After two years spent developing and launching a service to assist prescribers and long-term care pharmacies complete controlled substance orders using a mobile device, I was surprised to hear the response, “We cannot use this. Faxed orders are banned or about to be banned.”

Wait, what? Faxing is a technology that dates to the 1800s.

After a little digging, I discovered these beliefs are an apparent interpretation of a new federal Support Act. Blanket marketing efforts to promote the mandate of electronic prescribing regulations also confuse the issue. More than half of states have mandated eRx for CII orders and a half-dozen more states have similar legislation pending

In actuality, a review of the ban on faxed orders seems focused toward the retail side of pharmacies and not inclusive of closed-door pharmacies.

Notably, the Support Act placed more stringent regulations around the use of fax for controlled opioid prescriptions starting this month. It also outlines a set of provisions for e prescribing exceptions, specifically, “A prescription for an individual who receives hospice care that is not covered under the title or is a resident of a nursing facility.…”

“The Support Act has left in place the long-standing ability of DEA-registered practitioners to communicate their scripts via facsimile to the pharmacy provider where the patient is in hospice or resides at a long-term care facility,” says Ron Friedman, a regulatory compliance attorney in Seattle serving pharmacies as well as long-term care facilities. “This is consistent with the healthcare objective of ensuring that those most in need are able to receive their medication on a timely basis and without undue delay or suffering.”   

What does this federal regulation mean for you?

While this review is not comprehensive (please consult with legal counsel and your board of pharmacy), most states with eRx requirements contain exceptions and/or provisions related to LTC patients. So, in general, the eRx regulations do not mean that faxing is “banned” for nursing homes and hospice.  

DEA and state laws have their own exceptions and provisions that may be relevant to pharmacy regulations. On the pharmacy retail side, some of these changes may be substantial. However, for LTC patients the changes are unlikely to mandate the end of faxing orders.

For example, Arizona, which has had an eRx mandate in place since last January, requires all prescribers to use eRx for controlled prescriptions but has exceptions, two of which include nursing homes and hospice alliances for faxed orders. 

The more things change the more they stay the same?

So, if fax is still available in LTC and eRx is becoming widely available, an interesting question is whether faxed orders will evolve to compete with the expansion of eRx. What does it mean for LTC providers?

“Related to the amount of faxed orders with etherFAX, innovations of fax and fax is still an available pathway for orders in nursing homes and hospice patients,” reported EtherFax, which estimates it processes over a billion HIPAA-related pages a year.

“Fax technology is no longer synonymous with machines, phone lines, paper and toner. It is cloud-based and virtual and continues to be the leader in secure communications,” said EtherFax CEO Paul Banco.

The expansion of eRx and innovation in faxing will likely be a boon for LTC pharmacies, facilities and doctors. Allowing them to securely respond to order requests from fax or eRx based on ease, efficiency for all parties involved in LTC. 

In the end, a tech convergence is upon us and with more than just direct fax and eRx options. Just around the corner, secure messaging will combine with these ordering options and data-intelligence to give decentralized LTC healthcare and remote workers everything, everywhere, using whatever device is in hand. 

Nicholas Magers, R.D., is co-founder and leads business development at Mediprocity. He has decades of experience in healthcare and has worked on creating secure communications tools and innovations for the long-term care industry for the last 10 years.