Skip Navigation LinksWyoming Department of Health Healthcare Financing Pharmacy Tamper-Resistant Prescription Pads

 

Tamper-Resistant Prescription Pads

ATTENTION WYOMING MEDICAID PHARMACY PROVIDERS—IMPORTANT INFORMATION YOU NEED TO KNOW!!!

On May 25, 2007 Section 7002(b) of the U.S. Troop Readiness, Veterans’ Care, Katrina Recovery and Iraq Accountability Appropriations Act of 2007 was signed into law. The Center for Medicare and Medicaid Services (CMS) released guidance providing baseline requirements to States to define and implement tamper-resistant prescription pads as required by this law on August 17, 2007.  On September 29, 2007 these requirements were delayed by President Bush until April 1, 2008. 

The above law requires ALL written, non-electronic prescriptions for EqualityCare outpatient drugs must be executed on tamper-resistant pads in order for them to be reimburseable by the federal government. In order to meet the standards set forth in this law and to decrease prescription tampering to the greatest extent possible at this time, EqualityCare has instituted the following requirements. 

In addition to all current Wyoming Board of Pharmacy Requirements for Tamper-Resistant Prescription forms, all prescriptions paid for by EqualityCare must meet the following requirements to ensure that tampering does not occur:

 

Written prescriptions

·         As of April 1, 2008 must contain one, and as of October 1, 2008, must contain all three of the following characteristics:

1.      One or more industry-recognized features designed to prevent unauthorized copying of a completed or blank prescription form.  In order to meet this requirement all written prescriptions must contain:

¨      Some type of “void” or “illegal” pantograph that appears if the prescription is copied. 

¨      May also contain any of the features listed within category one or that meets the standards set forth in this category.

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

THIS REQUIREMENT APPLIES ONLY TO PRESCRIPTIONS WRITTEN FOR CONTROLLED SUBSTANCES!

In order to meet this requirement all written prescriptions must contain:

¨      Quantity check-off boxes PLUS numeric form of  quantity values

            OR alpha and numeric forms of quantity value

¨      Refill Indicator (circle or check number of refills or “NR”) PLUS numeric form of refill values

OR alpha and numeric form of refill values

¨      May also contain any of the features listed within category one or that meets the standards set forth in this category.

3.      One or more industry-recognized features designed to prevent the use of counterfeit prescription formsIn order to meet this requirement all written prescriptions must contain:

¨      Security features and descriptions listed on the FRONT of the prescription blank.

¨      May also contain any of the features listed within category three or that meets the standards set forth in this category.

 

Computer Printed Prescriptions:

·         As of April 1, 2008 must contain one, and as of October 1, 2008, must contain all three of the following characteristics:

1.      One or more industry-recognized features designed to prevent unauthorized copying of a completed or blank prescription form.  In order to meet this requirement all prescriber’s computer printed prescriptions must contain:

¨      Same as above for this category.

2.      One or more industry-recognized features designed to prevent the erasure or modification of information written on the prescription by the prescriber.  In order to meet this requirement all prescriber’s computer printed prescriptions must contain:

¨      Same as above for this category

3.      One or more industry-recognized features designed to prevent the use of counterfeit prescription forms.  In order to meet this requirement all prescriber’s computer printed prescriptions must contain:

¨      Security features and descriptions listed on the FRONT or BACK of the prescription blank.

¨      May also contain any of the features listed within category three or that meets the standards set forth in this category.

 

Inclusion of other industry recognized features on a prescription are acceptable if desired, however, the above features will be mandatory for all prescriptions paid for by EqualityCare as of the dates referenced above.

 

The following are some examples of current industry standards for each of the above categories.  They are subject to change and updating and are not exhaustive lists.  Judgment must be used to place security features available, but not shown in these lists, in a particular category.

 

CATEGORY 1:  One or more industry-recognized features designed to prevent unauthorized

copying of a completed or blank prescription form.

FEATURE

DESCRIPTION

“Void” or “Illegal” pantograph

 

The word “Void” appears when the prescription is photocopied. Due to the word “Void” on faxed prescriptions, this feature requires the pharmacy to document if the prescription was faxed.

Reverse “RX” or White Area on prescription

“Rx” symbol or white area disappears when photocopied at light setting. This feature is normally paired with the “Void” pantograph to prohibit copying on a light setting.

