E-Prescribing/I-STOP

NYACP /BU Online Pain  
Management Course
Now Available!

The NYACP in conjunction with Boston University School of Medicine has developed
a 3-hour online CME course that is also eligible for 3 MOC points.

By completing the online course and post test questions, all prescribers will satisfy the requirements and obtain the necessary certificates as mandated by Chapter 71 of the Laws of 2016,

The course must be completed by July 1, 2017.


 

5.1.17: DOH Releases Information on Paper Attestation

Regarding Paper Attestation:

Prescribers that do not have access to a computer can request a paper attestation form by calling the Bureau of Narcotic Enforcement (BNE) toll-free at 1-866-811-7957. They may then complete the form and return it by mail to the address provided.

For auditing purposes, you should keep your course completion documentation for a minimum of six years from the date of the attestation deadline. Documentation must include the name of the course provider, name of the course, location it occurred, date it occurred, and number of hours completed.

The Health Commerce System (HCS) will be discontinuing access for computers running Windows XP and Microsoft Internet Explorer 9 (IE9) and older web browsers as they pose a security risk to HCS applications. 
 
Windows XP users must upgrade their operating system and IE9 users must upgrade their browser by June 1, 2017 to continue using the HCS, as the HCS will block connections from computers running Windows XP and IE9 browser and older.

  • What:  The HCS will discontinue access for PCs using Windows XP and Microsoft IE9 and older web browsers. Upon implementation of this change, any computer running Windows XP or IE9 or older will not be able to connect to or open https://commerce.health.state.ny.us
  • When:  This change is scheduled for June 1, 2017.
  • Why:  Due to NYS application and data security requirements, HCS access will be discontinued for unsecured IE9 and older web browsers and Windows XP operating system on June 1, 2017. 
  • What is at stake:  Inability to access the HCS will affect your ability to: comply with New York State Public Health and Education laws; access critical information and data; and receive HCS technical support.

 Specifically, you will not be allowed access to the following applications:
o    Patient narcotic histories (i-STOP/PMP);
o    E-Prescribing waivers;
o    Your Physician Profile;
o    The New York State Immunization Information System;
o    Environmental Health EHCitrix Platform;
o    Evacuation of Facilities in Disasters System (eFINDS);
o    The Health Electronic Response Data System (HERDS); and
o    other mission-critical applications.
 
What to do next:  If you are using Windows XP or IE9, you must upgrade your PC to a modern, secure operating system as soon as possible, and upgrade your IE9 or older web browser.  It is suggested you perform the following actions to upgrade your PC and browser:
 
1.      OPERATING SYSTEM: To upgrade to a current Windows operating system please visit http://www.microsoft.com to determine if your computer can be upgraded.  To upgrade, follow the instructions on the Microsoft website. Please note that Windows 10 users will still need to use Microsoft Internet Explorer 11 or Google Chrome as most HCS applications do not yet support the Microsoft Edge browser, which is the default browser for Microsoft 10.
 
2.      BROWSER: If you are not sure which Internet browser you are using, please visit http://whatsmybrowser.org to determine your browser and version.
 
On the Windows platform, the HCS currently supports Microsoft Internet Explorer and Google Chrome, and offers partial support for Mozilla Firefox. You may download the latest version of these browsers from the following links:
Microsoft Internet Explorer:
http://windows.microsoft.com/en-us/internet-explorer/download-ie
 
Google Chrome:
https://www.google.com/chrome/browser/desktop/
 
Mozilla Firefox:
https://www.mozilla.org/en-US/firefox/new/
 
User of MacOS, OSX, Windows 7, Windows 8, or Windows 10 and users of Google Chrome, Microsoft Internet Explorer 10 or newer, or Safari on the Mac platform, are not affected by this change.
 
Thank you for your attention to this important matter.


12.19.16: Significant Changes Coming the Drug Enforcement Administration (DEA) Registration Renewal Process

Effective January 1, 2017, the DEA is eliminating the informal grace period which the agency has previously allowed for registrants to renew their registrations.  Only one renewal notice will be sent to each registrant’s mailing address approximately 65 days prior to the expiration date; no other reminders to renew the DEA registration will be provided. 

