Tamper proof prescriptions

Tamper proof prescription pads are already mandated by the government for Medicaid prescriptions and on October 1, the same requirement will apply to Medicare prescriptions.

Ordinary prescription pads are relatively easy to alter and people have found all sorts of ways to photocopy, use chemicals to dissolve handwriting, and forge signatures. After all, when you cannot read the doctors writing anyway, how hard could it be?

But I have to say that our local pharmacists are very good about questioning and calling when there is a potential forged prescription.

A cross section of interest groups has developed a list of prescription pad features to satisfy a Medicaid Rx security law that took effect April 1. Precautions are divided into three categories and written Medicaid prescriptions must have at least one feature from one category as of April 1. Pads must include one security element from all three categories by Oct. 1.

Category one: Features to prevent unauthorized copying
• Pantograph: The word "void" appears when the prescription is photocopied.
• Security back print: Words, such as "security prescription," printed on the prescription's back.
• Reverse "Rx" or white area: "Rx" symbol or white area that disappears when photocopied at a light setting.
• Watermarking: Paper with watermarks.

Category two: Features to prevent erasure or modification of information
• Non-white background: Paper's background features a solid color or consistent pattern.
• Quantity ranges: Boxes that can be checked by the physician to indicate the number of doses.
• Refill indicator: Indicates the number of refills allowed.
• Rx limit: A line specifying the number of prescriptions allowed for different drugs on the same form.
• Quantity and refill borders: For EMRs, quantity or refill limits appear between asterisks; quantity or refill limits also could be spelled out.
• Chemically reactive paper: Exposure to solvents, oxidants, acids or alkalis will leave a visible mark.
• Paper toner fuser: Special toner bonds tightly to paper, making modification difficult.

Category three: Features to prevent counterfeiting
• Features list: A complete list of security features on the paper (highly recommended).
• Serial number: Unique number for each prescription, which may or may not be sequential, but should be reported to the state to be valid.
• Batch number: For states with approved vendors, a number identifying each batch of prescriptions.
• Encoding techniques: Bar codes used to encode a serial number, for example.
Logos: Sometimes used as part of the background color or as a pantograph.
Metal strip: A strip of metal embedded in the paper.

Those using e-prescribing also have to meet these same guidelines if they print prescriptions but if they go electronically to the pharmacy via an intermediary, they avoid these hassles.