1.
Electronic Prescribing of Controlled
Substances: Future Opportunities &
Real-Life Experience
Ken Whittemore, Jr. | SVP, Surescripts
Rick Camp | Marketing Director, Surescripts
Melissa Kotrys | CEO, AZ Health-e Connection
May 6, 2014

2.
Presentation Description
Electronic prescribing of controlled substances (EPCS) is legal in all but 2
states, and represents an opportunity to reduce fraud and abuse,
improve care efficiency and support safety. Despite increasing adoption,
gaps in awareness and education result in lost opportunities.
Knowledge of the facts, real-life experience and effective approaches
provide a roadmap for future adoption and success.

3.
About NCPDP
Founded in 1977, NCPDP is a not-for-profit, ANSI-accredited, Standards
Development Organization with over 1,600 members representing virtually every
sector of the pharmacy services industry.
NCPDP members have created standards such as the Telecommunication Standard
and Batch Standard, the SCRIPT Standard for e-Prescribing, the Manufacturers
Rebate Standard and more to improve communication within the pharmacy
industry.
Our data products include dataQ®, a robust database of information on more than
76,000 pharmacies, and HCIdea®, a database of continually updated information
on more than 2.3 million prescribers. NCPDP's RxReconn® is a legislative tracking
product for real-time monitoring of pharmacy-related state and national
legislative and regulatory activity. www.ncpdp.org

4.
About Surescripts
Surescripts is a nationwide health information network that connects, exchanges
and activates health information between pharmacies, payers, pharmacy benefit
managers, physicians, hospitals, health information exchanges and health
technology firms. By providing information for routine, recurring and emergency
care, Surescripts is committed to saving lives, improving efficiency and reducing
the cost of health care for all.
For more information, go to www.surescripts.com and follow us at
twitter.com/surescripts.

5.
Today’s Speaker
Ken Whittemore, Jr. R.Ph, MBA
Senior Vice President, Professional & Regulatory Affairs
Surescripts, LLC
Ken Whittemore, Jr. is Senior Vice President, Professional & Regulatory Affairs at Surescripts.
He works with federal and state laws and regulations pertaining to health information
technology and serves as the liaison to pharmacy boards and associations. Formerly, Ken
worked at the National Community Pharmacists Association and also co-owned a successful
independent pharmacy in Maryland.
Ken is a graduate of the University of Maryland School of Pharmacy, is licensed to practice
pharmacy in Maryland, and holds an MBA degree from Mount Saint Mary’s University.

6.
Today’s Speaker
Rick Camp
Director, Customer Marketing
Surescripts, LLC
Rick Camp, is Director, Customer Marketing at Surescripts. He has over 20 years of experience
working in healthcare after receiving his BA in Economics & Business Administration from
Ursinus College. Formerly, he was a brand director at Merck Pharmaceuticals, senior director of
strategy & analytics consulting group at Epsilon and senior director of marketing strategy at
Healthcare Resources Online.
Rick leads all e-prescribing related healthcare technology market strategies and identifies new
opportunities to increase efficiency and innovation for physicians, pharmacies, PBMS and IT
companies.
In 2002, Rick’s work was featured in Pharmaceutical Executive and Product Management Today. In 2011, his team’s work won
two eHealthcare Leadership Awards for overall website design and best healthcare content.

7.
Today’s Speaker
Melissa Kotrys, MPH
Chief Executive Officer
Arizona Health-e Connection
Melissa (Rutala) Kotrys is Chief Executive Officer of Arizona Health-e Connection, the non-
profit that advances the adoption and optimization of health IT and health information
exchange in Arizona. AzHeC operates Arizona’s regional extension center and leads
ePrescribing efforts, Arizona’s HIE marketplace, and recruitment for the statewide health
information organization (HIO). Melissa serves as interim CEO for the Health Information
Network of Arizona.
Ms. Rutala holds a Masters in Public Health from The George Washington University with a
concentration in health policy, and a Bachelor of Arts from The University of North Carolina
at Chapel Hill.

8.
Faculty Disclosures
• Ken Whittemore, Jr., Rick Camp, and Melissa Kotrys report no
actual or potential conflicts of interest associated with this
presentation, OR
• Ken Whittemore, Jr., Rick Camp, and Melissa Kotrys report no:
» Grant/research support
» Consultant Interest
» Speaker’s bureau member compensation

9.
Accreditation Statement
The Institute for Wellness and Education is accredited by the
Accreditation Council for Pharmacy Education as a provider of
continuing pharmacy education. Attendees who participate in the
interactive portion and submit the completed evaluation form at the
conclusion of the program will have credit for 1.0 hour(s) of
continuing pharmacy education (0.10 CEU(s)) uploaded to CPE
Monitor within 60 days after the program date. ACPE program
numbers are 0459-0000-14-033-L04-P&T. Initial release date is
05/06/2014.

