Doctors assail law changing Rx pad rules

A new Medicaid law that takes effect nationwide Oct. 1 has doctors in a dither and pharmacists fuming.

The measure, contained in the federal 2007 supplemental appropriations bill and cast as a cost-savings measure, requires all doctors, nurse practitioners and physician assistants to use tamperproof prescription pads when writing any prescription for patients enrolled in Medicaid, which is called MaineCare here.

The pads have special watermarks and other anti-fraud features – such as heat-sensitive inks that are revealed if the prescription is photocopied – that make them difficult to falsify. They must be purchased from an approved manufacturer, and they cost significantly more than standard prescription pads.

According to one Internet prescription pad vendor, the cost of a package of 10 standard prescription pads with 100 sheets on each pad is $23.95, or about $2.40 per pad. The same number of anti-fraud prescription pads costs $33.95, or about $3.40 per pad, a cost increase of nearly 42 percent. It is unclear who will pay the additional cost.

“You can imagine how this is going to go over,” Andrew MacLean of the Maine Medical Association said Monday. “Doctors in Maine don’t need any more disincentives to participating in the Medicaid program.”

He noted that doctors and other prescribers in Maine already are required to use the special prescription pads for opiates and other powerful painkillers with a potential for abuse. But the new law extends the requirement to every class of drug prescribed for every man, woman and child enrolled in MaineCare – about a quarter of the state’s total population.

MacLean was in the process of composing an electronic newsletter to Maine physicians to inform them of the impending requirement.

“I’m sure the phone is going to start ringing off the hook as soon as this goes out,” he said.

Dr. Edward Langston, board chairman of the American Medical Association, said in a prepared statement Monday that the organization fears the fast-track implementation of the new law may threaten Medicaid patients’ access to prescription drugs.

“The implementation timetable is too short to educate prescribing physicians about the new law and is also likely too short to produce and distribute the enormous quantity of new prescription pads that will be needed,” Langston said.

Under the new law, any pharmacist presented with a written prescription for any MaineCare enrollee will have to check to see that it is written on the tamper-resistant paper. MaineCare will not pay for prescriptions found to have been written on nonsecure paper.

Bangor pharmacist Christopher Gauthier, board coordinator of the Maine Pharmacy Association, said Monday that the new requirement would pose an ethical dilemma for community pharmacists.

“By law, you’re supposed to refuse to fill it,” he said. “But in reality, it’s 5 o’clock Friday afternoon and there’s a little old lady staring you in the face and if you don’t fill it, she won’t get her medication. It falls on pharmacists to police this regulation, and that’s not right.”

In the office of MaineCare Services at the Department of Health and Human Services, Brenda McCormick said it is ultimately up to states to monitor physician and pharmacy compliance with the new law. Maine will be developing a new “audit function,” she said, adding that it will cost thousands of dollars to build and will require additional staff to coordinate.

McCormick stressed that DHHS is just beginning to work on the best way to implement and monitor the impending MaineCare requirement.

“We really have not been given a lot of guidance” from the federal Center for Medicare and Medicaid Services, or CMS, she said.

A spokeswoman at the regional CMS office in Boston said Monday afternoon that the agency has consulted extensively with physicians and pharmacists as well as with state Medicaid programs in developing guidelines for implementing and enforcing the new law. The guidelines are still being completed, Roseanne Pawelec said, so details are not yet available.

“However, we can assure you that in drafting the guidance, CMS is making every effort, within the constraints of the law, to ensure there is no interruption in the continuity of care provided to Medicaid recipients,” she said.