Using Care360 ePrescribing

Care360 ePrescribing and EHR comply with DEA requirements for EPCS. If you want to electronically prescribe controlled substances, your organization must be located in a state enabled for electronic prescribing of Schedule II-V or Schedule III-V drugs and have EPCS . Additionally, you must be set up in Care360 ePrescribing or EHR as a provider with a DEA number and an NPI number. Your electronic prescribing capabilities may be limited by your organization's state settings and that state's associated rules; however, if your organization has EPCS, you will be able to electronically prescribe either Schedule II-V or Schedule III-V substances. Additionally, your controlled substance prescribing capabilities may be limited by your license type (provider/clinician, nurse practitioner, or physician assistant) and state settings. Check with Care360 Customer Support for further information about your state settings. Once you understand who, within your organization, is qualified to prescribe controlled substances, those providers must be nominated as EPCS Registrants, purchase an OTP token, and complete registration (including identity verification and OTP token activation), and then be approved as an EPCS prescriber. For more information on this process, see Managing Electronic Prescriptions for Controlled Substances.

Once you are an approved EPCS prescriber, the process for electronically prescribing controlled substances is very similar to prescribing non-controlled substances in Care360 ePrescribing or EHR. Electronically prescribing controlled substances includes two additional steps:

• You must verify that the chosen pharmacy supports electronic prescriptions for controlled substances, or select one that does. Pharmacies that have been certified for EPCS have next to them.

• After you approve the prescription, you must review and verify the controlled substances you want to prescribe. This two-step authentication process requires you to enter a one-time password from your OTP token, along with your Care360 ePrescribing or EHR password.

Note: The option to submit prescriptions for controlled substances electronically is only available for prescribers after an EPCS Administrator has enabled the Allow controlled substances to be electronically prescribed organization preference. For more information, see Set ePrescribing Preferences for an Organization.

As you write a prescription, several indicators can appear that indicate whether or not a particular medication or supply is on the patient’s formulary list. This can help you determine the best medication or supply choice based on the patient’s insurance coverage, formulary indicator, and copay options. The patient’s formulary information appears in the Rx pad on the patient’ssummary and when you write a prescription. Formulary indicators appear next to medications and supplies so that you are informed as to the formulary status of the medications and supplies that you prescribe.

Note: Formulary information appears only for patients who are members of a PBM that is associated with Care360 ePrescribing or EHR. If no PBM information is available, a message in the corresponding section indicates that the information is not available. In this case, the only formulary indicator that appears is the “unknown” indicator (described in the table below).

The following formulary indicators may appear for medications and supplies:

Indicator	Description
	The selected medication or supply is on formulary, and is preferred. The tier number of the preferred medication or supply appears next to the on formulary symbol. This can range from 1 to 99 and is based on the patient’s health plan. The most preferred medication or supply has the highest tier number.
	The selected medication or supply is on formulary, but is not preferred.
	The selected medication or supply is not on formulary.
	The selected medication or supply is not on formulary, and is not reimbursable. The medication or supply is not covered by the patient’s health plan and no copay data will be shown for the medication or supply.
	The selected medication is available over-the-counter and may be either on formulary or not on formulary, depending on the medication and the patient’s health plan.
	The selected medication’s or supply's formulary status cannot be determined.
	The selected medication or supply may have formulary alternatives. Click the icon to view a list of formulary alternatives and their tier information.

While writing a prescription for a patient using Care360 ePrescribing or EHR, each medication that you select is reviewed against the patient’s summary to determine if any potential interactions or contraindications may occur. For drug‑to‑drug interactions, the medication is reviewed against other medications that have been added to the current prescription as well as medications in the patient’s active Medications list. Care360 ePrescribing or EHR also reviews the selected medication against a number of days in the patient’s claims history and pharmacy history, which is specified in the ePrescribing organization preferences. For drug-to-allergy interactions, the medication is reviewed against active allergies or adverse reactions (to medications or categories selected from the drug database) in the patient’s summary that have not been excluded from interaction checking. For drug-to-age or drug-to-sex contraindications, the medication is reviewed against the age or sex recorded in the patient’s summary.

Note: Drug-to-drug interaction notifications are displayed based on your organization’s Interaction Severity preferences. For information about specifying the severity level for which you want to receive interaction messages, see Set ePrescribing Preferences for an Organization.

