PRESCRIPTION PAD RULES LEAVE DOCTORS WITH QUESTIONS

GREENSBORO -- An impending requirement that doctors use tamper-proof
prescription pads for some patients has them waiting for specifics
and wondering whether they'll be ready for the Oct. 1 deadline.

The requirement, inserted without debate into a larger bill on
defense spending, is intended to prevent fraudulent prescriptions.

It applies to prescriptions for people covered by Medicaid, a
federally funded program that, with some state money, provides health
insurance for some lower-income children and families.

A doctor's failure to use a tamper-proof pad could mean that the
pharmacy would not be paid by Medicaid for the prescription.

Steven C. Anderson, the president and CEO of the National Association
of Chain Drug Stores, has written Congress asking for a delay in the
start date so that doctors, pharmacists and Medicaid itself can prepare.

In North Carolina, the State Division of Medical Assistance, which
administers Medicaid at the state level, must write guidelines for
how the pads are to be used.

That hasn't happened yet, said Brian Ellerby, the director of
Guilford Child Health. That agency, a partnership of the county
Department of Public Health and the Moses Cone and High Point health
systems, provides primary and specialty health care services for
children whose family income is well below the poverty level.

The program's clients include many who use Medicaid. Ellerby said he
is not sure what the lack of direction from the federal and state
governments might mean for those patients needing prescriptions after Oct. 1.

Earlier this month, the federal Centers for Medicare and Medicaid
Services, where Medicaid is administered at the federal level, hadn't
yet introduced written guidelines for states. A search of the
agency's Web site Tuesday turned up no new information, and attempts
to contact spokesmen for the agency were unsuccessful.

Jay Campbell, executive director of the N.C. Board of Pharmacy, says
the legislation doesn't define "tamper-proof" and appears to end
reimbursement for phone-in prescriptions, as well.

"An awful lot of Medicaid patients are not going to be able to get
their drugs, their prescription medications," he said, because the
new rules will make it too difficult for pharmacies to do the things
they need to get payments from Medicaid for prescriptions they fill.

Attempts to contact spokespeople for the State Division of Medical
Assistance were unsuccessful.

The requirement does not affect prescriptions delivered in electronic
format to pharmacies. Thus, some practices might be unaffected.

"We don't handwrite anything anymore," said Tracie Yoemann of
Cornerstone Pediatrics in High Point. "We send everything though
electronic medical records."