What Physicians Should Know about Pennsylvania's E-Prescribing Law

Last Updated: Mar 25, 2020

Important Note for COVID-19 Emergency: In a March 24, 2020 email to PA PDMP registrants, the Pa. Department of Health confirmed that "Act 96 of 2018 contains exceptions for prescribers who are unable to meet electronic prescribing requirements due to the COVID-19 response. A prescriber who reasonably determines that electronically prescribing a controlled substance would be impractical or cause an untimely delay resulting in an adverse impact on the patient's medical condition meets a statutory exception from the electronic prescribing requirements of Act 96."

prescriptions_onlinePennsylvania's e-prescribing law took effect on Oct. 24, 2019.

The law – Act 96 of 2018 – mandates that all Schedule II through V controlled substances, except when dispensed or administered directly to a patient by a practitioner or authorized agent, other than a pharmacist, to an ultimate user, shall be prescribed electronically. This law replaces the traditional method of prescribing controlled substances to a patient, i.e. paper prescription pads.

Guidance on Exceptions for Practitioners Who Lack EHR or Internet

In the Pennsylvania Department of Health's original guidance on Act 96, it said that practitioners would be required to apply for a hardship exemption if they lacked either an EHR system or internet access but not both and were unable to comply with the law.

The Pennsylvania Medical Society (PAMED) was concerned that this requirement could potentially force some practices to stop prescribing controlled substances or even close altogether. In September 2019, we sent this letter to DOH and asked them to reconsider their interpretation.  

On Oct. 21, 2019, PAMED received a response from Secretary of Health Rachel Levine, MD. She said that, based on our feedback, DOH has updated their guidance concerning Act 96.

The revised guidance clarifies the requirements for practices that do not have an EHR system but do have internet access (or vice versa):

  • The Department of Health will not take action against a practitioner if the practitioner has an EHR system but does not have internet access. Likewise, the Department of Health will not take action against a practitioner if the practitioner has internet access but does not have an EHR.
  • Under these circumstances (either lack of an EHR or lack of internet access), a practitioner is not required to apply for a hardship exemption and is therefore not required to e-prescribe.

Get DOH’s revised Act 96 guidance here.

We thank DOH and the Governor’s Administration for working with PAMED on this issue. 

How to Apply for a Hardship Exemption Under Act 96

For practitioners, pharmacies, or health care facilities that do not meet one of the exceptions in Act 96 (such as the exception for those without EHR or internet noted above) but is unable to comply with the law may petition DOH for a temporary exemption based upon economic hardship, technical limitations, or exceptional circumstances.

DOH offers online hardship exemption form that can be used when applying for a temporary exemption. View Hardship Exemption Form

Pharmacy Verification of Paper Prescriptions

Act 96 does not require a pharmacist who receives a written, oral or faxed prescription to verify that the prescription falls under one of the statutory exceptions or a hardship exemption. Therefore, a pharmacist may continue to dispense medications from an otherwise valid written, oral or faxed prescription that is consistent with current laws and regulations.

Note, however, that separate from Act 96, pharmacy regulations do not require a pharmacist to fill a prescription if the pharmacist knows or has reason to know that it is false, fraudulent or unlawful, or that it is tendered by a patient served by a public or private third-party payor who will not reimburse the pharmacist for that prescription. In addition, a pharmacist may decline to fill or refill a prescription if, in the pharmacist’s professional judgment exercised in the interest of the safety of the patient, the pharmacist believes the prescription should not be filled or refilled.

The pharmacist is required to explain the decision to the patient, and if deemed necessary, the pharmacist shall attempt to discuss the decision with the prescriber. Therefore, nothing in Act 96 or the pharmacy regulations require a pharmacist to unequivocally honor a prescription, regardless of whether it is filed electronically or via a prescription pad.

Get Answers to FAQs on the E-Prescribing Law

In this Quick Consult fact sheet, PAMED answers physicians’ frequently asked questions about the law. It clarifies all the exceptions under the law and the penalties for violating the requirements.

