Which States Require EPCS?

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Every year, prescription errors, drug reactions, and dosage miscalculations send 1.3 million Americans to the emergency room. In an effort to curb these dangerous prescription mistakes, the DEA released Electronic Prescribing of Controlled Substances (EPCS) proposal. Today, EPCS is part of the SUPPORT Act — a 2018 law targeting opioid abuse — which is set to make EPCS a federal mandate in 2021 (or 2022, depending on pushback due to the ongoing COVID-19 crisis).

Despite this relatively fast rollout, many states have moved their deadline forward. In fact, a few states already have EPCS standards in effect, with a few others rounding the corner at the beginning of 2021. So, which states require EPCS today? And which states will require them in the future? Here’s a deep dive into the regulatory landscape of electronic prescriptions on controlled substances.

For more information on EPCS, take a look at our article “All You Need to Know About EPCS Certification” or contact us today to speak to a specialist.

What is EPCS?

Electronic Prescriptions for Controlled Substances is a DEA proposal that allows prescribers to write prescriptions digitally, saving them time, energy, and risk in the process. While EPCS may seem like a small change in the world of EHR, the ability to electronically transmit prescriptions for Schedule II-V drugs is a wide-reaching, and wholly transformative change to the way practitioners and administrators navigate the prescription landscape.

In fact, the DEA’s proposal (which was initially a non-regulatory guideline) was rolled into the SUPPORT Act — a bill passed in an attempt to curb the opioid epidemic facing our country. The SUPPORT Act requires prescribers to implement EPCS systems by 2021 (though this date may get pushed back a year). In addition, many states have already passed laws requiring EPCS adoption, and around half of the country is already in the process of building out their EPCS capabilities.

Currently, EPCS implementation is happening across multiple layers. Practices are rushing to achieve HITRUST certification, EHR vendors are quickly integrating existing EPCS systems into their network, and small practices are preparing their tech stacks for new EPCS systems and solutions to meet regulatory guidelines.

But why? Obviously, there’s regulatory pressure to adhere to EPCS. However, adoption rates are skyrocketing — which may be surprising in a healthcare ecosystem that took nearly a decade to achieve near-universal EHR adoption. The answer is simple: EPCS provides significant non-regulatory value to healthcare systems, and prescribers are taking notice.

guide to epcs

Understanding the Non-regulatory Value of EPCS

It’s easy to understand EPCS in the context of regulatory control. But regulations often overshadow the valuable components of change. Practices are forced to undertake this relatively broad transformation, so the practice-centric and vendor-centric value levers of EPCS often get drowned out by the rush to comply.

Fortunately, there’s tangible value in EPCS that goes well beyond avoiding hefty regulatory fines and reputation damage. According to McKinsey, digitization efforts like EPCS can prevent 95% of adverse drug reactions, create billions of dollars in opportunity, and streamline pesky redundant administrative burdens. In other words, EPCS is good for patients and doctors.

In addition, EPCS adds layers of value to EHR vendors in the hyper-competitive healthcare platform space. Healthcare providers don’t necessarily want a hefty stack of digital tools. There’s a reason that healthcare is slow to transform and cautious of emerging technology. Pharmacists and doctors are already time-stressed (49% of doctors experience burnout), and adding technological burdens to their workflows is anything but ideal. Adopting a horizontal EPCS tool that’s integration-ready can improve the value of EHRs and provide critical relief to boots-on-the-ground practitioners.

Let’s quickly cover the core benefits of EPCS for EHR vendors, practicing prescribers, and patients:

  • Reduced risk: EPCS provides an immense amount of risk reduction for both patients and prescribers. Digitized systems can instantly safeguard against handwriting issues that generate prescription errors (e.g., misread abbreviations, illegible dosages, etc.), prevent drug-to-allergy and drug-to-drug interactions, alert prescribers of any duplicate medications or patient statuses (e.g., pregnant, allergies, etc.), and prevent the increasingly prevalent “doctor shopping” that plays a significant role in the opioid epidemic.
  • Cost-savings: The administrative burden of prescriptions is immense. Not only does writing, recording, and tracking prescription drugs sap time from already-stressed prescribers, but eliminating these administrative redundancies immediately improves quality-of-care. Research shows that prescribers who adopt EPCS systems significantly reduce costs associated with errors, pharmacy call-backs, and diversion. In fact, research suggests that the total cost-savings associated with EPCS systems is $140 billion to $240 billion, and that number only includes cost-savings associated with patient outcomes. There are also layers of saving on the administrative side, with prescribers only spending an average of 20 extra seconds per patient to reap the benefits of ECPS systems.
  • Efficiency: From pattern analysis to interoperability and deep visibility, EPCS systems give prescribers the tools they need to instantly understand the context of prescriptions, identify the ideal care route, and prevent misuse from impacting patients.

These benefits (along with the meaningful use standards set by CMS) have led to a massive increase in overall EPCS adoption by providers and vendors. Currently, nearly every EHR system is shopping for ECPS solutions, and providers are rushing to integrate the benefits of EPCS into their practices. But EPCS isn’t only a differentiating solution that provides cost-savings at scale; it’s a downright requirement in many states.

Which States Currently Require EPCS?

The EPCS regulatory landscape can be a little confusing. Currently, around half of the states are in the process of (or have already) rolling out EPCS requirements. Yet, prescribers (e.g., doctors, dentists, nurses, etc.) are required to use EPCS for all controlled substances under Part D of Medicaid. In other words, any states that have yet to announce an EPCS mandate are already impacted by Medicaid requirements, so EPCS is (by all accounts) a federal requirement for every state.

But, for clarity, these are the states that require EPCS systems as of January, 2021:

  • Arizona
  • Connecticut
  • Florida
  • Iowa
  • Maine
  • Massachusetts
  • Minnesota
  • New Jersey
  • New York
  • North Carolina
  • Ohio
  • Oklahoma
  • Pennsylvania
  • Rhode Island
  • Tennessee
  • Virginia

In addition, the following states are set to require (on the state-level) EPCS systems in 2021.

  • Arkansas
  • Colorado
  • Delaware
  • Indiana
  • Kansas
  • Kentucky
  • Missouri
  • Nevada
  • South Carolina
  • Texas
  • Washington
  • Wyoming

The blend of local, state, and federal guidelines make EPCS a little challenging to follow from a regulatory standpoint. However, within the next few years, EPCS will almost certainly be universally required at some level — especially given its requirements for Medicaid. That being said, EPCS is entirely legal across all states, so this is less a question of regulatory need and more a question of value. Healthcare systems and EHR vendors that adopt EPCS will secure their position in the future of prescribing and reap the benefits for their forward-thinking.

Are You Prepared?

Electronic prescribing of controlled substances cuts costs, improves quality-of-care, and reduces administrative burdens. Even in states where EPCS has yet to make a regulatory splash, the changes to Medicaid Part D and the raw value of EPCS has accelerated adoption timelines for many small practices and healthcare systems. Are you ready?

NewCrop is an industry-leading EPCS provider for practices and EHR vendors. Our world-class platform combines intelligent access controls, robust identity proofing, hyper-secure 2nd-factor technology, and an intuitive user interface to give practices access to the tangible benefits of EPCS without the headache-prone implementations or friction-filled learning process.

Intelligent, end-to-end electronic prescription is here, and we’re helping EHR vendors and practices lead the way. Contact us to schedule a demo and learn more about how NewCrop can help you claim your place in the future of prescribing.



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