New prescription rules could create chaos


WASHINGTON (AP) – Millions of Medicaid patients and their pharmacists could be in for a nasty surprise Oct. 1.

A provision tucked within an emergency spending bill for Iraq requires that prescriptions for Medicaid patients be written on “tamper-resistant” pads. Problem is, most doctors don’t use such pads.

The law is designed to make it harder for patients to obtain controlled drugs illegally and easier for the government to save money. But the quick startup date leaves little time to educate doctors and pharmacists.

“Our members are absolutely flabbergasted that they’re going to be put on the hook for denying prescriptions if something is not on a tamperproof pad,” said Paul Kelly, vice president of government affairs for the National Association of Chain Drug Stores. “Our biggest fear is the negative impact this could have on patient care and access to prescriptions.”

Pharmacists groups have mobilized and asked lawmakers and the Centers for Medicare and Medicaid Services to delay implementation of the law.

“Millions of Medicaid beneficiaries may not be able to obtain their medications after Oct. 1,” they said in a recent letter to lawmakers. “This could lead to higher Medicaid costs for emergency room visits, hospitalizations and physician office visits if medication cannot be obtained in a timely manner.”

Steve Hahn, a spokesman for the Centers for Medicare and Medicaid Services, said the agency, for now, has no plans to change the Oct. 1 startup. In the interim, it is consulting with health care providers and preparing guidance on how to comply with the law.

Several states already require tamperproof prescription pads, Hahn noted.

But health care providers in those states often had more than a year to prepare, Kelly said. New York, for example, had 18 months.

In this instance, many doctors aren’t even aware of the law.

Medicaid is the federal-state partnership that provides health coverage to about 55 million poor Americans. President Bush had recommended the requirement for tamperproof prescription pads in his 2008 budget. The Congressional Budget Office projected that the requirement would save taxpayers $355 million over the coming decade, mainly through preventing fraudulent prescriptions.

Some lawmakers say they are starting to hear concerns from pharmacists back home. Rep. Charles Wilson, D-Ohio, and Reps. Marion Berry and Mike Ross, both Democrats from Arkansas, circulated a letter to colleagues Wednesday that urged them to contact Medicaid officials.

The lawmakers want a clear definition of tamper-resistant prescription pads. They want to know who is responsible for the costs of the pads and where they can be obtained. They also want to know what will happen when customers show up with prescriptions on regular paper.

Wilson said he’s particularly concerned about what will happen to independent pharmacies in rural regions of the country.

“My concern is that some may end up forced to close up shop if they’re not getting reimbursed by Medicaid because their clients’ prescriptions aren’t on tamperproof pads,” Wilson said. “The loss of that rural pharmacy could hurt all of my constituents.”

AP-ES-07-18-07 1635EDT