The Pharmacist's Information Resource
The Pharmacist's Information Resource
for validating Prescription Paper Security Features
Dedicated to the Prevention of Unauthorized Script Duplication and Modification

Requirement for Use of Tamper Resistant
Prescription Pads
Under the Medicaid Program.

Section 1903b(i) of the Social Security Act (42 USC193b(i), paragraph (23)

(1) Payment shall not be made for amounts expended for medical assistance for covered outpatient drugs (as defined in section 1927(k)(2)) for which the prescription was executed in written (and non-electronic) form unless the prescription was executed on tamper- resistant pad (paper)

The amendments made by paragraph (1) shall apply to prescriptions executed after April 1, 2008

Excerpt from letter sent to State Medicaid Directors on August 17, 2007
from the Department of Health & Human Resources
Centers for Medicare & Medicaid Services

The purpose of this letter is to offer guidance to State Medicaid agencies on section 7002(b) of the U.S. Troop Readiness, Veteran's Care, Katrina Recovery, and Iraq Accountability appropriations Act of 2007. regarding the use of tamper-resistant prescription pads, which was signed into law on May 25, 2007 .....

To the extent permissible under State and Federal law and regulation, our guidance does not restrict emergency fills of non-controlled or controlled dangerous substances for which a prescriber provides the pharmacy with a verbal, faxed, electronic, or compliant written prescription within 72 hours after the date on which the prescription was filled.

To be considered tamper resistant on October 1, 2007, (extended to April 1, 2008)
a prescription must contain at least one of the following three characteristics:

1) one or more industry-recognized features designed to prevent unauthorized copying of a completed or blank prescription form;

2) one or more industry-recognized features designed to prevent the erasure or modification of information written on the prescription by the prescriber;

3) one or more industry-recognized features designed to prevent the use of counterfeit prescription forms.

No later than October 1, 2008,
to be considered tamper resistant,
a prescription pad must contain all of the foregoing three characteristics. Failure of a State to enforce the tamper-resistant pad requirement of section 7002(b) may result in the loss of Federal financial participation.

CLAIRIFICATION PROVIDED BY CMS (Centers for Medicare and Medicaid Services)

Several States have had questions about whether a provider can add a feature to a prescription to make it compliant with requirements. States have proposed various features including particular kinds of ink to write the prescription (gel or indelible), writing out the drug quantities rather than just the number (i.e. "thirty" vs "30"), embossed logos as well as two and three part script forms

The statute states that all written prescriptions must be "executed on a tamper resistant pad (paper). As a result, features added to the prescription after they are printed (written) do not meet the requirement of the statute. Features that would make the prescription tamper-resistant include certain types of paper as well as certain items that can be pre-printed on the paper.

Note: If a multi-part prescriptin form is used, PART ONE (the actual script) MUST contain all of the required security features.
Without the required features, the script does not meet Medicaid Requirements.

  • Tamper Resistant Paper - Article (pdf file)
    Article Revised October 14, 2007 (updated with new Medicaid Information)

  • Medicaid Tamper Resistant Prescription - Federal Law (pdf file)

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