Security Back print Printed on the back of prescription form.

The most popular wording for the security back print is “Security Prescription”.

Watermarking (forderiner)

Special paper containing “watermarking”.

Diagonal lines (patented “Void”)

Diagonal lines with the word “void” or “copy”.

Micro printing

Very small font writing, perhaps acting as a signature line. This is difficult to photocopy.

 

CATEGORY 2:  One or more industry-recognized features designed to prevent the erasure or modification of information written on the prescription by the prescriber.

FEATURE

DESCRIPTION

Uniform non-white background

color

Background that consists of a solid color or consistent pattern that has been printed onto the paper. This will inhibit a forger from physically erasing written or printed information on a prescription form. If someone tries to erase or copy, the consistent background color will look altered and show the color of the underlying paper.

Quantity check off boxes

In addition to the written quantity on the prescription,

Quantities are indicated in ranges. It is recommended that ranges be 25’s with the highest being “151 and over”. The range box corresponding to the quantity prescribed MUST be checked for the prescription to be valid.

Refill Indicator (circle or check

number of refills or “NR”)

Indicates the number of refills on the prescription. Refill number must be used to be a valid prescription.

Pre-print “Rx is void if more

than___ Rxs on paper” on

prescription paper

Reduces the ability to add medications to the prescription.  Line must be completed for this feature to be valid. Computer printer paper can accommodate this feature by printing “This space intentionally left blank” in an empty space or quadrant.

Quantity Border and Fill (for

computer generated prescriptions

on paper only)

Quantities are surrounded by special characters such as an asterisk to prevent alteration, e.g., QTY **50**. Value may also be expressed as text, e.g., (FIFTY).

Refill Border and Fill (for computer generated prescriptions on paper only)

Refill quantities are surrounded by special characters such as an asterisk to prevent alteration, e.g., QTY **5**. Value may also be expressed as text, e.g., (FIVE).

Chemically reactive paper

If exposed to chemical solvents, oxidants, acids, or alkalis to alter, the prescription paper will react and leave a mark visible to the pharmacist.

Paper toner fuser

Special printer toner that establishes strong bond to prescription paper and is difficult to tamper.

Safety or security paper with colored pattern

White (or some other color) mark appears when erased. This is expensive paper.

 

 

CATEGORY 3:  One or more industry-recognized features designed to prevent the use of

counterfeit prescription forms.

FEATURE

DESCRIPTION

Security features and descriptions

listed on prescriptions

Complete list of the security features on the prescription paper for compliance purposes.

Encoding techniques (bar codes)

Bar codes on prescription. A Serial number or Batch number is encoded in a bar code.

Logos

Sometimes used as part of the background color or pantograph.

Metal stripe security

Metal stripe on paper, difficult to counterfeit.

Heat sensing imprint

By touching the imprint or design, the imprint will disappear.

Invisible fluorescent fibers/ink

Visible only under black light.

Thermo chromic ink

Ink changes color with temperature change.

Holograms that interfere with

photocopying

May interfere with photocopying or scanning.

 

IN ADDITION TO THE GUIDANCE OUTLINED ABOVE, THE TAMPER-RESISTANT REQUIREMENT DOES NOT APPLY:

  • When a prescription is communicated by the prescriber to the pharmacy electronically, verbally, or by fax.
  • When a managed care entity pays for the prescription.
  • Or, in most situations, when drugs are provided in designated institutional and clinical settings.

 

The guidance also allows emergency fills with a non-compliant written prescription as long as the prescriber provides a verbal, faxed, electronic, or compliant written prescription within 72 hours.

 

 On the Wyoming Board of Pharmacy website, under "Items of Interest from the Board" is section on security paper and a listing of approved vendors. Please contact vendors directly for information on security features of their products.

 

AUDITS OF PHARMACIES WILL BE PERFORMED IN THE FUTURE BY THE WYOMING DEPARTMENT OF HEALTH, PROGRAM INTEGRITY UNIT TO ENSURE THAT THE ABOVE REQUIREMENT IS BEING FOLLOWED. If you have any questions about these audits or this regulation, please contact the Wyoming Department of Health, Division of Healthcare Financing at 1-307-777-7531.

 

Date:  06/21/2011