CMS Electronic Prescribing for Controlled Substances (EPCS) Program

In October 2018, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) was enacted into law to address the opioid crisis. Section 2003 of the SUPPORT Act generally mandates that Schedule II-V controlled substances under Medicare Part D prescription drug plans and Medicare Advantage prescription drug (MA-PD) plans be done electronically in accordance with an electronic prescription drug program. The CMS Electronic Prescribing for Controlled Substances (EPCS) Program is separate from state EPCS program requirements.

Electronic prescribing for controlled substances has many benefits such as improved patient safety and workflow efficiencies, fraud deterrence, adherence management, and reduced burden.

Section 2003 of the SUPPORT Act provides the Secretary of the Department of Health and Human Services with discretion on whether to grant waivers or exceptions to the EPCS requirement and gives the Secretary the authority through rulemaking to enforce and specify appropriate penalties for noncompliance with the EPCS requirement. In November 2023, CMS released the Calendar Year 2024 Physician Fee Schedule Final Rule. The final rule is available at: https://www.federalregister.gov/d/2023-24184.

CMS EPCS Program Milestones

• November 18, 2022 –  CY 2023 Physician Fee Schedule Final Rule released 
• January 1, 2023 – Compliance start date for 2023 measurement year
• December 31, 2023 – Compliance end date for 2023 measurement year
• Summer 2024 – CMS analysis of Part D Prescription Claims Data for 2023 measurement year 
• Fall 2024 – Non-compliance notices sent and prescriber information available via an EPCS Prescriber Portal
• 60-day waiver application period for 2023 measurement year
• Late 2024 – Prescriber notified of waiver approval or denial for 2023 measurement year

• November 16, 2023 – Calendar Year 2024 Physician Fee Schedule Final Rule released 
• January 1, 2024 – Compliance start date for 2024 measurement year
• December 31, 2024 – Compliance end date for 2024 measurement year
• Summer 2025 – CMS analysis of Part D prescription claims data for 2024 measurement year 
• Fall 2025 – Non-compliance notices sent and prescriber information available via CMS EPCS Prescriber Portal
• 60-day waiver application period for 2024 measurement year
• Late 2025 – Prescriber notified of waiver approval or denial for 2024 measurement year

2024 Measurement Year CMS EPCS Program Overview

CMS EPCS Program Prescribers

Prescribers who issue prescriptions for Schedule II-V controlled substances to Medicare Part D beneficiaries from January 1 through December 31, 2024.

CMS EPCS Program Compliance Determination

CMS will analyze Medicare Part D Schedule II-V controlled substance prescription claims and use the prescriber’s National Provider Identifier (NPI) to measure compliance: 

If the EPCS compliance rate is 70% or higher, the prescriber is considered compliant. 

CMS EPCS Program Exceptions

• Prescribers who issue 100 or fewer qualifying Medicare Part D controlled substance prescriptions in the measurement year.   
• Prescribers located in the geographic area of an emergency or disaster declared by a Federal, State, or local government entity. Starting in the 2024 measurement year, CMS will identify which emergencies or disasters qualify for this exception. 
• Prescribers who receive a CMS-approved waiver because the prescriber is unable to conduct electronic prescribing of controlled substances due to circumstances beyond the prescriber's control.  

Prescriptions written for a beneficiary in a long-term care (LTC) facility will not be included in determining compliance until January 1, 2025. 

Waiver

Prescribers may request a measurement year waiver when circumstances beyond their control prevented them from electronically prescribing Schedule II-V controlled substances. Prescribers may request a waiver in the CMS EPCS Prescriber Portal in the Fall after the measurement year. For the 2024 measurement year, the waiver application period will open in September of 2025.

Non-Compliance

For the 2023 and 2024 CMS EPCS Program measurement years, CMS will enforce compliance by sending non-compliance notices to prescribers not meeting the CMS EPCS Program requirements. Notices will be sent by e-mail when possible to available e-mail addresses in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) and the National Plan and Provider Enumeration System (NPPES), and by regular mail if there is no e-mail address in PECOS or NPPES. CMS strongly recommends that all prescribers keep their e-mail address accurate and up to date in both systems.

CMS encourages prescribers to subscribe to the EPCS listserv to stay up to date on the CMS EPCS Program. Click here to subscribe.

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