REGULATION

A growing patchwork of e-prescribing rules is creating a compliance headache

Most U.S. states would like you to throw away your prescription pad. In fact, some require it by law.

Catch up: Around three dozen states now require e-prescribing in some form. What these regulations actually require varies quite a bit across the country: 

• In six states—California, Delaware, Florida, Iowa, Michigan, and New York—the mandate covers all prescriptions, not just controlled substances. Elsewhere it's Schedule II only, or all controlled substances, or opioids alone.
  

• Some states have volume thresholds, below which practitioners aren’t covered by the
  mandate. In New York, it’s 25 prescriptions in a year, while in California, it’s 100.
  

• Penalties are also inconsistent. New York’s rules threaten professional misconduct charges plus civil and criminal exposure. California hands it to the licensing board. And Minnesota, one of the early movers on e-prescribing mandates, still has no teeth attached to theirs.

Why it’s happening: E-prescription mandates are meant to crack down on forgeries, make it more difficult to doctor-shop, and feed more data into prescription drug monitoring programs—all tactics aimed at reducing opioid abuse.

Why it matters: While these laws are designed to be enforced against individual licensees, decisions that DSOs make have a significant impact on whether compliance is a breeze or another administrative headache. Everything that needs to happen on the backend to make compliance as easy as possible, from filing state registrations to adopting the right technology, are levers DSOs can control.

What you can do: Taking the burden of worrying about compliance away is exactly the sort of benefit a DSO can offer its clinicians. Here are some steps to consider:

• Build a compliance matrix. If you’re operating in multiple states, build a dashboard that includes information on the mandate’s scope, exemption threshold, state registration requirement, waiver process, and penalties. Refresh it annually.
  

• Know your tech. The dominant e-prescribing engines in dental right now are DoseSpot, iCore, and Ensora eRx.
  

• Don’t lean on a low-volume exemption. Particularly if you’re operating in tightly regulated states, this can create real risks. 
  

• Track paper exceptions by location. Most states permit a non-electronic script during a technical failure. Track those exceptions to spot any irregular patterns early.
  

• Consider setting your operating standard at the level of your strictest state. Find the state that has the tightest rules and operate everywhere at the level demanded there—keeping your processes standardized at a high level can help avoid slip-ups.

Bottom line: E-prescribing mandates are becoming a critical part of a DSO’s regulatory compliance regime, and—as more states adopt them—one that requires special attention to get right. The answer, however, is straightforward enough: Get clear on what’s required, pick the right tech stack, and run consistent operating procedures.