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  • CMS Update

    Document Security Paper Information
    There is much more to Document Security Paper than just Hidden Message Technology
    (also known as "VOID Background").


    Requirement for Use of Tamper Resistant
    Prescription Pads
    Under the Medicaid Program.

    Section 1903b(i) of the Social Security Act (42 USC193b(i), paragraph (23)

    Date for full compliance: October 1, 2008

    Full Compliance means that all Medicaid Scripts
    must contain One or More industry-recognized features from EACH of THREE CATAGORIES.

    CLARIFICATION PROVIDED BY CMS (Centers for Medicare and Medicaid Services)

    Several States have had questions about whether a provider can add a feature to a prescription to make it compliant with requirements. States have proposed various features including particular kinds of ink to write the prescription (gel or indelible), writing out the drug quantities rather than just the number (i.e. "thirty" vs "30") and embossed logos.

    The statute states that all written prescriptions must be "executed on a tamper resistant pad" (paper). As a result, features added to the prescription after they are printed (written) do not meet the requirement of the statute. Features that would make the prescription tamper-resistant include certain types of paper as well as certain items that can be pre-printed on the paper.

    Note: If a multi-part prescription form is used, PART ONE (the actual script) MUST contain all of the required security features.
    Without the required features, the script does not meet Medicaid Requirements.

    Why is Medicaid requiring security features on all Medicaid prescriptions (scripts) ?

    The reason Medicaid requirements have been put is place is simply to prevent Medicaid prescription fraud. Medicaid loses millions and millions of dollars annually due to forged or altered prescriptions. By making it harder for patients to alter or forge prescriptions, which affects the sale of illegal drugs, it is anticipated that Medicaid can save a significant amount of money. Every Doctor should be concerned about forged and altered prescriptions since it is their signature that appears on the script. Forged and altered prescriptions affect everyone with higher insurance costs as well as higher state and federal taxes.

    What are the Medicaid Requirements -
    When do the Medicaid "Tamper Resistant" Prescription Regulations take effect ?

    On April 1, 2008 ---
    For a prescription form to be considered "Tamper Resistant,"
    prescriptions must contain at least 1 of the 3 features listed below.

    As of October 1, 2008 ---
    For a prescription to be considered "Tamper Resistant,"
    prescriptions must contain security features in all three catagories.

    All Micro Format Rx Paper Products meet and exceed
    all THREE CATAGORIES as required by Medicaid October 2008

    How are "Industry-recognized" security features defined and
    what are some of the features that meet the requirements as stated?
    1. Category One
      • Void Pantograph background (Hidden Message Technology)
      • Reverse Rx Symbol
      • Micro Printing
      • Artificial Watermark on back of script
    2. Category Two
      • Colored Shaded Pantograph background
      • Toner Grip Security Coating
      • "Check and Balance" printed features such as
        "quantity" check boxes, and space to indicate
        "number of medications" written on prescription form
    3. Category Three
      • Security Feature Warning Box and Warning Bands
      • Security Back Printing
      • Coin Activated Ink
      • Batch Number identification
      • Secure Rub Color Change Ink
      • Consecutive Numbering

    When considering the guide lines above, a MULTI-PART PRESCRIPTION DOES NOT MEET ANY OF THE THREE Medicaid Requirements

    The value of a multi part script lies in the fact that the signature can be verified. Should there be a question, the original signature can be compared to the signature on the carbonless copy.

    BUT the statue states that all written prescriptions must be "executed on a tamper resistant pad" (paper). As a result, features added to the prescription after they are printed (written) do not meet the requirement of the statute. "

    In this case, the "signature" and the "act of comparing the copy to the original" is the feature that provides the security. Since the "signature" is being added to the script at the time the prescription is being executed, a multi-part pad in itself does not meet the Medicaid Requirements.


    The following States which adopted security requirements prior to the Medicaid legislation are not required to make changes to their current program
    California, Florida, Indiana, Kentucky, Maine, New Jersey, New York, West Virginia, Wyoming.

    All Micro Format and Secure Guard Prescription Paper Products meet and exceed all three categories for Medicaid requirements.


    Requirement for Use of Tamper Resistant
    Prescription Pads
    Under the Medicaid Program.

    Section 1903b(i) of the Social Security Act (42 USC193b(i), paragraph (23)

    (1) Payment shall not be made for amounts expended for medical assistance for covered outpatient drugs (as defined in section 1927(k)(2)) for which the prescription was executed in written (and non-electronic) form unless the prescription was executed on tamper- resistant pad (paper)


    Excerpt from letter sent to State Medicaid Directors on August 17, 2007
    from the Department of Health & Human Resources
    Centers for Medicare & Medicaid Services

    The purpose of this letter is to offer guidance to State Medicaid agencies on section 7002(b) of the U.S. Troop Readiness, Veteran's Care, Katrina Recovery, and Iraq Accountability appropriations Act of 2007. regarding the use of tamper-resistant prescription pads, which was signed into law on May 25, 2007 .....

    To the extent permissible under State and Federal law and regulation, our guidance does not restrict emergency fills of non-controlled or controlled dangerous substances for which a prescriber provides the pharmacy with a verbal, faxed, electronic, or compliant written prescription within 72 hours after the date on which the prescription was filled.

    To be considered tamper resistant on October 1, 2007, (extended to April 1, 2008)
    a prescription must contain at least one of the following three characteristics:

    1) one or more industry-recognized features designed to prevent unauthorized copying of a completed or blank prescription form;

    2) one or more industry-recognized features designed to prevent the erasure or modification of information written on the prescription by the prescriber;

    3) one or more industry-recognized features designed to prevent the use of counterfeit prescription forms.

    No later than October 1, 2008,
    to be considered tamper resistant,
    a prescription pad must contain all of the foregoing three characteristics. Failure of a State to enforce the tamper-resistant pad requirement of section 7002(b) may result in the loss of Federal financial participation.

    ...



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