10.
Learning Objectives
1. Define state regulatory status, requirements and anticipated changes
2. Describe EPCS benefits to patients, providers and technology vendors
3. Outline the national landscape trends and obstacles
4. Categorize opportunities for broad adoption for EPCS
5. Employ effective techniques to stimulate adoption
6. Explain real-life experience of EPCS and a vision for the future

11.
Pre-Test Questions
1. What are the benefits of EPCS?
2. How many states have regulations allowing EPCS?
3. What is the national percentage of community
pharmacies that are enabled for EPCS?

12.
E-Prescribing for Controlled Substances:
Regulatory Progress & Prognosis
Ken Whittemore, Jr. R.Ph, MBA
Senior Vice President, Professional & Regulatory Affairs
Surescripts, LLC

13.
Controlled Substances are an Important
Medication Option
• Narcotic and psychoactive medications
• Regulated according to 5 schedules of
abuse potential
13%
of all
prescriptions
1. National Association of Chain Drug Stores (NACDS) 2013 dispense data for all new prescriptions, refills, and renewals in the US.

14.
Misuse of Controlled Substances: Epidemic
and growing health threat
of the U.S. population has used an
opioid pain reliever non-medically
Emergency Department visits
related to substance abuse in 2009
increase in drug overdoses since
1995
4.8%
1.2M
3X
• Laws are emerging to allow broad availability of opioid antidote
• Pharmacies and prescribers are intervention points, also subject
to investigations and loss of license
Drug Overdose Death Rates

15.
3%- 9%
Of diverted drugs
for abuse are tied to
fraud and forgery
of paper
prescriptions¹
States
MANY
Require special
paper Rx pads and
records²
Work
DUAL
When both paper
Rx pads and
e-prescribing
are used³
1. Butler SF, Budman SH, Licari A, et al. National addictions vigilance intervention and prevention program (NAVIPPRO): a real-time, product-specific, public health surveillance
system for monitoring prescription drug abuse. Pharmacoepidemiol Drug Saf 2008;17:1142–54. ALSO, Rosenblum A, Parrino M, Schnoll SH, et al. Prescription opioid abuse
among enrollees into methadone maintenance treatment. Drug Alcohol Depend 2007; 90:64–71.
2. Agency for Healthcare Research and Quality (AHRQ), Reducing and Preventing Adverse Drug Events to Decrease Hospital Costs, Publication #01-0020
3. Economic Impact Analysis of the Interim Final Electronic Prescription Rule, DEA, U.S. Department of Justice, March 2010
Paper Prescriptions for Controlled
Substances Add Additional Risk and Work

16.
Electronic Prescribing of Controlled
Substances (EPCS) Can Reduce Risks
• Reduced fraud and abuse
• Secure electronic records
• Improved safety and patient care
DEA, U.S. Department of Justice, Economic Impact Analysis of the Interim Final Prescription Rule, March 2010

17.
DEA’s Interim Final Rule (IFR) for EPCS1
1 Drug Enforcement Administration (DEA) issued an interim final rule (IFR) allowing electronic prescribing of controlled substances (EPCS) on
03/31/2010, effective 06/01/2010
Aims to ensure secure and auditable EPCS transactions to
reduce the risk for drug fraud, diversion and abuse
• Establishes new security requirements for prescribers, pharmacies and
systems that support electronic transmission
• Requires provider EHR and pharmacy management software updates
are independently certified as compliant
• Allows prescribers the option of signing and transmitting, and
pharmacies to receive, dispense and archive, controlled substance
prescriptions totally electronically
• However, the DEA’s EPCS rule does not preempt any state rules

18.
EPCS Regulatory Status in 2010

19.
Surescripts and NACDS Collaborated to
Align State EPCS Rules with the DEA
• Reviewed state rules related to EPCS
• NACDS’s state directors communicated with state authorities
o Asked to validate resulting assessments with respect to their EPCS rules
• Found both positive and negative variances
• Resulted in a roadmap for action - reliable, validated compilation of state EPCS rules
o Where necessary, urged local authorities to begin legislative and regulatory
processes to bring their rules into alignment with those of the DEA
• Industry wide collaboration facilitated steady regulatory
progress

