Surprise! Iraq War Bill Requires Secure Pads for Medicaid Prescriptions

Yes, that IS a surprise. Today’s email from the Texas Medical Association:

Surprise! Iraq War Bill Requires Secure Pads for Medicaid Prescriptions

All written prescriptions for Medicaid patients must be written on tamper-resistant pads, thanks to a provision slipped into the bill authorizing funding for the war in Iraq. The requirement, which originated in President Bush’s proposed 2008 budget but went nowhere until added to the Iraq bill without consulting the states, is supposed to prevent fraud and save money.

Helen Kent Davis, director of governmental affairs for TMA, says consultation with the American Medical Association and the Texas Health and Human Services Commission (HHSC) has unearthed several questions TMA and HHSC are working together to answer. For example:

· Who will be responsible for printing the forms used in Texas?

· How quickly can a printer produce the required number of forms? They’re supposed to be used starting Sept. 1.

· How will states pay for the printing costs? State Medicaid officials estimate that 10 to 15 million of the 30 million annual Medicaid prescriptions are written. (A faxed prescription is considered electronic, and telephone and electronic prescriptions are not affected.

· Will physicians be charged for the forms or will the state pay for them?

· How will the forms be distributed to physicians?

We’ll let you know the answers to these questions as soon as we get them.

First off, it doesn’t kick in until September 1st, so it’s NOT time to panic.

Second, what kind of prescription alterations are happening that it’s worth this much effort (and cost) to reduce? I write a ton of prescriptions, but have never worked in or near a pharmacy that fills them, so I wonder how much ‘script tinkering’ is going on? (I’ll send this to the Angry Pharmacist and see if he can enlighten me)(I would if he had an email address).

Third, and it’s not clear in the article, will there have to be a specific pad just for the medicaid patients, or would basically a generic script pad that’s made of ‘tamper resistant’ paper be okay? (And, either of these will result in more blank-pad theft). Seems to me the answer is to fax all the prescriptions to one medicaid clearinghouse, and the patient could then present themselves to any pharmacy, identify themselves, the the medicaid clearinghouse could forward the faxed script to them. No new printing, no new paper, more secure, better tracking of costs.


  1. No new printing, no new paper, more secure, better tracking of costs.

    Our ER charges the patient (or in the case of Medicaid, the government) more if we call in/fax a script as long as we document that we did it, so that kind of stuff would have to be looked at. It eats up a good 10 minutes of RN time at least to do this convenience-care for the patient, so the charge is necessary. Besides the increased charge to the patient, mass faxing doesn’t seem like a good idea…it would suck for the patient to have to wait for administrative delay while a script was processed when all they want is to start their antibiotics or whatever.

  2. I’m guessing that if you could actually find out about how many of your prescriptions have been tinkered with, you’d pop a gasket.

  3. Jedidiah Stott says:
  4. Oops, that update was lost in the server crash. I did email him, but haven’t heard anything back.