Get the Quick Consult 

You can also visit DOH’s Act 96 resource page here.

PAMED members with questions on Act 96 can contact our Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org


15 comments

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  1. Steve Karp | Oct 28, 2019

    So who is verifying that you don't have internet access or EMR? It's not the pharmacy. Why spend money for access that no one is verifying for which you are 'required' to have? Because if there are checks to see if you are complying then there are also demands that you prove that you aren't required to participate.

    Also, there's currently no penalties for non-compliance since there are currently no regulations with enforcement built in. And people wonder why government is despised. And this half crock issue isn't even under full legislative control. It's another farmed out issue to 'regulatory' agencies that haven't even designed the regulations.

  2. Michael Siget - PAMED Staff | Oct 28, 2019

    Hello Dr. Charlton,

     

    If you qualify for the statutory exception (no EHR or no Internet access), then you do not need to apply for a hardship exemption.  The statutory exception is permanent unless changed in the future.  If that occurs, we will let our members know.

  3. Steve Karp | Oct 25, 2019

    David Behar: First, stop pointing out the obvious and making all others recognize it (sarcasm). The leftists now control the medical field including our representation so resistance is futile. Seriously, the medical society won't be of any help with this issue. because that would requiring siding with us. Their job is to make us comply.

    The federal and state legislatures kick all they can to the bureaucracy i.e. the administrative state, those unaccountable to the voter. In this case DOH has been mandated to make up the regulations to enforce the law, which as of today there is no penalty in ignoring, since there are no regulations. See, I too can use circular logic.

    Philip Hamburger has written several books on the administrative state. Buy the shorter one unless you like tomes, doorstops, etc. When was the last time you saw someone in the Health Dept on the PA voting ballot? We don't vote for these people but they rule over us. If you can follow what is going on with this issue you can recognize the dysfunction in Washington and the Trump collusion nonsense. It all boils down to the same corrective; we need smaller government, fewer laws, and no administrative state.

  4. Judy Charlton | Oct 25, 2019
    So my question is this: Under these circumstances (either lack of an EHR or lack of internet access), a practitioner is not required to apply for a hardship exemption and is therefore not required to e-prescribe. - So is this a PERMANENT exemption as long as the condition exists of A) no internet or B) no EHR???? Or is it merely a one-year reprieve, and we must e-prescribe by the end of the one year?
  5. Stephen Powers | Oct 15, 2019
    ALL INCONVENIENCES AND POLITICS ASIDE, I APPARENTLY DO NOT QUALIFY FOR ANY FORM OF EXEMPTION, YET I HAVE SPENT OVER 13 HOURS TRYING TO GET EPCS REGISTRATION AND APPROVAL, BUT I ONLY GET TANGLED UP IN SCREENS AND PROCEDURES!  I'M LOST, FRANKLY.  A LITTLE ASSISTANCE IS NOT  ENOUGH!  WHERE CAN I GET AN ACCESSIBLE GUIDE TO SIT BESIDE ME FOR A DAY AND GUIDE ME THROUGH THE MASS OF CONFUSING TERMS AND PROCEDURES??  DOES THE STATE REALLY PREFER THAT ON OCT 24TH I ABANDON ALL MY ADHD AND SERIOUSLY ANXIOUS PATIENTS, PHASE OUT THE REST OF MY PATIENTS, AND CLOSE UP MY OFFICE?!  THE QUESTION IS DEAD SERIOUS.  I WILL NOT DO THIS UNLESS YOU COMPEL ME TO.  BUT I AM 75 YEARS OLD AND IT IS A SERIOUS OPTION.  GIVEN THE VERY LIMITED POOL OF DOCS TREATING THE 5% 0F THE POPULATION WITH CONTINUING ADULT ADHD, I AM GRIEVED AND TROUBLED.  I SUFFER FROM ADHD MYSELF AND I HAVE LIVED THIS WITHOUT MEDICATION - ITS MISERABLE.                    STEVE POWERS  10-15-19
  6. Michael Siget - PAMED Staff | Sep 27, 2019
    You can call our phone number    and ask to speak to any one of us. If you are referring to our general counsel, you can call our number and ask to speak to Angela. Have a great day. 
  7. David Behar | Sep 26, 2019
    Michael, I really want to speak the Society lawyer. Who is it now, and how do reach her? 
  8. Michael Siget - PAMED Staff | Sep 26, 2019
    Yes, I work for the Society.  I have written many articles and guidance documents that can be found on our website. Feel free to call the number at the bottom of our webpage and I would he happy to discuss your concerns with you. Thank you. 
  9. David Behar | Sep 26, 2019

