tamper-resistant pads or paper where the security pantograph is activated?

Prescriptions that are transmitted to the pharmacy by telephone, facsimile, or electronic means are not required to be on approved tamper-resistant paper. (Refer to law for other exceptions RCW 18.64.500.)

However, a pharmacist using his or her professional judgment may dispense a prescription receivedby fax where the security pantograph is activated,. Vendors of approved tamper-resistant prescription paper or pads and prescribers are strongly encouraged to use the words ?Copy? or ?Copy/Fax? when using this feature to prevents unauthorized copying of a completed or blank prescription form.

A faxed prescription with the word ?void? or ?illegal? can also be dispensed by a pharmacist. The pharmacist must call the prescriber to confirm the prescription?s authenticity. This makes it a verbal prescription. Documentation of the call will bring the prescription into compliance.

Note: other federal or state restrictions/limitation may apply for example RCW 69.50.308 and 21 CFR 1306.11 (e) & (f).

Who must have their tamper-resistant prescription pads or paper (TRPP) approved by the board?

All vendors must have their tamper-resistant prescription pads or paper approved by the board prior to the marketing or sale of pads or paper in Washington State. Approved TRPP will have the Board of Pharmacy ?seal of approval.?

Exemptions
Vendors exempt from requesting approval of their product from the Board of Pharmacy include:

* Manufacturers that supply the base stock to another entity that will add security features prior to submission for board approval.
*
Brokers and Distributors that facilitate the sale, purchase, and/or delivery of board-approved tamper-resistant prescription paper or pads directly to the prescriber.

What is the process for seeking board-approval of tamper-resistant prescription paper or pads?

The Board of Pharmacy has developed a review/approval process for vendors seeking approval of their TRPP.

Link to instructions: Tamper-Resistant Rx Review/Approval Process

Where can I find a list of vendors that provide board-approved tamper-resistant prescription paper or pads?

A list of vendors can be found on the Washington State