New regulation: tamper resistant prescription pads

New regulation: tamper resistant prescription pads

As of April 1, 2008, Medicaid outpatient prescriptions must be written on tamper-resistant pads. By April 1, prescription pads must have one (1) or more of the security features, and by October 1, 2008, the pads must have at least three (3) security features.

Baseline Characteristics of Safety Features:

  • One or more industry-recognized features designed to prevent unauthorized copying of a completed or blank prescription form;
  • One or more industry-recognized features designed to prevent the erasure or modification of information written on the prescription by the prescriber; and
  • One or more industry-recognized features designed to prevent the use of counterfeit prescription forms.*

States are also free to exceed these baseline standards to make their own determination as to what constitutes an acceptable tamper-resistant prescription pad in their state. States that do not enforce the tamper-resistant prescription pad requirement may lose Federal Medicaid funding. This new mandate applies to all written prescriptions provided in settings other than specific intuitions and clinical facilities. The provision does not apply to prescriptions being transmitted to pharmacies electronically, facsimile or verbally, nor does it apply to prescriptions filled in an emergency situation when an oral, faxed, electronic or compliant-written prescription is sent within 72 hours of the date on which the prescription is filled. For detailed information on the requirements, please refer to the State Medicaid Director letter link below. * Security Features on the Document:

  • Verification Box — Hold marked area between thumb and forefinger, or breathe on it. The color will disappear, then reappear.
  • Coin Reactant Ink — Rub the Rx mark on left with a coin. Ink will turn from white to gray.
  • MicroPrint — The right and left side rules of the large box on the front have the word “Security” in microprint. Can be viewed with magnifying glass.
  • Visible Fibers — Visible red and blue fibers are manufactured into the paper.
  • Invisible Fibers — Invisible fluorescent fibers are present. Can be viewed with black light.
  • Watermark — Paper has a true watermark embedded in the sheet. Can be viewed when held under light.
  • Chemical Sensitivity — Any attempt to alter the document with solvents, acids, bleach or alkalies will damage the paper, causing a brown stain to appear.
  • Void Pantograph — The face of the document has a colored background. The work “void” will appear when photocopied.


  • CMS-issued statement regarding the law change.
  • Locate your state pharmacy board’s contact information.
  • Top questions regarding tamper-resistant Rx pads.
  • Be compliant and ready for the October 1, 2008 deadline today.

* State Medicaid Director Letters