    Michael. Only 10% of overdose deaths are among our patients. Our patients are being scapegoated for the  conduct of  addicts. 

    I can get a kilo of carfentanyl for $3000 on the white web (Google), not even the dark web. That is 50 million human lethal doses. The German company has 4/5 stars in its reviews. The Chinese company has 2.5 stars in its reviews. Credit cards accepted. They use Fed Ex.

    I even want to help the addicts. Now they will be tracked by the Pennsylvania KGB. Is that encouraging or discouraging care?

  10. David Behar | Sep 26, 2019

    Hi, Michael. Can you tell me who you are? I have no interest in criticizing you. I just want to talk to you if you work for the PA Med Society. 

    Doctors may stand in for their patients. That is true for doctors outside of abortion providers.

    When a law places an undue burden on any clinical care, even outside abortion, they can enjoin such a law.

    In addition to restricting care, this law allows the PA gov KGB thugs to know everything about patients getting controlled substances. 

    We need to stop them.

    They are also quacks. This law will have no benefit in reducing misuse and overdose deaths.  Regulatory quackery violates Fifth Amendment Procedural Due Process rights. 

     

  11. Michael Siget - PAMED Staff | Sep 26, 2019

    Thank you for your comment.
    Please note that a permanent restraining order is not something thatis applicable, as federal law allowsfor e-prescribing and states may fashion their own requirements. 
    Currently, four states have e-prescribing mandates. Approximately 23 states, including Pennsylvania, have e-prescribing mandates in some form that will take effect in the next few years. Some states, unlike Pennsylvania, currently do not have waivers or exceptions in their laws. We do our best for our members and we thank you for your time and efforts. 

  12. David Behar | Sep 26, 2019
    I cannot believe the PA Med Society failed to obtain a permanent restraining order against this vicious attack on clinical care. I may have to do so on my own. 

    Explain again what this worthless organization is good for.
  13. Raymond Lodise | Jul 03, 2019
    The attempt to control illegal narcotics has fallen into the hand of legal prescribers.  Although, on the surface and with distorted research, it seems it can diminish narcotic addiction, it is once again penalizing the legal much like the gun laws and we have seen and will continue to see a waste of time and effort.  Controlling narcotics is in the hands of law enforcement not physicians. True a few physicians have failed, but far less the policing agencies.  They have too long turned their head, and now to blame others. These actions will not change the situation, they are just movements to make it appear something is being done.  As a former physician with a sub specialty of drug detox and rehab, I assure those active in this portion of medicine will agree, this will NOT change anything in the addiction picture because it has been misguided.
  14. Hil Rizvi | Mar 21, 2019

    so many anti doc laws. its time to hold legislators in contempt

    hello PaMed. You cannot have a higher security measure than an original handwritten Rx

  15. Steve Karp | Mar 21, 2019

    First they make us buy 'special' prescription pads to protect against forgery. Now we can only prescribe electronically and now another batch of prescriptions will get tossed. When does this nonsense stop? Average docs need to realize that there are sellouts among us who let this nonsense continue. If they weren't sellouts they would speak frankly to the state legislators and tell them where to place their initiatives.

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