By Neil Versel

July 29, 2008 | Digital HealthCare & Productivity | Electronic prescribers who want to print prescriptions for Medicaid patients no longer will have to spend up to 10 times the cost of plain paper to comply with new tamper-resistance regulations, the result of intense negotiations between government officials, medical societies, the pharmacy industry, paper manufacturers, and two health-IT advocacy groups.

The Centers for Medicare and Medicaid Services (CMS) last week updated its guidance for rules that take full effect Oct. 1. Starting on that date, paper fee-for-service Medicaid prescriptions must have security features to prevent unauthorized copying, modification, and counterfeiting of prescription forms. But prescribers printing from electronic health records (EHR) or ePrescribing software may generate security features from laser or inkjet printers instead of buying pricey tamper-resistant paper.

“This defines tamper resistance by functionality, not paper,” says Peter Basch, M.D., medical director for ambulatory clinical systems at MedStar Health (Columbia, Md.) Basch, as co-chair of the Physicians’ Electronic Health Records Coalition (PEHRC) pushed for the change during a June 26 forum convened by the National Council for Prescription Drug Programs (NCPDP), a standards-development organization for pharmacy services.

According to Basch, PEHRC and the HIMSS Electronic Health Records Vendors Association convinced CMS and the NCPDP that the technology exists to produce microprinting and “void” pantographs on plain paper with off-the shelf printers. A small Canadian company called AdlerTech International has a patent for pantographs on laser and inkjet printers, and some Hewlett-Packard models can print fonts as small as 0.5 points—just six pixels high.

“Inkjet ink will smear, so that’s a safety feature, too,” Basch adds. Additionally, Basch notes, EHR and ePrescribing software can generate unique numbers for each prescription, in theory making computer-generated prescriptions more difficult to counterfeit than security paper with embossed serial numbers.

The NCPDP details the changes in a letter to state Medicaid directors. Although the correspondence is dated July 18, copies did not go out until CMS revised its guidance last week.