Electronic Prescribing of Controlled Substances

Public Act 17-131, Section 3, requires Electronic Prescribing of Controlled Substances (EPCS) starting on January 1, 2018 for all controlled substances. In addition to improving efficiency, this will help stop prescription fraud with fewer opportunities to duplicate or modify paper prescriptions.

Drug Enforcement Administration

Exemption Instructions

Verifying An Exemption

1. Verify EPCS Exemption Status - These instructions will help you find an individual prescriber's exemption status in real time from https://www.elicense.ct.gov/Lookup/LicenseLookup.aspx.
2. Waiver List - This list is can be searched or downloaded and is updated every 24 hours.

Frequently Asked Questions

• General Questions
• Prescriber Questions
• Pharmacy/Pharmacist Questions

Update: Transfers of EPCS Prescriptions

Can a pharmacist transfer a prescription for a controlled substance that was sent to my pharmacy using electronic prescribing of controlled substances that was never filled?

• Yes.Public act 20-4 permits the transfer of unfilled prescriptions for any Schedule II, III, IV, or V controlled substances.

What is a pharmacy that receives an EPCS that is going to be transferred to another pharmacy required to do?

• Take measures to prevent the prescription from being filled at a pharmacy other than the pharmacy receiving the transfer
• Record the following information in the prescription record*
  • Name of the pharmacy who is receiving the transferred prescription
  • Telephone number of the pharmacy receiving the prescription
  • Address of the pharmacy receiving the prescription
  • Name and license number of the pharmacist receiving the prescription
  • Name and address of the patient or name and address of the owner of an animal and the species of the animal
  • Whether the patient is an adult or a child or specific age
  • Compound or preparation prescribed and the amount thereof
  • Directions for use of the medication
  • Name and address of the prescribing practitioner
  • Date of issuance
  • Federal registry number of the practitioner

*This information may be included on a facsimile to the receiving pharmacy after initial contact is made with the receiving pharmacy

What is the pharmacy that is receiving an EPCS transfer from another pharmacy required to do?

• Record the following information in the prescription record
  • Name and address of the patient, or the name and address of the owner of an animal and the species of the animal
  • Whether the patient is an adult or a child or specific age
  • Compound or preparation prescribed and the amount thereof
  • Directions for use of the medication
  • Name and address of the prescribing practitioner
  • Date of issuance
  • Federal registry number of the practitioner
  • That the prescription was transferred
  • The name of the pharmacy that first received such prescription
  • The date on which such prescription was issued
  • The date on which such prescription was transferred
  • For Schedule III, IV or V controlled substances, any refills issued for such prescription

Electronic Prescribing of Controlled Substances

Frequently Asked Questions

General 

1.  What is Electronic Prescribing of Controlled Substances (EPCS)?

• EPCS allows prescribers to use a software system to electronically transmit Schedule II-V controlled substance prescriptions to a pharmacy.

2.  What is required for a prescriber to transmit an electronic Schedule II-V controlled substance prescription?

• Software used by prescribers to transmit an electronic Schedule II-V controlled substance prescription must meet the requirements set forth by the Drug Enforcement Administration (DEA). 
• More information may be found on the DEA’s website.

• All Schedule II, III, IV, and V controlled substance medications
• For more information regarding controlled substances, see the Frequently Asked Questions.

Prescribers

1.  How should a transmitted electronic Schedule II-V prescription be stored?

• Dispensed electronic Schedule II-V controlled substance prescriptions may be stored electronically or on paper using the software that created the prescription. 
• All records must be maintained for a minimum of three (3) years and shall be made available for inspection at reasonable times.

 2.  What exceptions exist for Electronic Prescribing of Controlled Substance (EPCS)?

• Technological and/or electrical failure (temporary)
• Adverse impact on the patient’s medical condition or patient care (compounded prescriptions, complicated directions for use)
• The intended pharmacy is not located in the State of Connecticut
• Lack of technological capacity (requires a waiver)

3.  What constitutes “technological failure” or “electrical failure”?

• A temporary failure of computer system, application, or device or the loss of electrical power to such system, application, or device or any other reasonable service interruption to such system, application, or device that reasonably prevents the prescriber from utilizing their EPSC system. 
• Failure for a pharmacy to accept an electronic prescription would also be an appropriate use of this.  In this case, you may want to let the pharmacy know that they are having an issue so that they may attempt to correct it.

