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Thursday, March 24, 2016

How to Get a Paper Prescription When e-Prescribing Is Required

To save money on prescription drugs, it is often necessary to have a prescription in
hand to send to an international online pharmacy or to shop around at local pharmacies so they will disclose their best prices and discounts. However, some U.S. states, like New York, now require that most health professionals write prescriptions electronically, without giving you a paper prescription.

So are you out of luck if need a paper prescription? Fortunately, not.

The rules, for example, in New York (where e-prescribing becomes mandatory on March 27) provide a number of exceptions in which written prescriptions remain permitted. One of these is when the prescription is "to be dispensed by a pharmacy located outside the state." Therefore, in New York, a doctor can still legally hand you a prescription if you intend to have it filled outside of New York. (You can read this for yourself in paragraph (c)(5) of Title 10 NYCRR Section 80.64).

The New York law also says that a doctor who gives you a written prescription is supposed to report the issuance of that prescription to the New York Department of Health within 48 hours. However, the law does not explain how this is to be done, so I asked the Department of Health. My question was forwarded to a pharmacist consultant at the department. He told me that if a written prescription is given to a patient under one of the exceptions, "there is currently no functionality for reporting that to the Department of Health." Instead, he said "the fact that a written prescription was given should just be noted in the patient's chart."

I also asked the pharmacist if a doctor can give a patient a written prescription so they can shop it around to find an affordable price or discount. He said that that is acceptable "if it's deemed necessary by the doctor." Again, he said that this should be noted in the patient's chart.

E-prescribing is practiced to some degree in all 50 states and 60 percent of all NY prescribers already e-prescribe. Minnesota has adopted a comprehensive e-prescribing program. But only NY, as of March 27, will issue fines to prescribers who don't follow the rules.

The e-Prescribing laws were originally enacted to cut down on improper dispensing of controlled substances but are being extended to all prescriptions. The reasons given in New York are "to minimize medication errors" and "the integration of prescription records directly into the patient's electronic medical record." In addition, "Electronic prescribing has the potential to reduce prescription theft and forgery." That's all well and good, but it is also important that it does not interfere with the overall delivery of good medical care -- which includes making sure that a patient is able to affordably obtain his or her medicine.

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