Electronic Prescribing of Controlled Substances (EPCS)

Find EPCS software products and pricing, rule regulations and waiver exemption information. 

What is Electronic Prescribing?

Electronic prescribing, also known as “e-Prescribing” or “eRx”, is the process of electronically generating and sending a prescription order, so that physicians and other medical practitioners can transmit an electronic prescription to a pharmacy directly from the point of care using a special software program and connectivity to a transmission network.

What is e-Prescribing of Controlled Substances?

Electronic prescription of controlled substances or EPCS is a more secure form of prescription delivery and can help reduce controlled substance abuse caused by stolen prescription forms. EPCS differs from regular e-prescribing in that a physician must undergo an authentication process before using the technology. Authentication can involve the use of a PIN number, an iris scan or thumb print, or a device or card. Physicians can delegate EPCS to other clinical staff to complete all of the required information and then review, sign, and authorize the transmission of the prescription themselves.

What Am I Required to Do?

Texas state law e-prescribing requirements went into effect on Jan. 1, 2021. HB 2174 requires electronic prescribing of all controlled substances (CII–CV) by all Texas physicians, unless a waiver is granted. The Medicare eRx requirement is specific to any prescription for a covered part D drug under a prescription drug plan (or under a Medicare Advantage –PD plan) for a schedule II, III, IV, or V controlled substance. More information can be found in TMA's Mandatory E-Prescribing Requirement for Controlled Substances (FAQs).

Summary - E-Prescribing for Controlled Substance Mandates

Medicare - While the Electronic Prescribing for Controlled Substance federal mandate went into effect on Jan. 1, 2021, CMS has signaled it will not enforce compliance until Jan. 1, 2023. 

Texas - The Texas mandate for Electronic Prescribing for Controlled Substances went into effect Jan. 1, 2021. However, physicians who demonstrate financial or technical hardships, or other exceptional circumstances, can apply for a waiver that, if approved, will be granted a one year exception to the e-prescribing mandate and will need to reapply for another waiver once expired. Additional exceptions to the e-prescribing mandate that do not require a waiver include, a temporary technological or electronic failure, certain emergencies, or when a physician or physician’s delegate issues a prescription to be dispensed by an out-of-state pharmacy. Please review the TMB waiver information below.

E-Prescribing Costs- HCMS is aware that hospitals are forwarding costs sent to them from the EHR vendor for adding e-prescribing capabilities for controlled substances to physicians. See below for other options with free-standing e-prescribing vendors that may provide a less costly option.

As an additional reminder, beginning on March 1, 2020, prescribers and pharmacists are required to check the patient's Prescription Monitoring Program (PMP) history prior to issuing or dispensing a new or refill prescription for an opioid, benzodiazepine, barbiturate, or carisoprodol. For more information please visit Texas PMP - Mandated Use of the Texas PMP.

How Do I Meet These Requirements? 

Physicians may have the ability to e-prescribe controlled substances through their EHR. EPCS is typically a separate function from traditional e-prescribing therefore physicians must request that this be an added feature, that may require an additional cost.

If this is not an available function in the EHR, or the cost is prohibitive, stand-alone eRx solutions are available that work independently of the EHR/practice management system. Find stand-alone eRx software products below and search for EPCS products. 

The following is pricing information for the standalone eRx products identified in the Surescripts search tool:
  • Allscripts ePrescribe – Starts at $33 /month with EPCS.
  • DAW Systems ScriptSure – Users can purchase the software as a monthly license or annual license, additional fees apply for use of EPCS. Contact directly for price information.
  • DrFirst iPrescribe – Free for one year and will continue to be free if providers write 20 or more prescriptions a month. If less than 20 prescriptions are written, they will be charged $20/month.
  • DrFirst Rcopia – $799/year per prescriber (with EPCS) + $75 one-time set-up fee per prescriber. Fees for additional optional services include patient demographic import ($525) and custom training session ($149).
  • eazyScripts – $79.95/month or $799.95/year, EPCS included at no extra cost. No additional set up or cancellation fees included. Use code ONBOARD20 for 20% off. 
  • OnCallData – $600/year per provider, for EPCS, providers must be identity-proofed and have a private security certificate on a token issued by a third-party. Fees for additional optional services include one-time patient demographic import ($200) and Integration with practice management system or EMR for continuous patient demographic updates ($500).
  • MD Toolbox-Rx – $38/month or $420/year with EPCS (free 30-day trial).
  • RxNT eRx – $650/year + $75 fee for EPCS.
For product reviews visit Capterra e-Prescribing Software Reviews.

Are There Exemptions?

Both the Texas law (HB 2174) and the national Medicare mandate provide possible exemptions to their requirements via a prescriber waiver, which requires an application. If approved, prescribers will be granted a one-year delay and waivers can be renewed annually for up to five years.

To be eligible for a Texas waiver, a physician must demonstrate:
  • economic hardship;
  • technological limitations not reasonably within the control of the prescriber; or
  • other exceptional circumstances demonstrated by the prescriber. 
Texas law and Medicare policy also states a prescription for a controlled substance is not required to be issued electronically and may be issued in writing for the exceptions stated below.

Texas Exceptions (not requiring a waiver)
E-prescribing is not required if the prescription is issued:
  • by a veterinarian;
  • in circumstances in which electronic prescribing is not available due to temporary technological or electronic failure, as prescribed by board rule;
  • by a practitioner to be dispensed by a pharmacy located outside this state, as prescribed by board rule;
  • when the prescriber and dispenser are in the same location or under the same license;
  • in circumstances in which necessary elements are not supported by the most recently implemented national data standard that facilitates electronic prescribing;
  • for a drug for which the United States Food and Drug Administration requires additional information in the prescription that is not possible with electronic prescribing;
  • for a non-patient-specific prescription pursuant to a standing order, approved protocol for drug therapy, collaborative drug management, or comprehensive medication management, in response to a public health emergency or in other circumstances in which the practitioner may issue a non-patient-specific prescription;
  • for a drug under a research protocol; and
  • under circumstances in which the practitioner has the present ability to submit an electronic prescription but reasonably determines that it would be impractical for the patient to obtain the drugs prescribed under the electronic prescription in a timely manner and that a delay would adversely impact the patient’s medical condition.
Medicare Exceptions (not requiring a waiver)
E-prescribing is not required if the prescription is issued:
  • when the practitioner and dispensing pharmacy are the same entity;
  • that cannot be transmitted electronically under the most recently implemented version of the National Council for Prescription Drug Programs SCRIPT Standard;
  • by a practitioner under circumstances in which, notwithstanding the practitioner’s ability to submit a prescription electronically as required by this subsection, such practitioner reasonably determines that it would be impractical for the individual involved to obtain substances prescribed by electronic prescription in a timely manner, and such delay would adversely impact the individual’s medical condition involved;
  • by a practitioner prescribing a drug under a research protocol;
  • by a practitioner for a drug for which the Food and Drug Administration requires a prescription to contain elements that are not able to be included in electronic prescribing, such as a drug with risk evaluation and mitigation strategies that include elements to assure safe use;
  • by a practitioner — ‘‘(I) for an individual who receives hospice care under this title; and ‘‘(II) that is not covered under the hospice benefit under this title; and
  • by a practitioner for an individual who is — ‘‘(I) a resident of a nursing facility; and ‘‘(II) dually eligible for benefits under this title and title XIX.
A pharmacist who receives a controlled substance prescription in a manner other than electronically is not required to verify that the prescription is exempt from the requirement of electronic submission. The pharmacist may dispense a controlled substance pursuant to an otherwise valid written, oral, or telephonically communicated prescription. 

How Can I Apply for An Exemption Waiver?

A physician may apply for a waiver from the electronic prescribing requirement by:
     • submitting a waiver request to the TMB and providing required information, and
     • demonstrating circumstances necessitating a waiver from the requirement, including
          • economic hardship, including:
               - any special situational factors affecting either the cost of compliance or ability to comply;
               - the likely impact of compliance on profitability or viability; and
               - the availability of measures that would mitigate the economic impact of compliance; 
          • technological limitations not reasonably within the control of the physician; or 
          • other exceptional circumstances.

The Texas Medical Board has developed a waiver process. To request a waiver, complete the Electronic Prescribing Waiver form through your MyTMB account. Verification of an approved waiver will be displayed on the physician profile if granted. If approved, waivers will be issued for a period of one year.

To renew the EPCS waiver, physicians may apply for a subsequent waiver on their MyTMB account, no more than 30 days before an active waiver expires.

Physicians applying for this waiver typically have an immediate response granting the waiver. Some pharmacies are either checking to see if the waiver exists or requesting physicians send a copy of it with the patient bringing the paper prescription. The Texas State Board of Pharmacy did put out communication that the pharmacist is not responsible for ensuring there is a waiver and that if it is a valid prescription, the pharmacist can dispense the prescription.

Where Can I Find More Information?

You can find more information on electronic prescribing at the Texas Medical Association’s online prescribing resource center. You can also download TMA's EPCS Frequently Asked Questions (FAQs) document.