4.  What procedure must prescribers follow during a “technological failure” or “electrical failure”?

• Prescribers should attempt to correct any and all causes within one’s control. 
• Prescribers must document in the patient’s medical record the reason why a paper, facsimile (fax), or telephone  prescription was authorized during a “technological failure” or “electrical failure”.
• This must be done as soon as practicable, but no later than seventy-two hours following the end of the temporary “technological failure” or “electrical failure” that prevented the electronic transmission of prescriptions. 
• Prescribers are encouraged to document the reason for a paper prescription on the paper, facsimile (fax), or telephone  prescription provided to the patient.

5.  What procedure must a prescriber follow when issuing an electronic prescription that adversely impacts the patient’s medical condition?

• A paper, facsimile (fax), or telephone prescription may be issued to the patient for up to a five (5) day supply of a Schedule II-V controlled substance. 
• Prescribers issuing the paper, facsimile (fax), or telephone  prescription must document the reason why the prescription was not electronically transmitted.
• Prescribers are encouraged to document the reason for a paper, facsimile (fax), or telephone  prescription on the paper prescription provided to the patient.

6.  What procedure must a prescriber follow when the patient’s pharmacy is located outside of Connecticut?

• A paper, facsimile (fax), or telephone  prescription may be issued to the patient.  The prescriber issuing the paper prescription must document the reason why the prescription was not electronically transmitted. 
• The prescriber is encouraged to document the reason for a paper, facsimile (fax), or telephone  prescription on the paper prescription provided to the patient.

7.  What procedure must a prescriber follow when the issuance of an electronic Schedule II-V controlled substance prescription negatively impacts patient care?

• In these instances, a paper, facsimile (fax), or telephone prescription may be issued to the patient.
• Some examples of this may be:
  • a prescription requiring a pharmacist to compound two or more products; a prescription for direct administration to a patient by parenteral, intravenous, intramuscular, subcutaneous, or intraspinal infusion;
  • a prescription bearing long or complicated directions;
  • a prescription in which the federal Food and Drug Administration requires the inclusion of certain elements;
  • a prescription transmitted orally to a pharmacist by a health care practitioner for a patient in a chronic and convalescent nursing home.
• The prescriber is encouraged to document the reason for a paper, facsimile (fax), or telephone  prescription on the paper prescription provided to the patient or pharmacy.

8.  What does “technological capacity” mean?

• Possession of a computer system, hardware or device that can be used to electronically transmit controlled substance prescriptions consistent with the requirements of the Drug Enforcement Administration.
• More information may be found on the DEA’s website.

9.  What procedure must a prescriber follow when lacking the ability or “technological capacity” to comply with the requirements set forth for Electronic Prescribing of Controlled Substances (ECPS)?

• The prescriber must file an exemption with the Department of Consumer Protection’s Drug Control Division.  The exemption process can be found at the top of the page under "Exemption Instructions".

10.  What is the procedure for filing an Electronic Prescribing of Controlled Substances (ECPS) exemption with the Department of Consumer Protection’s Drug Control Division?

• The Department of Consumer Protection will send a brief questionnaire to each prescriber with an Active Controlled Substance Registration.  This questionnaire will serve as the exemption.  The questionnaire only needs to be completed by the prescriber if they are seeking the exemption.
• At this time, any prescriber that completes the exemption questionnaire and answers "Yes" to questions 4 that asks about the waiver has successfully completed exemption. 
• The prescriber is encouraged to document that they have completed the exemption with the Department of Consumer Protection on the paper, facsimile (fax), or telephone prescription prescriptions provided to the patient or pharmacy.

11.  What procedure must a prescriber follow when one’s ability to comply with the requirements set forth for Electronic Prescribing of Controlled Substances (ECPS) exists in some, but not all, practice settings?

• Prescribers must comply with the requirements set forth for Electronic Prescribing of Controlled Substances (ECPS) in practice settings with “technological capacity”.
• Prescribers may issue a paper, facsimile (fax), or telephone prescription prescription in practice settings without “technological capacity”.

• Yes. 

13.  Can a prescriber change/update my questionnaire for Electronic Prescribing of Controlled Substances?

• Yes.  If you log in to your account for your Controlled Substance Registration for Practitioner you can update your account at any time.

14.  Can prescribers electronically prescribe controlled substances prior to January 1, 2018?

• If your software is compliant with the Drug Enforcement Administration requirement then you can electronically prescribe controlled substances prior to the January 1, 2018 mandate. 

15.  Is an electronic facsimile of a prescription considered an electronic prescription?

• No.  A facsimile is a copy of an original prescription.

