Electronic Prescribing for Controlled Substances

Clarifying requirements for January 1 Missouri EPCS Statute

In its September/October 2020 Focus MDA issue, the MDA published an article titled, Surprising Ways e-Prescribing Can Speed Up Your Workflow.

The article referred to a Missouri Statute that became effective August 2019 and states, “beginning January 1, 2021, no person shall issue any prescription in this state for any Schedule II, III, or IV controlled substance unless the prescription is made by electronic prescription from the person issuing the prescription to a pharmacy.”

The article also incorrectly stated, “beginning January 1, 2021, all doctors are federally mandated to only use electronic prescriptions for any Schedule II, III or IV controlled substances.” 

While there is a state statute, the Missouri statute is different from the federal rule with the same start date. The Missouri statute requires the use of e-prescribing for Schedule II-IV controlled substances for all prescribers (but provides exceptions and waivers, which we will discuss following). In contrast, the federal e-prescribing final rule pertains only to Medicare Part D prescriptions per the electronic Real-Time Benefit Tool (RTBT).

This questions and answers document seeks to clarify current laws and how Missouri dentists can respond to those, and included the following:

  1. What does the Missouri Electronic Prescribing for Controlled Substances (EPCS) statute require? 
  2. What is electronic prescribing or e-prescribing? 
  3. Does this include fax, phone, scanned or emailed prescriptions? 
  4. Is the Missouri statute different from the federal rule with the same start date?
  5. Are there exceptions to the state statute? 
  6. Is there a waiver process?
  7. Will pharmacies accept paper prescriptions for controlled substances after January 1?
  8. Does this law apply to non-controlled substances?
  9. Should I implement an EPCS program in my practice, what are the basic DEA guidelines for e-prescribing software?
  10. How do I choose an e-prescribing software that adheres to the Missouri statute

The MDA regrets that in its original publication, it did not provide enough information for members about all aspects of the current statute. The MDA Board of Trustees is further researching this issue, including having discussions with other state healthcare associations, to best advocate for our member dentists. We will provide updates and information as available. 

As stated previously, while the statue is in effect, current rules have not been written to apply the statute, and thus the Bureau of Narcotics and Dangerous Drugs has stated that doctors can continue to prescribe as they have previously—including by paper or by e-prescribe, if it is a technology they already have implemented into their practice. 

Should a doctor not currently use e-prescribe and/or EPCS technology, but wish to do so, they should inquire with their current dental practice software about built-in technology or software integration. 

Members can receive discounts through iCoreConnect, an MDA Perks Program participant that offers iCoreRx which meets EPCS requirements and integrates with Dentrix, Eaglesoft, Open Dental and other practice management systems. The iCoreConnect team can discuss with members what iCoreRx interaction looks like with their particular PM software.