STORAGE NAME: h1297.HPP
DATE: 3/19/2025
1
FLORIDA HOUSE OF REPRESENTATIVES
BILL ANALYSIS
This bill analysis was prepared by nonpartisan committee staff and does not constitute an official statement of legislative intent.
BILL #: HB 1297
TITLE: Electronic Prescribing
SPONSOR(S): Partington
COMPANION BILL: None
LINKED BILLS: None
RELATED BILLS: SB 1568 (Brodeur)
Committee References
Health Professions & Programs
Health & Human Services
SUMMARY
Effect of the Bill:
HB 1297 aligns Florida’s exceptions to the electronic prescribing requirement with federal exceptions for electronic
prescribing by removing state-specific exemptions and adding federal exemptions.
Fiscal or Economic Impact:
The bill will have an indeterminate, negative fiscal impact on the state government. See Fiscal or Economic Impact.
JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
ANALYSIS
EFFECT OF THE BILL:
Florida law requires prescribers who have an electronic health record system to prescribe all medications
electronically unless one of eight exemptions apply. Current Federal regulations require prescribers to
electronically prescribe controlled substances under a Medicare Part D drug plan unless one of three exemptions
apply.
The bill aligns Florida’s exceptions to the electronic prescribing requirement with federal exceptions for electronic
prescribing by removing state-specific exemptions and adding federal exemptions. Specifically, the bill requires all
prescribers, not just those who have an electronic health record system, to prescribe all medications electronically
unless:
The prescriber has been issued a waiver by the Department of Health because the prescriber cannot meet
the requirement due to circumstances beyond the prescriber’s control;
The prescriber issues 100 or fewer relevant prescriptions per year; or
The prescriber is in the geographic areas for which a state of emergency is declared pursuant to s. 252.36.
(Section 1)
The bill updates cross references. (Sections 2 and 3)
The bill provides an effective date of July 1, 2025. (Section 4)
FISCAL OR ECONOMIC IMPACT:
STATE GOVERNMENT:
The Department of Health (DOH) estimates that there will be an indeterminate cost to comply with the bill. DOH
will incur nonrecurring costs for rulemaking, which can be absorbed within current resources. DOH will also incur JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
2
nonrecurring increase in workload associated with notifying and communicating changes to electronic prescribing
requirements, which can be absorbed within current resources.
1
RELEVANT INFORMATION
SUBJECT OVERVIEW:
Electronic Prescribing
Electronic prescribing (e-prescribing) is a method by which health care practitioners use an electronic device such
as a computer or tablet to enter and securely transmit prescriptions to pharmacies using special software and
connectivity to a transmission network.
2 Numerous benefits have been attributed to e-prescribing including,
improved prescription accuracy, increase patient safety, reduction of opportunities for fraud, and cost reduction.
3
Patient Safety
An adverse drug event (ADE) is harm experienced by the patient as a result of exposure to medicine.
4 Each year,
ADEs account for approximately 700,000 emergency department visits and 100,000 hospitalizations.
5 Some ADEs
occur without accessing hospital care, such as overdoses to opioid medications.
6 Medication errors most
commonly occur during the prescribing, ordering, and administration stage; approximately 50% of medication
errors occur when a medication is prescribed or ordered.
7 It is estimated that about half of ADEs are preventable.
8
E-prescribing can help reduce errors due to illegible handwriting, lost paper scripts, and incomplete or inaccurate
instructions.
9
Fraud
Individuals may illegally obtain prescription medication by using fraudulent, forged, or altered written
prescriptions. In an effort to reduce fraud related to the use or misuse of controlled substances, Florida law
requires prescribers to use counterfeit-proof prescription pads purchased from an authorized supplier for written
prescriptions for controlled substances.