16.  What should I do if my Electronic Health Record has temporary periods of “downtime” or temporary periods of time where Electronic Prescribing of Controlled Substances is unavailable?

• This is considered "technological failure or electrical failure".  If your "downtime" is scheduled, it is recommended that you share that information with pharmacies within your area if possible.  Please see above.

17.  Does an electronic prescription require a written follow-up prescription to be sent to the pharmacy?

• No.

18.  Is it mandatory for pharmacies to receive electronic prescriptions for controlled substances?

• Yes.

• If the prescription is of an urgent nature, they can either locate another pharmacy or utilize a different exemption such as the exemption where Electronic Prescribing of Controlled Substances may negatively impact patient care. 

20.  How do prescribers know if their software is compliant with the requirements for Electronic Prescribing of Controlled Substances?

• You should contact your software vendor as they should be able to provide you with information.

21.  Are oral prescriptions for controlled substances still permitted for Schedule II medications?

• Schedule II prescription can be communicated by a prescribing practitioner known to or confirmed by a pharmacist orally in an emergency. 
• The filling pharmacist shall promptly reduce such oral order to writing on a prescription blank.  Such oral order shall be confirmed by the proper completion and mailing or delivery of the prescription prepared by the prescribing registrant to the pharmacist filling such oral order within seventy-two hours. 
• The pharmacist shall affix the temporary prescription to the properly completed prescription. 
• The properly completed prescription can either be hand written or electronically transmitted but should indicated that it is part of the telephoned in prescription.

21.  Are oral or facsimile (fax) prescriptions for controlled substances still permitted for Schedule III, IV, or V medications?

22.  What if I am a prescriber and I work at multiple locations that don't all have the ability to comply with Electronic Prescribing of Controlled Substances?

• If you practice with a software system that can comply with Electronic Prescribing of Controlled Substances then you do not need to do anything.  If your software cannot comply with Electronic Prescribing of Controlled Substances then you should complete the questionnaire for a waiver. 

• A paper, facsimile (fax), or telephone prescription would still be permitted.

• No.

• Yes.  They are also eligible for all of the exemptions that are available as well.

• The prescribers should apply for the waiver until they are fully compliant with Electronic Prescribing of Controlled Substances.

Telephone Prescriptions

Schedule II (for emergency only)

• EPCS waiver on file with the Department
  • telephone prescription can be called into the pharmacy, however the original hard copy of that prescription must be mailed to the pharmacy within 72 hours (pharmacist are encourage to keep a log of these circumstances to reconcile these issues going forward)
• No EPCS waiver on file with the Department
  • see https://portal.ct.gov/DCP/Drug-Control-Division/Drug-Control/EPCS-Information-Page

Schedule III-V

• EPCS waiver on file with the Department
  • prescription can be telephoned into the pharmacy
• No EPCS waiver on file with the Department
  • prescription can be telephoned into the pharmacy for one of the non-waiver exemptions see https://portal.ct.gov/DCP/Drug-Control-Division/Drug-Control/EPCS-Information-Page,

Faxed Prescriptions - If a pharmacist questions the accuracy or authenticity of a prescription transmitted by facsimile machine, he or she shall contact the prescribing practitioner for verification before dispensing the prescription.

Schedule II –

• EPCS waiver on file with the Department or an exemption exists

  (a) Prescriptions for Schedule II controlled substances may be transmitted by a prescribing practitioner or his agent to a pharmacy by means of a facsimile machine provided the original written, signed prescription is provided to the pharmacist for review prior to the actual dispensing of the controlled substance, except as provided for in subsections (b) and (c) of this section. The original written prescription, once received by the pharmacist, shall be reviewed to ensure that it conforms with the requirements of section 21a-249 of the Connecticut General Statutes and shall be maintained as the original record of dispensing. The facsimile prescription order shall not be considered to be the actual prescription, but only a record of the transmission of the prescription order.

  (b) Prescriptions for Schedule II narcotic substances to be compounded for direct administration to a patient by parenteral, intravenous, intramuscular, subcutaneous or intraspinal infusion may be transmitted by the prescribing practitioner or his agent to a pharmacy by facsimile. The prescription transmitted via facsimile will be accepted as the original prescription for purposes of this section.

  (c) Prescriptions for Schedule II controlled substances for patients of a long-term care facility may be transmitted by a prescribing practitioner or his agent to the dispensing pharmacy by facsimile. The prescription transmitted via facsimile will be accepted as the original prescription for purposes of this section.

