Law: Tamper-Resistant Forms

What are Tamper-Resistant Form Laws?

Laws mandating the use of tamper-resistant forms are intended to prevent the use of fraudulent prescriptions to obtain controlled substances. A law was included in the resource if it requires special tamper-resistant prescription forms for controlled substances either in reference to the entire state population or in reference to the Medicaid-eligible population of a state.

Medicaid-related laws are written to comply with the provisions included in Section 7002(b) of the U.S. Troop Readiness, Veterans’ Care, Katrina Recovery, and Iraq Accountability Appropriations Act of 2007 (42 U.S.C. 1396b(i)(23)), which requires the use of special tamper-resistant prescription forms for prescriptions covered by the Medicaid program. The Centers for Medicare and Medicaid Services issued guidance specifying that as of October 1, 2008, “to be considered tamper resistant, a prescription pad must contain . . . industry-recognized features designed to prevent” all of the following forms of prescription tampering: (1) “copying of a completed or blank prescription form” (e.g., a void pantograph, white area on the prescription, or special paper containing watermarking); (2) “the erasure or modification of information written on the prescription by the prescriber” (e.g., quantity check boxes, refill indicators, or chemically reactive paper); and (3) “the use of counterfeit prescription forms” (e.g., serial numbers or logos printed on the prescription form).  However, a law did not have to require all these features to be included here.

States with Tamper-Resistant Prescription Form Laws

26 States: Alabama, California, Colorado, District of Columbia, Delaware, Florida, Idaho, Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, Mississippi, Nebraska, Nevada, New York, Ohio, Oklahoma, Oregon, South Dakota, Tennessee, Texas, Vermont, Washington, West Virginia

Tamper-Resistant Form Law Features by State

Features	Aspects of Feature	States
Circumstances under which tamper-resistant prescriptions are required	Required for all prescriptions or all controlled substance prescriptions	CA, DE, ID, KY, NY, OK, TN, VT, WA, WV
	Grants discretion to develop/require tamper-resistant forms (uses permissive language)	FL, IN
	Required if patient is to be reimbursed for the prescription by Medicare/Medicaid	AL, CA, CO, DC, ID, IL, IA, ME, MD, MS, NE, OH, OR, SD, TX
	Unless specific exemptions apply (for direct administration, emergencies, institutional settings, etc.)	AL, CO, DC, DE, ID, KY, MS, NE, NY, OH, SD, TN, WA, WV
	Provides specific deadlines for practitioners to begin using TR forms	AL, CA, DC, DE, ID, IL, IA, ME, MD, NE, NY, OH, OR, TX, VT, WA, WV
Security Features	Law directs board to recommend which security features to implement within specified categories	DE, VT, WV
	Law lists "industry recognized" categories of security features that prescription pads must have	AL, DC, ID, IL, MD, NE, OH, SD, WA
	Law lists "industry recognized" categories and enumerates specific features within the category which prescription pads must have	CO, MS
	Lists security features that may be used in the TR prescriptions	OR, TN, VT, WV
	Law mandates one or more security features prescription pads must contain	AL, CA, FL, IN, KY, NY, TN, VT, WV
	Law gives governor discretion whether to direct board to recommend security features	IN
Prescription must adhere to Section 1903(i)(23) of the Social Security Act (42 U.S.C. Section 1396b(i)(23)) for tamper resistance	N/A	IA, ME, OK, TN, TX