10 A counterfeit-proof prescription pad must include the following
features:
11
A background color that is blue or green and resists reproduction;
Printed on artificial watermarked paper;
Resists erasures and alterations; and
The word “void” or “illegal” must appear on any photocopy or reproduction;
1
Department of Health, 2025 Agency Legislative Bill Analysis on HB 1297, on file with the Health Professions & Programs
Subcommittee.
2
The Office of the National Coordinator for Health Information Technology, What is Electronic Prescribing?,
https://www.healthit.gov/faq/what-electronic-prescribing (last visited Mar. 17, 2025).
3
Agency for Health Care Administration, Florida Electronic Prescribing Annual Report for 2023,
https://ahca.myflorida.com/content/download/25388/file/2023eRxAnnualReport_Final.pdf (last visited Mar. 17, 2025).
4
U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Medication Errors and Adverse
Drug Events (last rev. Sep. 2019), https://psnet.ahrq.gov/primer/medication-errors-and-adverse-drug-events (last visited
Mar. 17, 2025).
5
Id.
6
Id.
7
Rayhan A. Tariq, Rishik Vashisht, Ankur Sinha, et al., Medication Dispensing Errors and Prevention, [Feb, 2024], available at
https://www.ncbi.nlm.nih.gov/books/NBK519065/ (last visited Mar. 17, 2025).
8
Id.
9
Matthew E. Hirschtritt, M.D., M.P.H., Steven Chan, M.D., M.B.A, and Wilson O.Ly, Pharm.D,M.Sc, Realizing E-Prescribing’s
Potential to Reduce Outpatient Psychiatric Medication Errors, [2017], available at
https://psychiatryonline.org/doi/10.1176/appi.ps.201700269 (last visited Mar. 17, 2025).
10
S. 456.42, F.S.
11
Rule 64B-3.005, F.A.C. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
3
Health care practitioners and health care facilities must return unused counterfeit-proof prescription to the vendor
to be destroyed.
12 Even with these precautions, there is still the danger of a legitimate prescription pad being
stolen from a health care practitioner’s office or a health care facility and fraudulent prescriptions written.
13
E-prescribing eliminates the risk of stolen prescription pads and, with the two-factor authentication required by
the U.S. Drug Enforcement Administration (DEA), may further reduce unauthorized or altered prescriptions.
14
Efficiency
E-prescribing creates efficiencies for prescribers, patients, and pharmacies. For prescribers, e-prescribing can be
integrated into electronic health records, which includes patient information such as clinical notes, laboratory
results, and clinical decision support functions.
15 E-prescribing also improves the accuracy of prescriptions and
helps guide clinical decision-making by checking the appropriateness of a prescription and connecting to a
patient’s health insurance for its formulary.
16 Prescribers have also indicated that less time is spent resolving
issues with pharmacies, including prior authorizations and refill requests, allowing more time to be spent on
patient care.
17 The software also automates certain tasks which allows staff to perform other functions. Such
efficiencies may ultimately lower overall operating costs.
Patients may also benefit from e-prescribing efficiencies due to the ability of the prescriber to check for drug
interactions, drug allergies, and whether a particular drug is covered by their insurance. This may enable patients
to reduce copayment expenses or inconvenience associated with requesting an alternate medication from the
prescriber if the drug prescribed is not covered or too expensive.
18
Finally, pharmacies will likely benefit from e-prescribing efficiencies because it reduces the time spent on
interpreting a prescription. Pharmacists must contact prescribers if a prescription is illegible or inconsistent,
which affords the pharmacist more time to counsel patients.
19
Cost Savings
As noted above, ADEs result in many emergency room visits and hospitalizations, as well as additional visits to the
prescriber’s office. Although e-prescribing will not prevent all ADEs,
20 they may reduce the number of ADEs due to
improved prescribing and the assistance of decision support systems.
21 The efficiencies noted above may also lead
to a reduction to overall operating costs.
Cost of Implementation
The cost of an e-prescribing system is based on the number of prescribers using the system and the options
included in the system. It has been previously estimated that the cost for of a full electronic health record (EHR)
12
Id.