The notice also advises that online capability to renew a DEA registration after the expiration date will no longer be available, and that failure to file a renewal application by midnight EST of the expiration date will result in the “retirement” of the registrant’s DEA number.  The original DEA registration will not be reinstated.  In addition, paper renewal applications will not be accepted the day after the expiration date.  If DEA has not received the paper renewal application by the day of the expiration date, mailed in renewal applications will be returned and the registrant will have to apply for a new DEA registration

To read more, click here.


New York Law Limiting Initial Opioid Prescribing Went Into Effect Friday, July 22

In an effort to curb prescription opioid abuse, New York passed legislation that limits prescriptions of Schedule II, III, or IV opioids to seven days upon initial consultation or treatment of acute pain. This new law went into effect on Friday, July 22, 2016. Here are additional details:

  • Acute pain is defined in NYS Public Health law as pain, whether resulting from disease, accidental or intentional trauma, or other cause, that the practitioner reasonably expects to last only a short period of time.
     
  • This rule SHALL NOT include chronic pain, pain being treated as part of cancer care, hospice or other end-of-life- care or pain being treated as part of palliative care practices. 
     
  • Upon subsequent consultations for the same pain, the practitioner may issue, in accordance with existing rules and regulations, any appropriate renewal, refill, or new prescription for an opioid.
     
  • Application of co-pays for the initial prescription of an opioid are also limited by the measure.  A prescriber can apply the co-pay one of two ways:
     
    1. A proportionate amount between the co-payment for a thirty day supply and the amount of drugs the patient was prescribed; or
       
    2. The equivalent to the copay for the full thirty-day supply provided that no additional co-pays may be charged for any additional prescriptions for the remainder of the thirty-day supply
  • Pharmacists are NOT required to verify with the prescriber whether an opioid prescription written for greater than a 7-day supply is in accordance with the statutory requirements. Pharmacists may continue to dispense opioids as prescribed, consistent with current laws, regulations, and Medicaid policies.

Additional information on opioids and this law may be obtained by contacting the NYS Department of Health’s Bureau of Narcotic Enforcement at 1-866-811-7957 or by clicking here.


10.6.16: NYACP Members Act and Governor Signs E-Prescribing Amendment

On Friday, September 30, Governor Cuomo signed as Chapter 350 of the Laws of 2016 legislation (A.9335/S.6778) changing e-prescribing exception regulations. Instead of sending an e-mail to the Department of Health containing an onerous amount of information about the issuance of the paper prescription every time an exception is invoked, as the regulations originally required, a prescriber can now make a notation in the patient's medical record indicating that they have issued a paper prescription and noting one of the three statutory exceptions as the reason why an e-prescription was not possible. This bill reduces an unnecessary administrative burden that was placed on physicians while preserving those measures within I-STOP that have been successful in reducing diversion and misuse of controlled substances.

Following a significant amount of effort by leaders and staff on this legislative priority, the bill was signed in part because of the large number of Chapter members that sent letters to Governor Cuomo through NYACP's Legislative Action Center, urging him to sign the bill.


10.6.16: Official Notice from the Bureau of Narcotic Enforcement Regarding Documentation of E-Prescribing Exceptions

Use of an exception to the e-prescribing mandate no longer requires a notification to the New York State Department of Health (as reported above). 

However, the prescribing practitioner must notate in the patient’s health record when they issue a non-electronic prescription for one of the approved exceptions below:

  • Temporary technological failure;
  • Temporary electrical failure;
  • To be dispensed by a pharmacy located outside the state, outside the country, or on federal property, including and not limited to the following examples; Veterans Administration, West Point, Fort Drum, and Indian Reservations;
  • The practitioner reasonably determines that it would be impractical for the patient to obtain substances prescribed by electronic prescription in a timely manner, and such delay would adversely impact the patient's medical condition.

BNE will be modifying its web page in the near future to reflect this information.


8.4.16: Bureau of Narcotic Enforcement (BNE) Releases Waiver Process for Practitioners
Prescribing 25 Prescriptions or Less

The Bureau of Narcotic Enforcement (BNE) has released the forms and an FAQ for practitioners who want to certify that they will not issue more than twenty-five prescriptions during a twelve-month period. Practitioners submitting a certification will not be required to issue prescriptions electronically. Prescriptions in both oral and written form for both controlled and non-controlled substances must be included in determining whether the practitioner will reach the limit of twenty-five prescriptions.

