Electronic Prescribing for Controlled Substances

Reminders & Updates to the Information Below

  • Practitioners may apply online for a waiver at the BNDD website (information is provided below). Remember, a waiver is valid for a one-year period only, pursuant to the statue, so practitioners have to apply every year.
  • The BNDD plans on asking waiver questions on their annual applications for registration. This may not be implemented until late 2022 or 2023 due to their division implementing a new online application process.
  • At this time, there is a COVID-emergency waiver and the EPCS law has not been implemented yet. The current waiver exists until 12-31-21. At this time, the Governor’s Office will determine if this waiver of EPCS will continue. Updates provided from the BNDD as of December 2, 2021.

In its September/October 2020 Focus MDA issue, the MDA published an article titled, Surprising Ways e-Prescribing Can Speed Up Your Workflow.

The article referred to a Missouri Statute that became effective August 2019 and states, “beginning January 1, 2021, no person shall issue any prescription in this state for any Schedule II, III, or IV controlled substance unless the prescription is made by electronic prescription from the person issuing the prescription to a pharmacy.”

The article also incorrectly stated, “beginning January 1, 2021, all doctors are federally mandated to only use electronic prescriptions for any Schedule II, III or IV controlled substances.”

While there is a state statute, the Missouri statute is different from the federal rule with the same start date. The Missouri statute requires the use of e-prescribing for Schedule II-IV controlled substances for all prescribers (but provides exceptions and waivers, which we will discuss following). In contrast, the federal e-prescribing final rule pertains only to Medicare Part D prescriptions per the electronic Real-Time Benefit Tool (RTBT).

FAQ Document

This questions and answers document seeks to clarify current laws and how Missouri dentists can respond to those, and included the following:

  1. What does the Missouri Electronic Prescribing for Controlled Substances (EPCS) statute require?
  2. What is electronic prescribing or e-prescribing?
  3. Does this include fax, phone, scanned or emailed prescriptions?
  4. Is the Missouri statute different from the federal rule with the same start date?
  5. Are there exceptions to the state statute?
  6. Is there a waiver process?
  7. Will pharmacies accept paper prescriptions for controlled substances after January 1?
  8. Does this law apply to non-controlled substances?
  9. Should I implement an EPCS program in my practice, what are the basic DEA guidelines for e-prescribing software?
  10. How do I choose an e-prescribing software that adheres to the Missouri statute

The MDA regrets that in its original publication, it did not provide enough information for members about all aspects of the current statute. The MDA Board of Trustees is further researching this issue, including having discussions with other state healthcare associations, to best advocate for our member dentists. We will provide updates and information as available.

As stated previously, while the statue is in effect, current rules have not been written to apply the statute, and thus the Bureau of Narcotics and Dangerous Drugs (BNDD) has stated that doctors can continue to prescribe as they have previously—including by paper or by e-prescribe, if it is a technology they already have implemented into their practice.

Waiver Process from BNDD Available

Beginning December 16, 2020, DHSS/BNDD has established a system to issue waivers for electronic prescribing. Practitioners may:

  • Visit the BNDD website at health.mo.gov/safety/bndd
  • At the top of the page, click on the link Applications for Electronic Prescribing Waivers
    • From this page, you will find documents including a copy of the statute, the emergency rule to push back compliance until 3/31/21, a copy of the emergency waiver and the BNDD rule.
    • Also from that page is an Application for Prescribing Waiver. The application is one page and asks limited questions. IMPORTANT—The form must be saved and submitted to a specific email address. Applications will be handled in the order in which they are received, to begin being processed January 1, 2021.

The BNDD has stated that during the next year, the waiver questions will be added to the annual application that registrants complete and submit once a year when they get a new registration.

Additional Resources

Should a doctor not currently use e-prescribe and/or EPCS technology, but wish to do so, they should inquire with their current dental practice software about built-in technology or software integration. Members can receive discounts through iCoreConnect, an MDA Perks Program participant that offers iCoreRx which meets EPCS requirements and integrates with Dentrix, Eaglesoft, Open Dental and other practice management systems. The iCoreConnect team can discuss with members what iCoreRx interaction looks like with their particular PM software.