The opioid epidemic in the United States is an ongoing public health emergency, with over 100,000 people dying of opioid overdoses in 2021. To address this crisis, CMS is continuing to implement a provision of the SUPPORT Act, which requires that the prescribing of controlled substances under Medicare Part D be done electronically.
In this blog, we'll review what this requirement means for providers, how they can prepare for compliance, and what proposed changes to the e-prescribing requirements are being discussed in the 2023 Medicare Physician Fee Schedule Proposed Rule.
What is EPCS?
EPCS stands for the Electronic Prescribing of Controlled Substances. While many states already have state EPCS requirements in effect, the federal EPCS compliance date for most providers is coming up on January 1, 2023. Long-term care facilities have until January 1, 2025 to comply. This means that most providers must be e-prescribing at least 70% of their Schedule II-V drugs beginning in 2023.
Some exemptions to the EPCS requirement, under current policy, are:
- When the pharmacy and the dispensing pharmacy are the same entity.
- Prescribers who issued <100 prescriptions for controlled substances in the previous year, as determined by CMS claims data.
- Prescribers who have an NCPDP database address in the geographic area of an emergency or disaster declared by a Federal, State, or local government entity.
- Prescribers who receive a CMS-approved waiver due to circumstances beyond the prescriber’s control.
- This exemption is very similar to the Extreme and Uncontrollable Circumstances exception for MIPS.
For 2023, the penalty for non-compliance with the EPCS requirement will be a letter from CMS sent to the provider containing:
- A notification that they are in violation of the EPCS requirement,
- Information about how they can come into compliance and the benefits of EPCS,
- An information solicitation as to why they are not using EPCS, and
- A link to the CMS portal to request a waiver.
How to Prepare:
If you use an EHR
Your EHR vendor likely has the option available for e-prescribing controlled substances. You should check with your EHR vendor to determine if the e-prescribing option is activated for your platform. EPCS is a separate function from traditional e-prescribing, and you may need to ask for this feature to be added. This add-on will likely be an added cost to your current EHR system.
If you do not use an EHR, your EHR does not have EPCS functionality, or your EHR charges too much
There are standalone options for EPCS available. To search standalone certified EPCS software, go to the Surescripts page for prescriber software and “focus your search” by choosing the “standalone eRx” and "EPCS" options.
If you are unable to put EPCS in place by January 1, 2023, you will need to apply for and secure a waiver to avoid violating the requirement.
Proposed Changes for Calendar Year 2023
With the compliance date coming up fast, CMS is still proposing a few changes to the EPCS requirement in the 2023 Medicare Physician Fee Schedule Proposed Rule.
- CMS is proposing to evaluate whether prescribers qualify for an exception for falling below the 100 prescription threshold based on the performance year, rather than the year prior.
- This proposed change is meant to reflect that providers might change practices, and to ensure that providers are being evaluated accurately and fairly.
- Providers may already be viewing 2022 as their year to establish a small prescriber exemption from the EPCS requirement. So, CMS is proposing that for the 2023 performance year only, providers could qualify as small prescribers using either 2022 or 2023 PDE data.
- CMS is also seeking comment as to whether or not this proposed change, which would enable providers to monitor their likelihood of reaching EPCS requirement threshold, would disincentivize provision of prescriptions to Medicare beneficiaries.
- CMS is also proposing to change the timing of prescriptions for the disaster zone exemption.
- Currently, the disaster zone exemption would apply to all prescriptions within the evaluation year.
- Under the new proposal, disaster zone exemptions would need to have a dispensing date that falls within the disasters as declared by local, state, or federal government.
- Another proposal is to alter the data source used for the disaster zone exemption.
- This data source is linked to the dispensing pharmacy, not the provider.
- For providers who do not have addresses in PECOS, CMS is proposing to use NPPES data to locate providers.
- Our analysis sees this change as a positive, as it would be able to more accurately determine providers eligibility for exemption.
- Current policy is to use data from the NCPDP Pharmacy database to establish whether or not a disaster zone exemption should apply.
- CMS is proposing to utilize the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) to determine provider addresses and more accurately determine eligibility for exemption.
- The final proposed change is to delay non-compliance penalties by an additional year (to begin in CY2025, instead of CY2024).
- During this time, compliance actions would be limited to a non-compliance letter sent to prescribers that CMS believes are violating the EPCS requirement.
- CMS also seeks comment on other potential future penalties, such as referral to the DEA, postings on CMS' website or Care Compare, and/or potential corrective action plans. If finalized, these potential penalties would go into effect in CY2024, at the earliest.
Next Steps
- Share this information with your colleagues.
- Check out our Top 2023 Proposed MIPS Changes Report for a quick rundown of major proposed MIPS changes relevant to our specialties.
- Subscribe to our newsletter to get alerts on this and other important issues. You can subscribe using the field in our website footer below.
- Keep an eye out for future resources from MarsdenAdvisors about the rulemaking process and how you can comment to make your voice heard in future policies.
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