In 2013 four Missourians were charged with stealing a prescription pad from a psychiatrist and using it to forge prescriptions for opioids and Xanax that they filled at multiple pharmacies.
In 2016 a University of Kansas pharmacy intern lost his license after he stole a pad from a Topeka hospital where he worked and used it to forge prescriptions for opioid pills that he used and sold.
Now Kansas and Missouri lawmakers are considering a simple policy that drug stores say would prevent that type of fraud: Doing away with paper prescriptions and requiring doctors send them directly to the pharmacy electronically.
“We remain absolutely committed to electronic prescribing as a way to address fraud and abuse in the system and we think it’s very important to helping with the solution to opioid abuse,“ said Chris Krese, a spokesman for the National Association of Chain Drug Stores.
New research from the Missouri Hospital Association estimates that opioid abuse costs the state about $14 billion a year — almost 5 percent of its GDP.
Surveys commissioned by Krese’s group showed 62 percent of people in Kansas and Missouri support requiring electronic prescribing as a potential fix.
But so far it’s taking a number of compromises to get Kansas and Missouri physician groups on board.
According to the association of chain drugs stores, most prescriptions nationwide are already written electronically, but those for controlled substances are still more likely to be written on paper.
Forged prescriptions account for about 3 percent to 9 percent of all opioids that are diverted for illegal use.
Prescription pad theft remains a problem and, although the federal government has required “tamper-resistant” paper for more than a decade, there have still been cases of people photo-copying a single prescription from their doctor and successfully filling it at multiple locations.
Missouri is especially vulnerable to that type of fraud because it’s the only state that doesn’t have a prescription drug monitoring program that allows doctors and pharmacists to see what prescriptions people are filling and where.
For now, it’s up to the pharmacists to spot fakes and forgeries, and the drug stores say the electronic system is more fail-safe at this point.
Krese’s trade group, which represents CVS, Walgreens and a slew of grocery and department store pharmacies nationwide, successfully lobbied last year for a federal law that will require prescriptions for controlled substances to be sent electronically starting in 2021.
But it will only apply to prescriptions covered under Medicare Part D, not to those written for people on Medicaid or private insurance, or for people who pay out of pocket.
“We still need the state legislation to go even further,” Krese said.
According to DrFirst, a Maryland company that sells medical software, five states already have laws in effect requiring electronic prescribing of controlled substances: Maine, New York, Connecticut, Minnesota and Arizona. Another seven have passed laws that will take effect later. And at least 10 more are, like Kansas and Missouri, considering it.
In Kansas and Missouri the legislation started off broad, but was whittled down at the request of the organizations that represent the states’ doctors: the Kansas Medical Society and the Missouri State Medical Association.
The groups have a number of concerns. Electronic prescribing software can be expensive for doctors in solo or small practices, and internet access is still spotty in some rural areas of both states. There are also philosophical objections to more government regulation of how physicians practice.
In both states bills that were originally introduced would have required all prescriptions to be sent electronically starting in 2021.
Missouri doctors are also negotiating to allow waivers based on technology challenges and replacing fines for non-compliance with discipline from the state medical licensing board.
“We were opposed to the original bill and testified as such,” Jeff Howell, the Missouri State Medical Association’s vice president of government relations said via email. “We have been involved in making the bill better.”
The group has also requested an exemption for any patient who specifically requests a paper prescription.
“The reason the patient retains the right to ask for a paper script is because they currently have a statutory right to have a paper script and the ability take it to a pharmacy of their choice,” Howell said. “Not including that exception in the committee substitute (bill) would have nullified that right.”
In Kansas, House Bill 2389 and Senate Bill 234 also now include exemptions for technological or financial hardships. Both bills would also apply only to controlled substances that contain opioids — a point of contention during a committee hearing Monday.
Sen. Molly Baumgardner, a Republican from Louisburg, said that leaves out several other types of controlled substances that can be dangerous. As a teacher at the K-12 and community college level, she heard of students abusing prescription stimulants like Adderall, as well as other drugs that aren’t opioids.
“Those would be the kind of things folks would sell, they would crush they would snort and use,” Baumgardner said.
But the Kansas Medical Society said it would oppose efforts to expand the bill to include all controlled substances.
“There are no physicians that will support that position, it’s simply too broad,” Rachelle Colombo, the group’s director of government affairs, said during the hearing. “We don’t support the government getting in between the patient-physician relationship.”