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Amid physician pressure, Walmart backs off plan to reject paper Rx

What’s in the news: Walmart Inc., the world’s largest retailer, said it is delaying a previously announced move to mandate electronic prescriptions for controlled substances (EPCS) that was scheduled to begin Jan. 1, 2020. The AMA and other medical societies had been urging the delay.

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“The AMA welcomes Walmart’s decision to delay implementation of an electronic prescribing mandate that would have resulted in harm to millions of Americans, including many in rural areas who rely on Walmart as the only pharmacy in reasonable distance,” said AMA President Patrice A. Harris, MD, MA.

“The policy, which the AMA urged Walmart to delay, was not developed in consultation with the nation’s physicians, who support electronic prescribing of controlled substances, but want to see it implemented in a manner that supports—rather than disrupts—patient care.”

Why it matters for patients and physicians: Only about 44% of physicians have the technology to submit electronic prescriptions for controlled substances (EPCS). Without a delay in implementation, “patients in every state” would have suffered “negative consequences from not having their necessary medications dispensed,” AMA Executive Vice President and CEO James L. Madara, MD, wrote in a letter to Walmart Chief Medical and Analytics Officer Thomas Van Gilder, MD.

Patients affected by the move, Dr. Madara wrote, would likely have included those “receiving care for opioid-use disorder, anxiety, depression, attention deficit hyperactivity disorder, auto-immune diseases, HIV/AIDS and painful conditions like sickle cell disease.” It also would likely have made it impossible for thousands of Walmart’s own employees to fill their paper prescriptions in a Walmart pharmacy.

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Not all EHR vendor products can satisfy the requirements for EPCS, and that implementation has been set back due to questions about certification, patient concerns and cost to prescribers, Dr. Madara noted in a letter earlier this year to vendors asking for their help to change the situation.

The burden does not lie solely on vendors’ shoulders, the AMA says. More should be done to modernize Drug Enforcement Administration (DEA) rules for EPCS to let doctors deploy the user-friendly devices they already have—such as fingerprint readers on laptop computers and mobile phones—to satisfy multifactor-authentication requirements.

What’s next: A federal law enacted in 2018 requires the DEA to modify those requirements, and the agency is working to make the changes. The measure—the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, or SUPPORT Act—requires that, starting Jan. 1, 2021, Schedule II–V drugs prescribed to patients with Medicare Part D prescription-drug coverage be submitted electronically.

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The SUPPORT Act allows for multiple exceptions to the ECPS requirements. States have added other exceptions and ways for doctors and other health professionals to apply for a waiver from the ECPS requirements.

Walmart’s move to delay implementation of its electronic prescribing-only applies to the pharmacies in the company’s Walmart and Sam’s Club stores.