The practitioner can either submit a certification online through the Electronic Prescribing Waiver (EPW) application on the NYS Health Commerce System (login required) or by submitting a paper certification form to BNE at this address:

NYS Bureau of Narcotic Enforcement
OPP Registration Unit Riverview Center
150 Broadway Albany, NY 12204
FAX: (518) 402-1058


New York State E-Prescribing Waiver Exceptions

NYACP has received numerous questions regarding what physicians who have not been issued a waiver need to do if their electronic prescribing system is unavailable.

There are a few exceptions upon which a practitioner may rely if they are unable to issue a prescription electronically. These are:

  • Temporary technological or electrical failure - PHL 281(3)(b).
  • Issued by a practitioner under circumstances where, notwithstanding the practitioner’s present ability to make an electronic prescription, a practitioner reasonably determines that it would be impractical for the patient to obtain substances prescribed by electronic prescription in a timely manner and such delay would adversely impact the patient’s medical condition, provided that if such prescription is for a controlled substance, the quantity of controlled substances does not exceed a five day supply if the controlled substance were used in accordance with the directions for use - PHL 281(3)(d).
  • A prescription issued by a prescriber is to be dispensed outside of New York State – PHL 281(3)(e).

In such cases, a physician may issue an Official New York State prescription form, oral prescription or a fax of an Official New York State prescription.

However, if a physician relies upon one of these exceptions, a note of such fact must be included in the patient’s record and notice must be sent to the NYS Department of Health (DOH) by email.

The e-mail notification to the Department should be sent to erx@health.ny.gov and must include the following information:

  1. That it is a notification to the Department pursuant to Public Health Law Section 281(4) or (5);
  2. Practitioner’s name;
  3. Practitioner’s license number;
  4. Practitioner’s telephone number;
  5. Practitioner’s preferred work e-mail address;
  6. Practitioner’s work address;
  7. Patient initials only (the Department does not want patient confidential information to be sent); and
  8. The reason(s) for the exception(s), including the citation(s) to PHL Section(s) 281(3)(b), (d), and (e) as referenced in the bullets above.

In those cases involving temporary technological or electrical failure, the  notice must be sent to DOH as soon as practicable, but in no instance more than 72 hours following the end of the technological or electrical failure that prevented the issuance of an electronic prescription. 

In the case of a prescription to be dispensed outside New York or the physician reasonably determines that it would be impractical for the patient to obtain substances prescribed by electronic prescription in a timely manner and such delay would adversely impact the patient’s medical condition, such notice must be sent to DOH within 48 hours of the date the prescription was issued.

NYACP continues to monitor the implementation of the electronic prescribing mandate and encourages members to contact the Chapter office at (518) 427-0366 if they are experiencing problems.


E-Prescribing Mandate Effective Immediately!

While ALL PRESCRIPTIONS, including prescriptions for controlled substances, must be submitted in electronic format, your Chapter continues efforts on your behalf to seek clarifications and solutions to several unresolved issues as identified by our members. We seek to minimize the burden on our members, their practices and their patients – so as you encounter any problems, at the bottom of this article we ask you to keep us informed so we can continue to work toward resolution of these challenges. 

There has been constant discussion with the Department of Health (DOH) and the Bureau of Narcotic Enforcement (BNE) since the delay of the e-prescribing mandate one year ago, but now it is urgent to keep the lines of communication open.

On March 16, 2016, the Commissioner of the New York State Department of Health issued a memorandum to practitioners and pharmacists granting a “blanket one year waiver” of the requirement to e-prescribe in certain “exceptional circumstances”. Prescriptions written under this blanket waiver do not need to be reported to the DOH as they are treated as a waiver for one year.  

You can view the Commissioner’s Letter here.

These circumstances had been identified as barriers to patient care, and is precisely why the Chapter needs to continue to monitor issues you face as you implement the e-prescribing law in your practice.