20.
Now in 2014, Only 2 States Do Not Yet
Permit EPCS in Some Form
Data through April 2014

21.
Special State Considerations - Georgia
Georgia Drugs and Narcotics Agency (GDNA) EPCS Policy*
• Application vendors must submit their Part 1311 EPCS audits to GDNA
• GDNA doesn’t evaluate said audits, but accepts at face value
• GDNA posts a list of all of the approved vendors on its website
http://gdna.georgia.gov/
• Pharmacies not required to maintain any audit reports
o Instead, GDNA collects and is responsible for keeping and posting a list of approved vendors
• EPCS can begin when
o Vendors email their audit reports to Mr. Rick Allen, Director, Georgia Drugs and Narcotics
Agency at rallen@gdna.ga.gov
* 09/16/13 edited

22.
Special State Considerations - New York
Internet System for Tracking Over-Prescribing (I-STOP)*
• Designed to address prescription drug abuse and diversion,
providing law enforcement and medical professionals tools to stop
abuse and diversion before it occurs
o Allowed EPCS in the state and makes e-prescribing mandatory for both
controlled and non-controlled substances as of 03/27/15
o Created a prescription drug monitoring program (PDMP) for New York
that requires real-time reporting of PDMP information
o NY State Department of Health, Bureau of Narcotic Enforcement (BNE)
released required packets for pharmacies and prescribers to register
their certified electronic prescribing applications
*I-STOP bill announced, introduced, passed and signed in 2012

23.
In Spite of Tremendous Regulatory
Progress, Many Still Think EPCS is Illegal
I wish I could electronically
prescribe controlled substances.
I’m not sure if we are
able to accept EPCS

24.
E-Prescribing for Controlled Substances:
National Landscape, Perspectives, Opportunities
Rick Camp
Director, Customer Marketing
Surescripts, LLC

25.
Barriers Impeding EPCS Adoption
• Education
o Low awareness of legality and availability of EPCS
o Unclear requirements / credential verification & authentication
o Uncertainty around on-going costs of compliance (third party audits)
• Competing Priorities
o IT vendor workload for 10.6, MU2, ICD-10, etc.
o Pharmacy /provider responsibilities limit time for EPCS training
• Lack of Critical Mass
o Pharmacy vendors and EHRs waiting to see progress first
o Geographic disparity of EPCS capable pharmacies and providers

26.
Certified EPCS Software / Limited RolloutPharmacyCompanies
ProviderEHRCompanies

27.
0
EPCS Enabled Pharmacies: Nationwide Scale
 More than 40% of total
pharmacies are EPCS enabled
o Five States over 60%: DE, MA,
NH, IL, RI
o EPCS mail order enabled:
Express Scripts Home Delivery
March 2014 data

28.
EPCS Enabled Providers: EHRs Trail Pharmacy
Provider Enablement
March 2014 data
 More than 2% of providers
are EPCS enabled
o Top States: FL (23%), MI (10%),
CA, WY, AZ
o Top EPCS volume: MA, CA,
MI, IL, AZ

29.
Geographic Disparity Between Pharmacy /
Provider Enablement Hinders EPCS Adoption
March 2014 data
Pharmacy enablement
by NY county
Provider enablement
by NY county
30% disparity between
pharmacy and provider EPCS
enablement in NY
 30% EPCS enabled
 1352 locations
 62 counties
 <1% EPCS enabled
 274 prescribers
 13 counties

30.
10 States Represent 50% of National Controlled
Substance Volume: Greatest Need for EPCS
Top 10
States
40 Other
States
National CS Prescription Volume
CALIFORNIA
TEXAS
FLORIDA
NEW YORK
PENNSYLVANIA
OHIO
TENNESSEE
MICHIGAN
NORTH CAROLINA
GEORGIA
1. National Association of Chain Drug Stores (NACDS) 2013 dispense data for all new prescriptions, refills, and renewals in the US.

31.
EPCS Utilization Potential Varies by
Medical Specialty
Controlled substances as a percent of total prescriptions
1Suescripts 2010 Internal Survey of 1375 prescribers
0%
20%
40%
60%
80%
100%
Primary Care Pain Specialist Psychiatrist
1 - 20%
21 - 60% 21 - 60%

32.
Providers Interested in EPCS
1 2010 Internal Survey of 1375 prescribers
2 2013 Black Book Survey of 80,000 e-prescribing doctors
Interest highest in practices
with 40% or more of total Rx
for controlled substances
87% expect to see
reductions in
o Doctor shopping
o Prescription fraud
o Drug overdoses2
80% say they are
very much or
extremely interested1