13
U.S. Department of Justice, Drug Enforcement Administration, Diversion Control Division, A Pharmacist’s Guide to
Prescription Fraud, (Feb. 2000), available at https://www.deadiversion.usdoj.gov/GDP/(DEA-DC-002R1)(EO-
DEA009R1)_RPH_Guide_to_RX_Fraud_Trifold_(Final).pdf (last visited Mar. 17, 2025).
14
National Association of Chain Drug Stores, Opioid Abuse Epidemic: Solutions from the Front Lines of Care, (last rev. May
2019), available at https://www.nacds.org/pdfs/government/2017/Opioid-Policy-Oct-2017.pdf (last visited Mar. 17, 2025).
15
Amber Porterfield, et. al., Electronic Prescribing: Improving the Efficiency and Accuracy of Prescribing in the Ambulatory Care
Setting, Perspect. Health Inf. Manage. 2014 Spring: 11 (Apr. 2014), available at
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995494/ (last visited Mar. 17, 2025).
16
Academy of Managed Care Pharmacy, Concept Series Paper on Electronic Prescribing, available at
https://amcp.org/sites/default/files/2019-03/Electronic%20Prescribing.pdf (last visited Mar. 17, 2025).
17
Supra, note 15.
18
Id.
19
Amina Hareem, Joshua Lee, et al., Benefits and Barriers Associated with E-prescribing in Community Pharmacy—A systemic
Review, available at https://pmc.ncbi.nlm.nih.gov/articles/PMC10746557/ (last visited Mar. 17, 2025).
20
Some ADEs are unavoidable even if the medication is properly prescribed and administers. These are often known side
effects of a medication. See supra note 4.
21
Supra, note 4. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
4
system that includes e-prescribing for an office with 10 full-time prescribers is approximately $42,332 for
implementation and $14,725 for annual maintenance.
22 According to an industry analysis of e-prescribing software
costs, the annual cost of a stand-alone e-prescribing system that meets the Drug Enforcement Administration’s
requirements for electronically prescribing controlled substances (EPCS) ranges from $170 to $650.
23 The fee for
initial set-up of the software may be included; however, some vendors may charge additional fees for set-up and
for a token for the two-factor authentication. In 2018, a health IT management consulting company identified the
estimated cost of adding on EPCS functionality to the most widely used EHR systems:
24
EHR EPCS Setup (One-time fee) Annual Ongoing Cost
Allscripts Professional $340 per provider $150 per provider
Allscripts Touchworks $6,000 per practice $150 per provider
Amazing Charts $0 $250 per provider
Aetna $0 $0 per provider
Cerner Varies based upon # of providers
DrFirst $90 per provider $75 per provider
eClinicalWorks $250 per provider $0 per provider
E-MDs $225 per provider $120 per provider
Epic Varies based upon # of providers
GE Centricity $0 $5,988 per provider
Greenway Intergy $150 per provider $90 per provider
Greenway PrimeSuite $150 per provider $90 per provider
NewCrop $150 per provider $150 per provider
NextGen $0 included in ePrescribing
Practice Fusion $0 included in ePrescribing
The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, authorized incentive
payments through Medicare and Medicaid to health care practitioners and hospitals for meaningfully using EHRs
to help offset some of the costs related to the adoption of electronic health record systems.
25 The incentive
program consists of two stages. Stage one required the electronic capture of clinical data, including transmitting at
least 40 percent of eligible prescriptions electronically.
26 In stage two, health care providers must demonstrate
meaningful use for a full year; stage two retains the objective that eligible prescriptions be transmitted
electronically.
27 Participants could choose to participate under Medicare or Medicaid, but could only participate in
22
Supra, note 15.
