5.3 The Massachusetts Electronic Prescribing Mandate

The Massachusetts Electronic Prescribing Mandate

Massachusetts is an electronic-prescribing state by default. Beginning January 1, 2021, unless an exception applies, all prescriptions for controlled substances and for medical devices must be issued electronically. The requirement is woven into M.G.L. c. 94C, §§ 1, 17, 18, 20 and 23 rather than living in a single section, and the DPH Drug Control Program's Circular Letter DCP 19-12-108, the Electronic Prescribing and Dispensing Manual, is the operational reference.

[!IMPORTANT] State Schedule VI makes the mandate near-universal. In most states an "electronic prescribing of controlled substances" mandate reaches Schedules II through V and leaves ordinary legend drugs alone. In Massachusetts, Schedule VI is the ordinary legend drug class and is a controlled substance schedule, so the mandate covers essentially every outpatient prescription — antibiotics, inhalers, statins and insulin included.

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The Recognised Exceptions

Where an exception applies, the practitioner may issue a written, oral or facsimile prescription instead:

The expedited-partner-therapy exception is a genuinely Massachusetts-specific item and a good discriminator: it exists because the recipient of the prescription is, by design, a partner who is not the prescriber's patient of record and often has no identifiers in the prescribing system.

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The Pharmacist's Position

When a written, oral or faxed prescription arrives, the dispensing pharmacist is not the enforcement mechanism for the prescriber's mandate. The DPH Electronic Prescribing and Dispensing Manual makes clear that a pharmacist is not required to verify that the practitioner properly fell within an exception before dispensing. The pharmacist may fill a non-electronic prescription in good faith.

This makes practical sense: the pharmacist cannot know whether a prescriber's EHR crashed that morning or whether the prescriber holds a DPH waiver. The obligation to prescribe electronically sits on the prescriber and is enforced against the prescriber.

[!WARNING] This does not suspend the pharmacist's other duties. A non-electronic prescription still has to be a valid prescription: correct elements, a prescriber acting in scope, appropriate registration, no unresolved red flags, and — for a Schedule II — compliance with the signature and dating rules. "I do not have to check the e-prescribing exception" is not "I do not have to check anything."

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Electronic Prescriptions for Federally Controlled Substances

For Schedules II through V, the Massachusetts mandate operates on top of the DEA's Electronic Prescriptions for Controlled Substances (EPCS) rules. An EPCS prescription requires:

• certified prescribing and pharmacy application software that has passed a third-party audit or certification;
• identity proofing of the prescriber;
• two-factor authentication at signing — something the prescriber knows, plus something the prescriber has or is (a hard token or biometric); and
• a digital signature applied at the moment of signing, with the record retained electronically.

A prescription that is merely typed, printed and faxed is not an electronic prescription; neither is one emailed as a scanned image. 247 CMR 20.04 governs orally and electronically transmitted prescriptions and reporting to the Prescription Monitoring Program on the pharmacy side; it replaced the former 247 CMR 5.00, which is now reserved.

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Practical Consequences at the Pharmacy

• Fewer forgeries, different forgeries. As paper volume falls, the residual paper stream carries proportionally more risk. A paper Schedule II prescription in an electronic-by-default state deserves more scrutiny, not less.
• Transfer mechanics change. Electronic prescriptions are transferred through the pharmacy management system rather than by voice, and the audit trail requirements in 247 CMR 9.00 apply to the electronic record.
• Downtime procedures matter. 247 CMR 9.04 requires defined procedures for computerised system downtime, including recording what happened during the outage in the patient's medication profile when the system is restored, preserving continuity of care, and performing an appropriate drug utilization review.

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Worked Traps

• A prescriber's office faxes a paper prescription for lisinopril, saying nothing about why. Fill it if it is otherwise valid. The pharmacist need not verify the exception.
• A patient brings a handwritten prescription for oxycodone from a Massachusetts physician. The e-prescribing exception question is the prescriber's problem, but the Schedule II validity questions — manual signature, true date of issuance, 30-day validity window, corresponding responsibility — are all the pharmacist's.
• A veterinarian hands a client a written prescription for a compounded animal medication. Squarely inside the veterinary exception; no electronic transmission required.