A tiny provision tucked into a spending bill for Iraq requires that prescriptions for Medicaid patients be written on "tamper-resistant" pads. But most doctors do not use such pads.
The law is designed to make it harder for patients to obtain controlled drugs illegally and easier for the government to save money. The quick start date leaves little time to educate doctors and pharmacists.
"Our members are absolutely flabbergasted that they're going to be put on the hook for denying prescriptions if something is not on a tamper-proof pad," said Paul Kelly, vice president of government affairs for the National Association of Chain Drug Stores. "Our biggest fear is the negative impact this could have on patient care and access to prescriptions."
Pharmacists' groups have asked lawmakers and the Centers for Medicare and Medicaid Services to delay putting the law in place.
"Millions of Medicaid beneficiaries may not be able to obtain their medications after Oct. 1," they said in a recent letter to lawmakers. "This could lead to higher Medicaid costs for emergency room visits, hospitalizations and physician office visits if medication cannot be obtained in a timely manner."
Steve Hahn, a spokesman for the centers, said the agency has no plans now to change the Oct. 1 date. In the interim, it is consulting with health care providers and preparing guidance on how to comply with the law.
Several states already require tamper-proof prescription pads, Hahn noted. They usually require them only for controlled drugs, those easily subject to abuse.
But health care providers in those states often had more than a year to prepare, Kelly said. New York, for example, had 18 months.
In this instance, many doctors are not even aware of the law.
Dr. Edward Langston, chairman of the board of trustees for the American Medical Association, said the organization is also concerned the new law may threaten some Medicaid patients access to medicine.
"The implementation timetable is too short to educate prescribing physicians about the new law and is also likely too short to produce and distribute the enormous quantity of new prescription pads that will be needed," Langston said.
The tamper-resistant pads often contain a chemical that reveals when efforts have been made to alter the paper. For example, the heat from a copier may cause the word void to appear. Sometimes, the pads contain serials numbers that are entered into a computer by the pharmacist so that they can be matched against a doctor's order.
Medicaid is the federal-state partnership that provides health coverage to about 55 million poor people. President Bush had recommended the requirement for tamper-proof prescription pads in his 2008 budget. The Congressional Budget Office projected that the requirement would save taxpayers $355 million over the coming decade, mainly through preventing fraudulent prescriptions.
Some lawmakers say they are starting to hear concerns from pharmacists back home. Rep. Charles Wilson, D-Ohio, and Reps. Marion Berry and Mike Ross, both Democrats from Arkansas, circulated a letter to colleagues Wednesday that urged them to contact Medicaid officials.
The lawmakers want a clear definition of tamper-resistant prescription pads. They want to know who is responsible for the costs of the pads and where they can be obtained. They also want to know what will happen when customers show up with prescriptions on regular paper.
Wilson is worried that some pharmacies in rural areas "may end up forced to close up shop if they're not getting reimbursed by Medicaid because their clients' prescriptions aren't on tamper-proof pads."