23
The U.S. Drug Enforcement Administration requires electronic prescribing software for controlled substances to have two-
factor authentication to verify the identity of the prescriber and protect such credentials from misuse (21 C.F.R. 1311). See
Eclinicworks, E-prescribing of Controlled Substances, available at https://www.eclinicalworks.com/wp-
content/uploads/2016/11/ePrescribing-of-Controlled-Substances-Slick.pdf; RxNT, ERX, available at
https://www.rxnt.com/eprescribing/ (last visited Mar. 17, 2025).
24
HealthTech Zone, Three Factors Contributing to Lagging Provider Adoption of EPCS, (Apr. 2018), available at
http://www.healthtechzone.com/topics/healthcare/articles/2018/04/03/437665-three-factors-contributing-lagging-
provider-adoption-epcs.htm (last visited Mar. 17, 2025).
25
Medscape, EHR Incentive Programs: Achieving Meaningful Use, available at
https://www.medscape.org/viewarticle/770841#content=0_0 (last visited Mar. 17, 2025).
26
Id.
27
Centers for Medicare and Medicaid Services, Stage 2 Overview Tipsheet, (Aug. 2012), available at
https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/downloads/stage2overview_tipsheet.pdf
(last visited Mar. 17, 2025). For the initial year of stage 2, CMS required providers to demonstrate meaningful use for 90 days,
but in subsequent year the requirement is for a full year. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
5
one of the programs. The maximum incentive available under Medicare was $44,000 across five years and under
Medicaid, $63,750 across six years.
28
Incentive payments for the Medicare program ended in 2016, and the Medicaid program ended in 2021.
29 The
Centers for Medicare and Medicaid Services (CMS) subsequently launched the Promoting Interoperability Program
and implemented a merit-based incentive program to reward value and outcomes.
30 The focus of the program is on
interoperability, improved flexibility, and placing emphasis on the use of electronic exchange of health information
between patients and providers.
31 Promoting interoperability objectives, which includes the use of e-prescribing
and EHRs, may account for up to 25 percent of the final score for the merit-based incentive.
32
According to the Office of the National Coordinator for Health Information Technology (ONC), approximately 80
percent of office-based physicians in Florida have adopted EHRs that meet the criteria for meaningful use.
33 The
ONC also found that, as of June 2017, 97 percent of hospitals of Florida hospitals had adopted EHRs that meet the
criteria for meaningful use.
34
EPCS Application Requirements
E-prescribing relies on specialized software to securely generate and transmit sensitive information between the
health care provider and pharmacy. All applications used for EPCS must meet standards established by the Federal
Drug Enforcement Administration (DEA).
35 All prescriptions issued electronically for controlled substances must
meet these requirements regardless of whether the patient is under Medicare Part D. EPCS software must be
capable of authenticating prescriber and patient identities, detecting irregularities, and preventing duplication,
among other technical security standards.
36
The federal Drug Enforcement Administration (DEA) implements the Comprehensive Drug Abuse Prevention and
Control Act of 1970, often referred to as the Controlled Substances Act (CSA).
37 In 2010, the DEA adopted a rule
authorizing prescriber to issue electronic prescriptions for controlled substances and permitted pharmacies to
receive, dispense, and archive these electronic prescriptions.
38 To e-prescribe controlled substances, a prescriber
must:
39
Purchase or use DEA-compliant software that supports e-prescribing;
28
Centers for Medicare and Medicaid Services, An Introduction to the Medicare EHR Incentive Program for Eligible
Professionals, available at https://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/Downloads/EHR_Medicare_Stg1_BegGuide.pdf (last visited Mar. 17, 2025).
29
Centers for Medicare and Medicaid Services, Medicare and Medicaid Promoting Interoperability Program Basics, (last rev.
Aug. 2019), available at https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/basics.html (last
visited Mar. 17, 2025). Participants must have enrolled to participate in the Medicaid program before 2016 to be eligible for
incentive payments.
30
Id.
31
Id.