  • Any practitioner prescribing a controlled or non-controlled substance, containing two (2) or more products, which is compounded by a pharmacist;
  • Any practitioner prescribing a controlled or non-controlled substance to be compounded for the direct administration to a patient by parenteral, intravenous, intramuscular, subcutaneous or intraspinal infusion;
  • Any practitioner prescribing a controlled or non-controlled substance that contains long or complicated directions;
  • Any practitioner prescribing a controlled or non-controlled substance that requires a prescription to contain certain elements required by the federal Food and Drug Administration (FDA) that are not able to be accomplished with electronic prescribing;
  • Any practitioner prescribing a controlled or non-controlled substance under approved protocols under expedited partner therapy, collaborative drug management or in response to a public health emergency that would allow a non-patient specific prescription;
  • Any practitioner prescribing an opioid antagonist that would allow a non-patient specific prescription;
  • Any practitioner prescribing a controlled or non-controlled substance under a research protocol;
  • A practitioner prescribing a controlled or non-controlled substance either through an Official New York State Prescription form or an oral prescription communicated to a pharmacist serving as a vendor of pharmaceutical services, by an agent who is a health care practitioner, for patients in nursing homes and residential health care facilities as defined in section twenty-eight hundred one of the public health law;
  • A pharmacist dispensing controlled and non-controlled substance compounded prescriptions, prescriptions containing long or complicated directions and prescriptions containing certain elements required by the FDA or any other governmental agency that are not able to be accomplished with electronic prescribing;
  • A pharmacist dispensing prescriptions issued under a research protocol, or under approved protocols for expedited partner therapy, or for collaborative drug management;
  • A pharmacist dispensing non-patient specific prescriptions, including opioid antagonists, or prescriptions issued in response to a public health emergency issued; and
  • A pharmacist serving as a vendor of pharmaceutical services dispensing a controlled or non-controlled substance through an Official New York State Prescription form or an oral prescription communicated by an agent who is a health care practitioner, for patients in nursing homes and residential health care facilities as defined in section twenty-eight hundred one of the public health law.

The blanket waivers do not impact any general waiver that a practitioner has obtained directly from the Department (see reference below on how to obtain a waiver).

What does need to be reported to DOH:

Of special importance, there are only a few exceptions upon which a practitioner may rely if he or she is unable to issue a prescription electronically. These are:

 

  • Temporary technological or electrical failure - PHL 281(3)(b)
  • Issued by a practitioner under circumstances where, notwithstanding the practitioner’s present ability to make an electronic prescription, a practitioner reasonably determines that it would be impractical for the patient to obtain substances prescribed by electronic prescription in a timely manner and such delay would adversely impact the patient’s medical condition, provided that if such prescription is for a controlled substance, the quantity of controlled substances does not exceed a five day supply if the controlled substance were used in accordance with the directions for use - PHL 281(3)(d)
  • A prescription issued by a prescriber to be dispensed outside of New York State – PHL 281(3)(e).


If you rely upon one of these exceptions, you must make a note of such fact in the patient’s record and you must also notify the NYS Department of Health (DOH) by email. The e-mail notification to the Department should be sent to erx@health.ny.gov and must include the following:

  1. That it is a notification to the Department pursuant to Public Health Law Section 281(4) or (5);
  2. Practitioner’s name;
  3. Practitioner’s license number;
  4. Practitioner’s telephone number;
  5. Practitioner’s preferred work e-mail address;
  6. Practitioner’s work address;
  7. Patient initials only (the Department does not want patient confidential information to be sent); and
  8. The reason(s) for the exception(s), including the citation(s) to PHL Section(s) 281(3)(b), (d), and (e) as referenced in the bullets above.

I-STOP REMINDER:  

There were two important sections of the I-STOP (Internet System for Tracking Over Prescribing) law – one was mandating use of the Prescription Monitoring Program (PMP) and the second was e-prescribing.

As we remain in the midst of a serious opioid epidemic, the new CDC opioid guidelines recommend the use of PMP's as a central way to track opioid prescriptions. Utilizing the PMP allows you to obtain your patient’s history of access to controlled substances from yourself and other prescribers and helps to inform your decision to prescribe a controlled substance to your patients at the time of care.

These are the original I-STOP exemptions (those who do not need to consult the PMP prior to writing a controlled substance script):

  • Veterinarians
  • Certain prescriptions for methadone
  • Controlled substances administered in the prescriber’s office
  • Prescriptions and orders for controlled substances for use within a hospital or clinic
  • Prescriptions written in an emergency department for no more than a 5-day supply
  • Prescriptions written for hospice patients
  • Not reasonably possible to access the registry in a timely manner
  • Registry not operational, or waiver granted due to technological limitations

Last Updated 11.21.18
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