Congress Delays Start of Prescription Rules

Congress votes to delay by six months a new requirement intended to reduce prescription drug fraud in the Medicaid health program. Health-care providers were unprepared to comply with rules for "tamper-proof" prescription pads.

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Congress is coping with the law of unintended consequences. The House, yesterday, passed and sent to President Bush a bill to delay by six months, a new requirement intended to reduce prescription drug fraud in the Medicaid health program.

The problem? Health care providers were so unprepared to comply with the new rules that millions of patients might have found themselves without needed medicines.

NPR's Julie Rovner reports.

JULIE ROVNER: The concept is a simple one: Require prescriptions to be written on so-called tamper-proof pads and you'll cut down on illegal use of prescription drugs.

There's lots of ways to do it says, Hurant(ph) Jan(ph) Goshen(ph) of the American Pharmacists Association.

Mr. HURANT JAN GOSHEN (American Pharmacists Association): Whether it's something that makes the prescription, say, void when you photocopy it or something that prevents someone from erasing it.

ROVNER: The requirement was added to a funding bill for the Iraq War last spring as a way to save money for an unrelated health provision. So it mostly went unnoticed - at least for a while.

Mr. ERNIE BOYD (Executive Director, Ohio Pharmacists Association): I'm afraid that we don't read Iraq funding bills very closely sometimes, and we missed it to be flat honest about it.

ROVNER: That's Ernie Boyd, executive director of the Ohio Pharmacists Association. When he did discover the provision, he realized that pharmacists were facing a serious problem if, on October 1st, every single prescription for every single Medicaid patient had to be written on tamper-proof paper.

Mr. BOYD: The way the language is written is to be reimbursable. A prescription shall be written on this paper, and our Medicaid Departments would have no choice but to take back 100 percent of the pharmacy's money.

ROVNER: The problem is if prescriptions are written by doctors not pharmacists. And doctors, even those who take care of large numbers of Medicaid patients are just now finding out they need new prescription pads for those patients.

Virgilio Licona of the Salud Family Health Centers in Fort Lupton, Colorado, doesn't remember exactly when he learned of the new rules, but he knows it hasn't been very long.

Dr. VIRGILIO LICONA (Associate Medical Services Director, Salud Family Health Centers): A couple of weeks ago, a week ago - very recently.

ROVNER: Getting ready for the change has been a big deal for the center, which has 45 doctors along with 20 physician assistants and nurse practitioners who also write prescriptions for their 75,000 patients. And the switch won't be cheap, Licona says.

Dr. LICONA: The cost for prescription for us now will go up four-fold, and that's because of the cost of the tamper-resistant type of prescription pad.

ROVNER: Of course, the Salud Center is lucky. It's found someone who will sell them the tamper-resistant pads.

Hurant Jan Goshen of the American Pharmacists Association says that's not the case nationwide.

Mr. GOSHEN: We've already heard from at least one printer of these pads that they stopped taking orders a couple of weeks ago because there, you know, was such a large demand.

ROVNER: Ohio Pharmacy official Ernie Boyd decided not to wait for bad things to happen. He came to Washington and talked to members of the Ohio House and Senate delegation into sponsoring a bill to delay the requirement for six months.

Freshman Congressman Charlie Wilson became the House sponsor.

Representative CHARLIE WILSON (Democrat, Ohio): It's going to have a significant impact on the people and the pharmacists in my area if people can't get their medications, if pharmacies try to go ahead and give the medication not knowing if they're going to be eligible for Medicaid reimbursement.

ROVNER: The Senate passed the bill Tuesday night. The House followed suit yesterday. The Bush administration doesn't oppose the extension, but hasn't said yet whether the president will sign the bill, which includes several other health provisions.

Julie Rovner, NPR News, Washington.

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