32
Centers for Medicare and Medicaid Services, Quality Payment Program, available at https://qpp.cms.gov/participation-
lookup/about?py=2019 (last visited Mar. 17, 2025), Centers for Medicare and Medicaid Services, Merit-based Incentive
Payment System: Promoting Interoperability Requirements, available at https://qpp.cms.gov/mips/promoting-
interoperability?py=2019 (last visited Mar. 17, 2025), and Centers for Medicare and Medicaid Services, Quality Payment
Program: Explore Measures, available at https://www.cms.gov/medicare/quality/measures (last visited Mar. 17, 2025).
33
U.S. Department of Health and Human Services, Office of the National Coordinator for Health Information Technology,
Florida Health IT Summary, available at https://dashboard.healthit.gov/apps/health-information-technology-data-
summaries.php?state=Florida&cat9=all+data (last visited Mar. 17, 2025).
34
Id.
35
The DEA establishes these requirements according to the agency’s responsibilities under the Controlled Substances Act. See,
21 U.S.C. 829 (a) and 871(b).
36
21 CFR 1311.120
37
21 U.S.C. 801–971.
38
21 C.F.R. s. 1306.08 and 21 C.F.R. Part 1311.
39
Id. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
6
Complete the identity-proofing process to acquire a two-factor authentication credential or digital
certificate;
Attach the authentication credential to his or her identity;
Set access controls so that only individuals who may legally prescribe a controlled substance are
allowed to do so; and
Access the e-prescribing or electronic health record platform.
Florida Electronic Prescribing Requirements
Current Florida law requires prescribers to prescribe electronically, but this requirement only applies to
prescribers who have an electronic health record system. Florida law also exempts prescribers from this
requirement if:
The practitioner and the dispenser are the same entity;
The prescription cannot be transmitted electronically under the current national standard;
The practitioner has been issued a waiver by the Department of Health;
40
The practitioner determines that the use of e-prescribing would delay a patient’s access to a drug thus
adversely impacting the patient’s medical condition;
The drug is being prescribed under a research protocol;
The prescription is for a drug which the federal Food and Drug Administration requires the prescription
contain elements that may not be included in e-prescribing;
The prescription is for an individual receiving hospice care or a resident of a nursing home facility; or
The practitioner determines that it is in the best interest of the patient, or the patient determines that it is
in his or her own best interest, to compare prescription drug prices among area pharmacies. The
practitioner must document such determination in the patient’s medical record.
Current law requires prescriptions that are electronically generated and transmitted to contain the following:
41
The name of the prescriber;
The name and strength of the drug prescribed;
The quantity of the drug prescribed in numerical format;
Directions for use;
Date and electronic signature of the prescriber.
E-prescribing software may not interfere with a patient’s choice of pharmacy or use any means, such as pop-up
ads, advertising, or instant messaging to influence or attempt to influence the prescribing decision of the
prescriber at the point of care.
42 E-prescribing software may provide formulary information, as long as nothing
makes it more difficult or precludes a prescriber from selecting a specific pharmacy or drug.
43
Federal Electronic Prescribing Requirements
Federal policy does not broadly mandate the use of e-prescribing for prescriptions generally, nor controlled
substances specifically. Federal policy establishes requirements for e-prescribing applications used in prescribing
controlled substances in order to ensure secure and fraud-free transmissions. The only circumstance where the
Federal government mandates the use of e-prescribing is for controlled substances prescribed under a Medicare
Part D drug plan.
Medicare Part D Mandatory e-Prescribing
40
Waivers are not to exceed one year, and may be issued due to demonstrated economic hardship, technological limitations
that are not reasonably within the control of the practitioner, or another exceptional circumstance demonstrated by the
practitioner.
41
S. 456.42, F.S.
42
S. 456.43, F.S.
43
Id. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
7
Federal law requires all Schedule II-V controlled substances prescribed under a Medicare Part D drug plan must be
prescribed electronically unless an exemption applies.
44
CMS monitors prescriber compliance through the EPCS Program. Prescribers who use e-prescribing for less than
70 percent of annual prescribing for controlled substances under Medicare Part D are notified of their
noncompliance which may be considered by CMS during the assessment for potential fraud, waste, and abuse.
