Pain doctors face backlog in transition to new pads
Pharmacy board’s policy leads to a delay in orders for 600 prescription forms
When Roy Kauffman, a 73-year-old Kerrville resident, went down to his local CVS to get his pain medication refilled earlier this month, it took about a week and four exchanges between his doctor’s office and the CVS before he finally got his medicine.
The issue? His prescription was written on an old form.
The Texas State Board of Pharmacy mandates that all official prescription forms for Schedule II drugs that were filled out by doctors on or after June 1 must have been ordered on or after Sept. 1, 2018, in order to be valid. According to the board of pharmacy website, “Schedule II drugs include certain narcotic, stimulant and depressant drugs.”
Doctors say the policy has resulted in a backlog for ordering the new forms, and some have said they’ve had to wait months to receive the new forms.
“I was concerned I was probably going to have to wait until that new pad arrived at the doctor’s office,” Kauffman said.
A CVS employee, who spoke on the condition of anonymity because he was not authorized to discuss the issue, said standard practice is that prescription forms must be post-dated. He did not, however, specifically address Kauffman’s experience.
Kauffman’s physician, Dr. Ralph Menard, ordered the new prescription pads on March 1 — three months before physi
cians would have to begin using them. Still, he didn’t receive them until June 6, a few days after the policy had already taken effect.
“They knew how many doctors needed those prescription (pads) and why they didn’t print more, I don’t know,” Menard said.
Allison Benz, executive director of the Texas State Board of Pharmacy, said the unfilled orders may be partly due to people being unaware of the changes. However, she said they are mainly the result of people forgetting to provide all of the verification information for their orders.
If prescribers want to ship the pads to the address on their driver’s license, they must provide a photocopy of their driver’s license. The process of ordering prescription pads also requires a provider’s valid DEA number and Social Security number.
“If we have all the verification information, it’s about a four-week turnaround,” Benz said.
For orders without proper identification, arrival time depends on when prescribers provide their information.
“We can’t just process it like you’re ordering something off of Amazon,” Benz said, stressing the importance of verifying orders.
Why new pads are needed
The purpose of the new forms is to increase security through four features: a unique control number for each form, a pantograph security feature to protect against photocopies, a thermochromic red Rx and two watermarks. Prescription pads are also now sold in packs of 50 instead of 100 as an additional security measure.
Benz said the pharmacy board had about 600 orders that had not been fulfilled by the end of May because physicians hadn’t sent a photocopy of their driver’s license.
“It sounds like a lot, but it’s actually a pretty small (part) of the total we’ve received,” she said.
Since Sept. 1, the board has received about 30,000 orders for Schedule II prescription pads, Benz said.
While the State Board of Pharmacy works to fulfill orders for the new forms, pharmacists have been directed to use their “professional judgment” with regard to prescription forms printed before Sept. 1, Benz said. If the form is otherwise valid, pharmacists “may, if they want to, dispense the prescription,” she said.
If a pharmacist rejects the old prescription form, however, waiting for a refill can be debilitating for patients.
Kauffman said he has been taking hydrocodone acetaminophen since April to manage hip and back pain. After back surgery in February, he said he developed a urinary tract infection that spread to his hips and he needs his medication to fully manage the pain.
“If I want to do any walking at all, I have to take one,” he said.
As physicians adjust to the new forms, the Texas Medical Association has been working to aid them in the process.
For about the past five months, the association has received between three and five calls daily from physicians who have questions regarding the new policy, said Marcus Cooper, the medical association’s multimedia manager.
“It’s been frustrating for some doctors because the new Schedule II forms that they’re trying to get ready have been delayed,” he said.
The Texas Medical Association has been advocating changes it believes will help physicians transition to the new forms. The group has asked the Texas State Board of Pharmacy to list the driver’s license requirement on the first page for its online order form in addition to the note listed on the webpage that directs to the online order form.
The association has also supported House Bill 3284. This bill — which was signed by Gov. Greg Abbott on June 14 — gives doctors more time to set up an account with the Texas Prescription Monitoring Program, pushing the deadline from Sept. 1, 2019, to March 1, 2020.
“We’re available to answer questions … and we’ll be working with physicians to hear their concerns and also share their concerns with the board of pharmacy,” Cooper said.
The Texas Medical Association has been encouraging doctors to look into implementing electronic prescribing while they wait for the new forms.
Dr. Matthias Wiederholz, with Performance Pain & Sports Medicine, said the new policy has had little effect on his practice, as he has long used electronic prescribing. He noted, however, that this may not be the case for all physicians.
“I think if you’re a doctor that doesn’t do electronic prescribing, it’s going to be a very impactful issue,” he said.
More changes coming
But that alternative may not be viable for all clinics.
Dr. Irvin Sulapas, a Baylor physician who works in sports and family medicine, ordered the new prescription forms in late February and received them about eight weeks later. But he said e-prescribing can help clinics continue their normal operations while waiting for paper forms.
“That’s an option if the practice allows that, but for small private practices, the ability to send these prescriptions electronically may be too expensive,” he said.
But electronic prescribing will soon be required for all controlled substances, beginning Jan. 21, 2021, thanks to House Bill 2174, which was signed into law by Abbott this month. Still, the bill allows waivers for “economic hardship,” “technological limitations not reasonably within the control of the prescriber” or “other exceptional circumstances demonstrated by the prescriber.”
The bill also includes a few other exceptions, including when veterinarians prescribe controlled substances. Pharmacists will be allowed to continue dispensing “an otherwise valid written, oral, or telephonically communicated prescription,” and will not be required to confirm “the prescription is exempt from the requirement that it be submitted electronically.”
Dr. C.M. Schade, former president of the Texas Pain Society, said the organization has been pushing for a switch to e-prescribing to head off counterfeit forms, as well as to address issues such as the recent backlog in ordering forms. The state has been using some type of print prescription form since 1981, he said.
“It’s archaic and we need to eliminate it,” he said.