When adding a new allergy/adverse reaction (to a medication or category in the drug database) to a patient’s summary, Care360 ePrescribing or EHR completes allergy-to-drug interaction checking against the patient’s active Medications list and against a number of days of the patient’s stored claims history and pharmacy history. If you do not want an allergy or adverse reaction to be used for interaction checking, you can specify that the allergy or adverse reaction be excluded. If an interaction is detected, an interaction report provides details about the potential interaction.

Notes:   • Interaction checking is not performed for substances/devices or free text allergies/adverse reactions. • For information about excluding allergies or adverse reactions (to a medication or category in the drug database) from interaction checking, see Add an Allergy or Adverse Reaction or Edit an Allergy or Adverse Reaction. Only Providers, Clinicians, or Clinical Office Staff who have administrator permissions can exclude allergies or adverse reactions from interaction checking.

If drug-to-drug, drug-to-allergy, drug-to-sex, or drug-to-age interactions or contraindications are detected, a warning indicator and message appears as soon as the medication is selected. When you take action on, or acknowledge, the interaction or contraindication, another indicator and message appears.

Interaction Message	Description
Interaction or Contraindication Detected	Care360 ePrescribing or EHR detected a potential interaction between the selected medication and one of the following: • Another medication on the current prescription • Another medication in the patient’s active Medications list, Claims History list, or Pharmacy History list • An allergy/adverse reaction recorded in the patient’s summary. • The age recorded in the patient’s summary • The sex recorded in the patient’s summary
Interaction or Contraindication Overridden	Care360 ePrescribing or EHR detected a potential interaction for the selected medication, and the provider reviewed the interaction report and decided to add the medication anyway.

When an interaction indicator appears, you can click the indicator to view the complete interaction or contraindication report for the selected medication or allergy/adverse reaction.

For drug-to-drug, drug-to-allergy, drug-to-sex, or drug-to-age interactions or contraindications, click the arrow next to the interaction or contraindication to view additional report details about the potential interaction, and then determine what you want to do, such as prescribing the medication anyway or adding a reason for overriding the interaction.

The interaction or contraindication report provides the following options:

• Prescribe the medication anyway. If you have thoroughly reviewed the interaction or contraindication report and want to add the selected medication to the prescription despite a potential interaction.

• Add a reason for overriding the interaction. If you have decided to prescribe the medication anyway, and would like to optionally add a reason for overriding the interaction or contraindication before the prescription is approved,

• Remove the selected medication from the prescription. If you determine that you do not want to leave the selected medication on the prescription you can remove it.

Notes:   • A brief description of the interaction or contraindication indicators appears in the Medication Legend area when you write a prescription. • For instructions on managing a patient’s medication history, see Managing a Patient’s Medications. • For instructions on maintaining a patient’s allergy/adverse reaction list, see Add an Allergy or Adverse Reaction.

While writing a prescription, you can select the frequency with which the medication or supply should be administered. Selecting the correct frequency abbreviation is crucial in guaranteeing that the prescription is filled by the pharmacy as intended.

The values available for medication and supply frequency are described in the following tables:

Abbreviation	Description		Abbreviation	Description
qd	Each day		q8h	Every eight hours
bid	Two times a day		q8-12h	Every eight to twelve hours
tid	Three times a day		q9h	Every nine hours
qid	Four times a day		q10h	Every ten hours
qhs	At bedtime		q12h	Every twelve hours
As Directed	Take as directed		q18h	Every eighteen hours
qac	Before every meal		q24h	Every twenty-four hours
pc	After meals		q36h	Every thirty-six hours
qam	Every morning		q48h	Every forty-eight hours
qpm	Every evening		5xd	Five times a day
qnoc	Every night		6xd	Six times a day
qod	Every other day		q2d	Every two days
x1	One time		q3d	Every three days
stat	Immediately		q4d	Every four days
At 4 PM	At 4 pm		q5d	Every five days
At noon	At noon		q6d	Every six days
q1h	Every hour		q7d	Every seven days
q1-2h	Every one to two hours		biw	Two times per week
q2h	Every two hours		tiw	Three times per week
q2-3h	Every two to three hours		qwk	Every week
q2-4h	Every two to four hours		q2wk	Every two weeks
q3h	Every three hours		q3wk	Every three weeks
q3-4h	Every three to four hours		q3-4wk	Every three to four weeks
q4h	Every four hours		q4wk	Every four weeks
q4-6h	Every four to six hours		q1mo	Once every month
q6h	Every six hours		q6mo	Every six months
q6-8h	Every six to eight hours		qY	Every year
q7h	Every seven hours