
Preventing Inappropriate Request by Insurers, Pharmacies, or Durable Equipment Suppliers
The Problem
The Drug Enforcement Administration (DEA) registration number system was implemented as a way to successfully track controlled substances from the time they are manufactured until the time they are dispensed to the patient. At the present time, however, the DEA number also is being used as a physician identifier by pharmacies for non-controlled substances, suppliers of durable medical equipment, and insurance companies for reimbursement purposes. Using the DEA number for purposes such as these could lead to the DEA number falling into the hands of people who sell and use drugs illicitly and could lead to use of the DEA number for fraudulent prescriptions.
The DEA opposes use of the DEA number for other than its intended purpose for tracking controlled substances, and strongly opposes insurance company practice of requiring that a DEA number be placed on prescriptions for non-controlled substances. According to the DEA, "the usage of the DEA number as an identification number for the insurance industry forces practitioners who might otherwise not need a DEA registration to obtain one if they perceive it as a requirement for reimbursement. This manner of usage by the insurance industry is not legitimate practice and could potentially lead to a weakening of the legal control measures imposed by the Controlled Substances Act." Some local DEA offices have issued advisories to this effect. (This link will take you off the AMA Web site. The AMA is not responsible for the content of other Web sites.)
AMA Policy and Activities
The AMA similarly opposes the utilization of the DEA number for uses other than its intended purposes. Nearly ten years ago, the AMA House of Delegates established policy in response to member concerns about the confidentiality of DEA numbers. Policy 100.982 states that the AMA " (1) believes that the DEA should refrain from divulging a physician’s DEA number unless there is a valid reason for doing so; (2) believes that insurance companies and pharmaceutical companies should use a physician’s medical license number to identify a physician in the computer files instead of the DEA number when controlled substance are not involved; and (3) will develop model legislation to restrict the use of the DEA number for monitoring the prescribing of controlled substances only."
Policy 100.972, adopted at the 1997 Annual Meeting, affirms AMA "opposition to the DEA license number for any purpose other than for verification to the dispenser that the prescriber is authorized by federal law to prescribe the substance;…." It also stresses the Association’s plans to "explore measures to discourage or eliminate the use of physicians’ DEA license numbers as numerical identifiers in insurance processing and other databases." Also at A-97, the AMA adopted Policy 120.973, which states that the AMA, "in order to protect patient confidentiality and to minimize administrative burdens on physicians, will work to eliminate requirements by pharmacies, prescription services, and insurance plans to include such information as ICD-9-CM codes, DEA numbers, and diagnoses on prescriptions."
Most recently, in 1998, AMA delegates reaffirmed the Association’s policies and directed the AMA to work diligently to enact legislation to prohibit:
The AMA Council on Legislation has developed model bills for use on a state and federal level to restrict the use of the DEA number to those federal and state entities that use the number to oversee and enforce the law regarding the manufacture, distribution and dispensing of controlled substances (see Appendices C and D). The AMA currently is seeking a Congressional sponsor to introduce the bill.
Recently, the Health Care Financing Administration was mandated to develop a national provider identifier. The AMA has been working with the Department of Health and Human Services to specify the purposes for which this unique health identifier may be used. The AMA also is lobbying to have the universal provider identifier be the physician’s medical education number.
An Action Plan to Prevent Inappropriate Request by Insurers, Pharmacies or Durable Medical Equipment Suppliers
The AMA-YPS suggests that you take the following steps to prevent inappropriate use of your DEA number: