Overview of the NYS Official Tamper Proof Prescription Program

1

• Overview of the NYS Official Tamper Proof
  Prescription Program
• NAMPI San Diego - August 2007
• Sal Medak, Director, Bureau of Information
  Technology and Fraud Detection Systems - OMIG /
  Lydia J. Kosinski, R.Ph, Manager, Recipient
  Activities Utilization Review , BIE - OMIG

2

• Tamper-proof program is expected to significantly
  curtail illegal drug diversion
• Illegal diversion costs the Medicaid program
  and private health insurers millions of dollars
  annually.
• Diverted drugs resold to consumers is a
  serious threat to public health of all
  consumers.

3
Background

• New Section 21 of PHL (2004) required that as of
  4/19/06, all (not just MA) prescriptions written
  in NYS shall be issued on an Official NYS Rx
• Exemptions were granted for non-controlled
  substance Rxs
• Hospitals
• Certain DOH designated NFP CHCs
• Exemption does NOT apply to controlled substance
  Rxs

4
NYSDOH BNE Official Prescription Section
Functions

• Prescription Operations
• Registration/Ordering
• Practitioners and facilities must register with
  DOH effective 4/19/06
• No fee for registration
• Valid for 2 years
• May be denied, suspended or revoked if DOH finds
  that the license of practitioner or facility was
  terminated, revoked or suspended by a State or
  Federal agency

5
Registration/Ordering

• Once registered, HPN account set up, and
• Rxs can be ordered free of charge from our
  vendor (Standard Register) through on-line
  ordering system
• Shipped within 5-7 business days, emergency
  shipping available - 25 with an HPN account)
• BNE limits quantities/general rule of thumb is
  2,000 Rxs per month/per practitioner
• Requests higher amounts reviewed on a
  case-by-case basis/do not impede patient care

6
Prescription Operations (continued)

• Contract Management
• Bureau recently continued contract w/ the
  Standard Register Company for March 1, 2007
  through February 28, 2009
• Anticipate working with vendor to make
  improvements in ordering system based on
  experiences of last two years
• Invoiced monthly for products shipped
• Issued 142.3 million scripts in 2006 at a cost of
  10.2 million

7
Lost and Stolen Prescriptions

• Reported by physicians - either by phone or
  mail/Form DOH-4387 available on website.
• Pharmacies may detect problem with an Rx and call
  the Prescriber, initiating discovery of lost
  /stolen Rx
• Information entered into our database, uploaded
  nightly/available as reference for pharmacists

8
Lost and Stolen Prescriptions (continued)

• Information also shared with Medicaid program for
  post and clear
• We encourage doctors to notify us when scripts
  are found so that they can be removed from system
• Alleged/appearance of criminal activity - to
  Narcotic Investigations Section for disposition

9
SYSTEM EDITING

• OMIG sponsored claims system edit
• Denies pharmacy claims without serial number
• Info on NCPDP 5.1- transaction set DE 454-EK
• Effective October 26, 2006

10
Claims edits phase 2

• Beginning May 25, 2007
• Serial numbers reported lost or stolen are loaded
  to claims system in real-time
• Pharmacies are alerted at point of service-
  cannot submit claim if dispensed
• Prescriber must contact BNE and have script
  removed from list for pharmacy to dispense and
  get paid

11
Editing Phase 3

• Effective in late 2007
• All serial numbers and prescribers they are
  assigned to will be front loaded
• If serial and prescriber ID submitted by
  pharmacy do not match, the transaction will be
  rejected at point of service

12
For Medicaid paid lost or stolen Rx, the NYS
Office of the Medicaid Inspector General monitors
takes action Since inception, to date
13
Savings Calculated

• Savings are calculated monthly
• Edits are monitored for lack of a serial number
  and rejects for stolen/forged scripts
• Claims allowed to be resubmitted within 90 days
  if situation corrected, ie, stolen scripts
  reported as found, or missing serial number is
  entered correctly
• Medicaid savings since implementation in October,
  2006 total over 68M

14
OMIGs Recipient Lock-In Program Makes use
of corroborated accounts of official blank
forgeries for MA Restriction purposes CY
2006 RAUR staff processed affidavits from 35
prescribers that were victimized by
stolen/altered official Rx cashed in under
Medicaid 230 Restrictions resulted cases
referred to Local District fraud offices for
prosecution
15
BNE Official Prescription Section Responsible For

• Data Management
• Pharmacy Submission/EDT
• As of 6/1/05, pharmacies required to submit
  dispensing data for all controlled substances
  including out of state
• As of 1/1/06, data must be transmitted via
  internet through HPN account
• Data audited for compliance with formats
  specified in EDT manual
• Daily error reports received in hard copy

16
Pharmacy Submission/EDT (continued)

• Currently returning data submissions with 50
  error rate
• Pharmacies given 20 days to correct/resubmit data
• Non-compliant pharmacies referred to DOH Division
  of Legal Affairs for disposition
• Hearing, fines, imposed - DOH discretion
• New pharmacies identified through update
  program/National Council for Prescription Drug
  Programs (NCPDP)

17
Available Official NYS Prescription Products

• Official NYS Prescription - Padded product

18

Available ONYSRx Products - (continued)

• EMR L-1 (laser sheet, 1 Rx per page)
• EMR L-4 (laser sheet, 4 Rx per page)-for security
  reasons, this product will be discontinued in the
  near future
• thermal rolls (thermal printer)
• intermec rolls (specific hospitals use these)
• two-part NCR pads

19
All ONYSRx products have following security
features

• 24 white-controlled safety paper
• Invisible eradicator sensitive ink that will show
  VOID if tampered with (either with chemicals,
  attempted erasure)
• Pantograph which activates a VOID pattern if
  photocopied
• Artificial watermark that fluoresces green under
  a black light

20
Official NYS Rx Security Features (continued)

• Thermochromic ink - pharmacist test area on front
  that is heat sensitive (light blue area turns
  clear when touched, then back to light blue)
  friction activated on back (orange changes color
  or disappears when warmed by touch - returns to
  original color when cooled)
• Unique serial number, barcoded
• No duplicate serial numbers

21

If we can assist you in any way, please feel free
to call
Jennifer L. Treacy, R.Ph. Assistant
Director Bureau of Narcotic Enforcement 433 River
Street, 4th Floor Troy, New York 12180 e-mail
JXT03_at_health.state.ny.us Telephone (518)
408-0307
22
OMIG CONTACTS

• SAL MEDAK [phone]
• sxm15_at_omig.state.ny.us
• LYDIA KOSINSKI, RPh [phone]
• ljk02_at_omig.state.ny.us
• PINALI PATEL, PharmD [phone]
• pinali.m.patel_at_dhs.state.nj.us