33.
Providers Using EPCS Report Benefits
1 Journal Am Medical Info Assoc., June 2013, Early experience with electronic prescribing of controlled substances in a community setting
2 American Institutes for Research - CHCF Pilot , November 2013 http://www.chcf.org/projects/2013/epcs-pilot and Surescripts Experience
Saves time for provider and patient
with less steps, less driving to office for
renewal, less waiting at pharmacy2
Better prescription
monitoring and pharmacy
coordination1
70% Say
o Easy to use from any
EPCS enabled computer
o Improved accuracy
and less errors1
Eases security concerns
with improved records / tracking2
Saves Money with less use of
watermarked paper and secure
printers for wet signature2

34.
“We want the prescription to be something
people don’t question. When there is concern
about misuse or improper medicines, it’s easy
to just look into the electronic records.
It’s all secure, and if it’s in there, it was
prescribed by me. That’s 100 percent
accountability for me and the patient.
We all gain confidence”
Dr. Larry Sumner
Family Practitioner
Tahlequah Medical Associates
An Experienced EPCS Doctor Shares…

35.
Dr. Sumner on E-Prescribing of Controlled
Substances
“It’s reliable. Once I send it electronically, I never have to
visit it again. In other words, the pharmacist is not going to
call me and ask what it says.”
“Convenience and accountability with EPCS is good, but
the number one benefit of electronic prescribing is that it
has helped us to reduce our medication errors to virtually
zero. This safety benefit is the most important reason that
lead us to begin e-prescribing in the first place.”

36.
Positive Pharmacy EPCS Experience
• Stronger security reduces fraud risks of paper Rx
• Improves safety with more accuracy / less errors
• Saves time by eliminating rekeying and manual paper processes
• Lowers cost of call backs and paper record storage
• Easy to use, similar to regular e-prescribing
Collaborate Early for Success
“We’ve had a lot of communication keeping each
other informed…that has been very helpful.”
- Pharmacist
Surescripts Experience and American Institutes for Research Pilot , November 2013 http://www.chcf.org/projects/2013/epcs-pilot

37.
EPCS Enhances Medication Management
for Providers, Pharmacies, Patients
1 DEA, U.S. Department of Justice, Economic Impact Analysis of the Interim Final Prescription Rule, March 2010 and Surescripts Analysis
FEWER
Callbacks between
pharmacy and
providers with less
risk of fraud1
ONE
Workflow, secure
and efficient for all
prescriptions1
$700M
Reduction in annual
healthcare costs of
calls and record
keeping1
Up To

38.
EHR Vendor / Provider IT Vendor / Pharmacy
EHR Updates Software
• EPCS Certification
• Select Identify Proofing
• Verified Audit
Key Steps for EPCS Transactions
Vendor Updates Software
• EPCS Certification
• Verified Audit
Step 1
Step 2
Systems connected to
Surescripts network for
secure EPCS transactions
Enable Pharmacy Systems
• Access Controls Set
• Training
Enable Provider EHR Systems
• ID Proofing Setup
• Dual Authentication Device
• Training
EHR
Prescriber ready to send EPCS
PMS
Pharmacist ready to receive EPCSStep 3

39.
Know the Facts About EPCS
Access Online Resources www.surescripts.com/epcs
Found 314 pharmacies within 50 miles of Scottsdale, AZ 85254
Find E-Prescribing Pharmacies Enabled for EPCS
Find E-Prescribing Healthcare Providers Enabled for EPCS

40.
Collaborate to Realize the Full Value of EPCS

41.
Collaboration Case Study:
Driving EPCS Success in Arizona
Melissa Kotrys, MPH
Chief Executive Officer
Arizona Health-e Connection

42.
Arizona Health-e Connection (AzHeC) exists to
Convene, Coordinate and Communicate
for health information infrastructure improvements that
affect every Arizonan.

43.
AzHeC Programs & Initiatives
HIT HIE
REC: Helping Arizona providers meet their health IT goals
HIE Marketplace : viable HIE
solutions for providers
Policy development: leading legislative efforts
eRx Initiative: increasing adoption
Consumer Outreach: education, awareness & engagement
HINAz Provider Outreach:
Recruitment & Enrollment
Arizona’s Health IT Roadmap 2.0: 2-3 year plan for HIT/HIE in Arizona

44.
Arizona eRx Initiative - An Overview
Outreach,
Education and
Resources
EPCS Program
Provider &
Pharmacy
Technical
Assistance
Pharmacy
Incentive Program

45.
Arizona EPCS Initiative
AzHeC established an advisory committee, conducted a
needs assessment and implemented four key programs
between May and December 2013
Key EPCS Program Strategies:
• Provider and pharmacist focused education and outreach
• Encouraged pharmacy chains to get EPCS-enabled
• Worked collaboratively with EHR vendors to support EPCS
• EPCS incentive program to reimburse providers for their identity
proofing costs

