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Complaints Cause Bush Administration to Delay Prescription-Pad Mandate

Many physicians were unable to get access to so-called tamper-resistant prescription pads before the deadline, which could have limited Medicaid beneficiaries' drug access.

President Bush approved legislation granting a six-month delay to a new Medicaid prescription-pad requirement two days before it was to go into effect. The new effective date is April 1, 2008.

The requirement calls for Medicaid prescriptions to be written on tamper-resistant pads to be eligible for reimbursement.

The delay was sought by APA and other physician groups (Psychiatric News, August 17). The original implementation date was October 1.

The Senate and House passed the measure (S 2085) in the last week of September as part of a package of programs that were set to expire October 1, and the president signed it that weekend.

"The purpose of the tamper-proof requirement is to combat fraud, not create chaos for patients and pharmacies," said bill sponsor Sen. Sherrod Brown (D-Ohio) in a written statement.

Physician groups sent letters to the Centers for Medicare and Medicaid Services (CMS) in the months preceding the implementation deadline identifying obstacles to the new requirement and warning that Medicaid beneficiaries may have difficulties filling their prescriptions.

The requirement was tucked in a massive budget measure (PL 110-28), enacted in May, which limited federal reimbursements of state Medicaid programs to those states in which physicians are required to write prescriptions on so-called tamper-resistant pads.

The prescription-pad mandate aimed to make it harder for patients to obtain controlled drugs illegally and to save the government money. The Congressional Budget Office estimated that the requirement will save taxpayers $355 million over the coming decade, mainly through preventing fraudulent prescriptions.

APA sent an initial letter to CMS on July 23 to raise concerns about the short implementation period for physicians to obtain the pads, whose design requirements were never clearly defined in the federal law. In a September 21 follow-up letter, APA noted that its concerns about delays in physicians obtaining appropriate prescribing pads were becoming reality.

"Since the initial APA letter, it has come to our attention that some physicians are experiencing the predicted delays in obtaining 'tamper-resistant pads' due to the high demand causing supply shortages and backlogged orders," said James H. Scully Jr., M.D., APA medical director, in the September letter. "Unless and until an adequate supply of 'tamper-resistant pads' is available to physicians, it will be a matter of impossibility for them to comply with the statutory directive."

Those comments echoed the concerns of other physicians groups, including the AMA, which sent letters to CMS urging a delay in implementing the requirement.

The AMA called for a six- to 12-month delay to make multiple fixes, including creation of a consistent definition for "tamper-resistant" and the need to exempt prescriptions dispensed to beneficiaries with "retroactive eligibility."

Other concerns raised by APA included the possibility that the October 1 implementation of the prescription-pad requirement might have resulted in discriminatory treatment against Medicaid beneficiaries, since filling their prescriptions may cause additional administrative problems. Those problems might have created a reason for physicians and pharmacists to avoid serving Medicaid beneficiaries.

Scully noted that among Medicaid beneficiaries is a group of about 6 million people who are dually eligible for Medicaid and Medicare, and nearly half of these patients have a cognitive or mental impairment. Delays in obtaining prescribed medications can cause substantial complications, even to the point of decompensation, for many patients for whom psychotherapeutic drugs are essential, he said.

APA information on tamper-resistant prescription pads is posted at <www.psych.org/downloads/TamperResistantPadNoticeFINAL.pdf>.

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