  (d) Prescriptions transmitted by facsimile machine in accordance with subsections (b) and (c) of this section shall comply with the requirements set forth in subsection (b) of Section 21a-243-15 of the Regulations of Connecticut State Agencies.

  Schedule III-V

• EPCS waiver on file with the Department or an exemption exists

  (a) Prescriptions for Schedule III, IV and V controlled substances may be transmitted by a prescribing practitioner or his agent to a pharmacy by means of a facsimile machine.

  (b) All prescriptions transmitted pursuant to subsection (a) of this section must comply with the following in addition to any other requirement of federal or state statute or regulation:

  (1) The facsimile prescription shall clearly contain the name of the pharmacy to which the facsimile is being transmitted and the name of the facility from which it is transmitted if the prescription is written for an inpatient of a chronic or convalescent nursing home or a rest home with nursing supervision;

  (2) The facsimile prescription shall clearly display a statement in substantially the following form: "This prescription is valid only if transmitted by means of a facsimile machine"; and

  (3) The facsimile document may be maintained as the actual prescription only if the nature of the equipment and paper ensures that the prescription will remain non-fading and durable for the minimum amount of time required for the maintenance of prescription records under federal and state statute or regulation. If the document will not remain non-fading or durable, the prescription transmitted by facsimile machine shall be reduced to writing, photocopied or converted to an individual printout.

  Note: It shall be the responsibility of the prescribing practitioner to ensure that the prescription form that is used to transmit a prescription by facsimile machine is either destroyed immediately or marked or controlled in such a manner that prevents the use of such form to obtain controlled substances other than as authorized by these regulations.

  Mailed Prescriptions

  Schedule II-V
  

• EPCS waiver on file with the Department or an exemption exists
  • Nothing would prevent the practitioner from mailing prescription to the pharmacy in these situations.

Pharmacy/Pharmacist

1.  What is the pharmacist responsibility when receiving a written prescription for a controlled substance in Schedule II-V after January 1, 2018?

• A pharmacist has a duty to determine if a prescription is valid whether it was transmitted electronically or otherwise permitted by law. 
• Prescribers are encouraged to place the reason for the written prescription on the prescription.
• Any prescriptions issued prior to January 1, 2018 with refills are still valid without an electronic prescription.
• NEW:  A pharmacist is NOT required to verify that a prescriber has a waiver from the requirement to electronically prescribe, or properly falls under one of the other exceptions from the requirement to electronically prescribe.  Pharmacists may continue to dispense medications from otherwise validwritten, oral, or fax prescriptions that are consistent with current laws and regulations.

• The law does not specifically require a pharmacist to verify the prescribing practitioner's exemption status for every written prescription.  It is the pharmacists responsibility to determine the validity of a prescription prior to dispensing it using their professional judgment.

• Yes

• Yes.  It is recommended that the verification is performed that it is documented.  Please see the list of providers who have successfully completed the exemption process at the top of the page or the instructions for looking up individual providers.

• All records are required to be maintained on file for three (3) years at the premises of the pharmacy and maintained current and separate from other business records.
• All records must be stored in a manner that is readily available for inspection by the Department of Consumer Protection, or authorized agents at reasonable times.
• Prescription records that have been received electronically may be stored electronically, provided the files are maintained in the pharmacy computer system for not less than three (3) years.  If an electronically transmitted prescription is printed, it shall be filed along with written and telephone prescriptions chronologically and sequentially. 

• Technological and/or electrical failure (see prescriber area above for more information)
• Adverse impact on the patient’s medical condition or patient care (compounded prescriptions, complicated directions for use)
• The intended pharmacy is not located in the State of Connecticut
• Lack of technological capacity

8.  As a pharmacist, how do I know if a prescriber has applied for the exemption from the EPCS requirement?

• All exemption information will be available on our website at www.elicense.ct.gov by prescriber.  There is also a list available at the top of the page.  NEW: There is no specific number issued to a prescriber when a waiver is requested.

• If the pharmacist, in their professional judgment believes that the prescription is appropriate they should fill the prescription.  If the pharmacist decides to fill the prescription, they may document their rationale in a manner that would be readily retrievable.

10.  Are oral prescriptions for controlled substances still permitted?

• Pharmacists may dispense a controlled substance medication pursuant to an out-of-state written or electronic prescription provided they meet all of the requirements, state and federal, for issuing a prescription.  It is the pharmacists responsibility to determine the validity of a prescription prior to dispensing it using their professional judgment.