45
Currently, there are three exemptions:
The prescriber has obtained a CMS-approved waiver because the prescriber cannot meet the requirements
due to circumstances beyond the prescriber’s control;
The prescriber issues 100 or fewer relevant prescriptions per year; or
The prescriber is in the geographic area of an emergency or disaster declared by a Federal, State, or local
government entity.
E-Prescribing Exemptions: Federal vs State
Federal –
Medicare Part D
Patients Only
Florida –
All
Patients
Controlled
Substances
(Schedules II-V)
46
All Drugs
Exemptions
1. Prescriber and dispenser are the same
entity
X
2. Prescriber issues fewer than 100
relevant prescriptions annually
X
3. Prescriber is located in a declared
emergency or disaster area
X
4. Prescriber has been issued a waiver due
to circumstances outside of the
prescriber’s control
X X
5. Prescriber does not maintain an
electronic health record system
X
6. Prescription cannot be transmitted
electronically under the most recent
National Council for Prescription Drug
Programs SCRIPT Standard
X
7. Prescriber determines that eRx would
be impractical for patient to obtain an
electronically prescribed drug in a
timely manner and such delay would
adversely impact patient’s medical
condition
X
8. Drug is being prescribed under a
research protocol
X
44
P.L. 115-271, Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and
Communities Act (SUPPORT Act).
45
Centers for Medicare & Medicaid (2024). CMS Electronic Prescribing for Controlled Substances (EPCS) Program. Available at
https://www.cms.gov/medicare/e-health/eprescribing/cms-eprescribing-for-controlled-substances-program (last visited
Mar. 17, 2025).
46
The shaded cells were federal exemptions at the time the Florida e-prescribing exemptions became law but have
subsequently been removed. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
8
9. Federal FDA requires the prescription
contain elements not available in eRx
X
10. Patient is receiving hospice care or who
is a resident of a nursing home facility
X
11. Prescriber or patient determines that it
is in the patient’s best interest to
compare drug prices among pharmacies
X
Florida Prescribers
The Agency for Health Care Administration (AHCA) houses a clearinghouse of information on electronic
prescribing, including trends on the adoption and use of e-prescribing in the state.
47 In creating the clearinghouse,
AHCA worked in collaboration with the private sector and relevant stakeholders, including representatives of
health care practitioners, pharmacies, health care facilities, organizations that operate e-prescribing networks,
organizations that create e-prescribing products, and regional health information organizations.
48 AHCA annually
reports to the Governor and Legislature on the implementation of electronic prescribing by health care
practitioners, facilities, and pharmacies.
49
In its November 2024 report, AHCA reported that the average number of e-prescriptions per month increased
from 372,085 in 2008 to 17,472,000 in 2023. The report also states that e-prescribers in the state increased by
106.20% with 73% of prescribers and 92% of pharmacies capable of e-prescribing controlled substances.
50
47
S. 408.0611, F.S.
48
Id.
49
Id., and Agency for Health Care Administration, Florida Center for Health Information and Transparency, Florida Electronic
Prescribing Annual Report for 2023, (Nov. 2024), available at
https://ahca.myflorida.com/content/download/25388/file/2023eRxAnnualReport_Final.pdf (last visited Mar. 17, 2024).
50
Agency for Health Care Administration, Florida Center for Health Information and Transparency, Florida Electronic
Prescribing Annual Report for 2023, (Nov. 2024), available at
https://ahca.myflorida.com/content/download/25388/file/2023eRxAnnualReport_Final.pdf (last visited Mar. 17, 2025). JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
9
BILL HISTORY
COMMITTEE REFERENCE ACTION DATE
STAFF
DIRECTOR/
POLICY CHIEF
ANALYSIS
PREPARED BY
Health Professions & Programs
Subcommittee
McElroy Clenord
Health & Human Services
Committee