Pharmacists and Physicians Beware: New Medicaid Statute Could Affect You

Pharmacists and physicians should take note that on October 1, 2007, Medicaid will deny reimbursement for prescriptions written on traditional prescription pads. Effective October 1, an amendment to 42 U.S.C. § 1396(b)(i) will require that all written, non-electronic prescriptions be issued on "tamper-resistant" prescription pads. The amendment applies to prescriptions for covered outpatient drugs.

The purpose behind the requirement is to reduce Medicaid fraud and to make it harder for patients to illegally obtain controlled drugs. However, the Centers for Medicare and Medicaid Services ("CMS") has not issued any regulations or guidelines indicating what measures are necessary to make a prescription pad "tamper-resistant," nor has there been any indication of who will bear the cost of increased security.

Physicians and pharmacists who have expressed concern about turning away customers with prescriptions written on traditional pads have received no response from the Department of Health and Human Services or CMS. Despite the lack of guidance, the potential exists for a false claim accusation if a pharmacy seeks reimbursement for a Medicaid prescription that is not written on a tamper-resistant prescription pad. Additionally, physicians who do not comply may find their patients unable to fill prescriptions.

For Further Information

For more information about this Alert, please contact Frederick R. Ball, any of the other members of the Healthcare Fraud and Abuse Practice Group or the attorney in the firm with whom you are regularly in contact.

Disclaimer: This Alert has been prepared and published for informational purposes only and is not offered, nor should be construed, as legal advice. For more information, please see the firm's full disclaimer.