46.
193 More Arizona Pharmacies Became
EPCS Enabled Through the Campaign
March 2014 data
262
455
0
50
100
150
200
250
300
350
400
450
500
May 2013 March 2014
EPCS Enabled Pharmacies
74%
Growth

47.
209 Arizona providers Were EPCS Enabled
Through the Campaign
March 2014 data
16
225
0
50
100
150
200
250
May 2013 March 2014
EPCS Enabled Providers
1306%
Growth
119
78
12
4
4
7
1

48.
AZ EPCS Program Grew Provider Enablement
and Transaction Volume
20 14 11
494
2,718
3,113
3,311
3,546
4,070
3,454
3,723
49 54
96
119
144
215 218 220 223 225 225
40
90
140
190
240
290
340
390
440
490
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
5,000
May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14
#ofActiveEPCSPrescribers
NewRXEPCSVolume
NewRx EPCS Volume # of Enabled EPCS Prescribers

49.
AZ EPCS Prescriber (EHR) Vendor Progress
March 2014 data
3
70
42
5
48
57
225
3 0
19
2
12
49
85
0
50
100
150
200
250
Allscripts Cerner DrFirst NewCrop NextGen RxNT Total
AZ Enabled and Active EPCS Prescribers
Enabled
Prescribers
Active
Prescribers

50.
AZ State Pharmacy EPCS Connectivity
Pharmacy EPCS Enabled
Stores
eRX Enabled
Stores
% EPCS
Enablement
Chain Pharmacies 403 888 45%
Independent Pharmacies 52 113 46%
Total 455 1001 45%
Arizona (45%) is above the national average
of 40% EPCS enablement
March 2014 data

51.
Considerations & Next Steps for AZ
What we learned: What we can do:
Many prescribers and
pharmacists still believe EPCS
is not legal!
Continue educational efforts
• Keep the subject alive in newsletters, AzHeC
speaking opportunities, forums, etc.
EPCS remains a low priority
for many provider vendors
Maintain software vendor relationships to help
them understand how EPCS benefits them
• Encourage certification for Tier 1 endorsement
Prescriber and pharmacy
communities have strong
interest in doing EPCS
Keep EPCS in front of providers and pharmacies
• Attend meetings, invite them to contact us with
questions or concerns, etc.

52.
Considerations & Next Steps for AZ (cont.)
What we learned: What we can do:
Additional training needed
for pharmacy staff after
pharmacy is certified for EPCS
Maintain relationships with corporate pharmacy
contacts.
• Encourage ongoing training with staff and solicit
their help in addressing store by store problems.
Prescribers need a place to go
for issue resolution or they
may drop the use of the
technology
Continue to work with DTAPS to keep them
involved and helping with EPCS related issues.
• Use the AzHeC website, meetings , etc., to
continue offering help.
EPCS is part of the bigger
need for prescribers to adopt
ePrescribing technology
In efforts to increase Arizona’s status for SafeRx,
incorporate the benefits of EPCS as part of the
rationale for using ePrecribing systems.

53.
2014 Arizona eRx and EPCS Efforts
• Continue to track EPCS adoption – both by providers and pharmacies
• Develop proposal to have Medicaid health plans support ongoing eRx
and EPCS promotion and adoption
• Continued online education for EPCS at www.azhec.org

54.
Summary: Realize the Full Value of EPCS
• Efficiency
• Safety
• Accountability
• Minimize fraud and abuse
Collaborate for Successful Adoption

55.
2. What are the key benefits EPCS can provide for patient care
management?
 Reduced fraud and abuse of paper prescriptions
 One streamlined electronic workflow for all e-prescriptions
 Improved safety and patient care
 All of the above
Post-Test Questions
1. What is the estimated annual cost savings potential to U.S. pharmacies
based on EPCS reduction on callbacks and paper record keeping?
 $50 million
 $500 million
 $700 million

56.
4. In general, to e-prescribe controlled substances, a prescriber must?
 Have E-Prescribing software certified for EPCS
 Have ID proofing set up
 Use a two factor authentication method (ie. FOB, mobile app, biometric)
 Have pharmacies ready for EPCS
 All of the above
3. How many states have legislation for EPCS?
 34 states
 40 states
 48 plus DC
Post-Test Questions

57.
6. Once pharmacy software is certified for EPCS, is staff education needed?
 Yes
 No
Post-Test Questions
5. Obstacles preventing prescribers use of EPCS include?
 Unclear on legality
 Pharmacy and EHR software readiness
 Confusion around credentialing and authentication
 All of the above

58.
Q & A