AMDIS Response to the Federal Tamper-Resistant Rx Law

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A new federal law governing the Medicaid program states that by October 1, 2008, paper prescriptions should only be reimbursed if they are "executed on a tamper-resistant pad" (Section 7002(b) of the U.S. Troop Readiness, Veterans’ Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007). This law appears to have been created to reduce instances of unauthorized, improperly altered, and counterfeit prescriptions.

While this laws seeks to make improvements in a paper based paradigm we should be devoting the resources and focus this will require to achieving universal ePrescribing. This will much more effectively deal with the issues of abuse while reaping many other benefits in terms of efficiency, safety, and quality. This current paper based focus is a diversion from that much more worthy approach.

Concerns about this law

There are New Costs

Potential new costs for physicians include the purchase of “special tamper-resistant prescription pads”, buying new multi-tray printers or retro-fitting old printers, creating security mechanisms for the new paper and the printers on which it will be used, reprogramming electronic medical record systems to recognize the new trays, and time and energy spent dealing with implementation and maintenance of this law. As leaders in healthcare information technology in organizations throughout the United States, AMDIS members have noted delays in EHR implementation and conflicts created by tamper-resistant paper prescriptions with good and efficient patient care.

There is No Evidence of Benefit

We know that a small percentage of people abuse our healthcare system by copying, altering or counterfeiting prescriptions. However, there is no factual evidence that mandating the use of tamper resistant prescriptions will change these statistics. First, the law still allows for anyone to call up a pharmacy and communicate an order verbally – a simple thing for an abuser to perform. Second, these abusers will almost certainly be able to gain access to “tamper-free” paper themselves and write their own prescriptions with even more authority then before. Third, a large amount of abuse is based on getting real prescriptions from doctors – no tampering is needed.

There is the Potential for Harm

This law may cause unintended harm to efficiency and quality issues. Example One: There will be times when a pharmacy does not accept a legitimate prescription, thus hurting efficiency for the physician who has to clarify the situation and decreasing quality for the patient whose access to medications may be delayed or lost. Example Two: A physician who prints out legible prescriptions for patients may be forced to hand-write prescriptions on tamper proof pads for Medicaid patients only – thus fragmenting their care and increasing the risk of medical errors due to illegibility. This isn't just a fear. Both of these problems have been experienced in States that have enacted similar legislation. Further, a move from computer to paper may bypass important safety tools like drug interaction checking and appropriateness checking for medication dose ranges.

The law creates another barrier to accepting Medicaid

Many state Medicaid programs have difficulty obtaining adequate physician participation because of poor payments and increased "hassles". In addition, Medicaid "equal access" provisions were intended to make sure that Medicaid recipients had the same access to healthcare as that provided by privately insured patients. Requiring tamper-proof paper in this age of electronic prescribing puts one more "hassle" in the path of physicians who accept Medicaid and reduces "equal access" even further.

Who is AMDIS?

Founded in 1997, the Association of Medical Directors of Information Systems (AMDIS) is the premier non profit physician membership association dedicated to advance the field of applied medical informatics and improve the practice of medicine through direct physician use of information technology. AMDIS is the home for the connected CMIOs, who are the thought leaders and decision makers for clinical information systems.


If someone wants to abuse our healthcare system for their own gain, this law will have minimal effect on them. However, this law has the potential to hurt honest patients and physicians by creating an extra barrier to care that will at times impede efficiency and quality while also increasing costs to physicians. Therefore, the members of the Association of Medical Directors of Information Systems (AMDIS) strongly encourage the federal government to rescind this law before it goes into effect.


A new federal law has the potential to increase costs while decreasing quality of care for Medicaid patients across the nation. The Association of Medical Directors of Information Systems (AMDIS) strongly encourages federal authorities to either rescind this law or further study its impact before moving forward with enforcement.