New electronic prescribing mandate: What you need to know

An electronic prescribing mandate is coming in early 2020.

What should prescribers and pharmacists know about the mandate and how it affects them? Check out our Q&A below for more information.


Q: What is electronic prescribing and why is it a required practice?

A: Electronic prescribing is the transmission of the prescription to a pharmacy via a secure electronic portal. Faxing a prescription image to a pharmacy is NOT included in electronic prescribing.

During the 2018 General Assembly, the Iowa Legislature and Governor Reynolds enacted House File 2377, which mandates the electronic transmission of all prescriptions (controlled and non-controlled substances).

Q: When does the law go into effect?

A: The law requires all prescriptions be sent via electronic transmission starting Jan. 1, 2020. However, University of Iowa Hospitals & Clinics was granted a temporary extension from the Iowa Board of Pharmacy to become compliant. New processes to meet the legislative mandate will be implemented over the next few months.

Q: What processes are being implemented at University of Iowa Hospitals & Clinics for compliance?

A: A project team is currently working on an alternate solution for prescribers to use Duo Security as a second, two-factor authentication solution, along with BioKey. This will be a phased implementation of the two-factor authentication solution, starting in December through February.

Q: Are there prescriptions that are exempt?

A: Most prescriptions from UIHC are transmitted electronically, approximately 88%. For the remaining that are printed locally, there are some exceptions allowed from the Board of Pharmacy. Exclusions from the mandate include these prescriptions:

  • For a patient residing in a nursing home, long-term care facility, correctional facility, or jail.
  • Dispensed by a United States Department of Veterans Affairs pharmacy.
  • Requiring information that makes electronic submission impractical, such as complicated or lengthy directions for use or attachments.
  • For a compounded preparation containing two or more components.
  • Issued in response to a public health emergency in a situation where a non-patient-specific prescription would be permitted.
  • Issued pursuant to an established and valid collaborative practice agreement, standing order, or drug research protocol.
  • Issued during a temporary technical or electronic failure at the practitioner’s or pharmacy’s location, provided that a prescription issued pursuant to this exception shall indicate on the prescription that the practitioner or pharmacy is experiencing a temporary technical or electronic failure.
  • Issued in an emergency situation pursuant to federal law and regulation rules of the Board.

Q: Can prescriptions still be called into a pharmacy?

A: Unless an authorized prescription is issued pursuant to an exemption, the prescription must be submitted to a pharmacy through an electronic prescribing platform. Prescriptions that are written in violation of the electronic prescribing mandate are still valid prescriptions and may be filled by pharmacists. However, violating the mandate may result in a fine to the prescriber of $250 per occurrence.

Q: What should a pharmacist do if they get a paper, fax, or telephonic prescription?

A: The electronic prescribing mandate does not automatically nullify or void prescriptions transmitted by nonelectronic methods. After the pharmacist fulfills their professional responsibility as it relates to prescription dispensing, the pharmacist may fill prescriptions transmitted verbally, via facsimile, or written on paper. The pharmacist may, in their professional judgement, report violations of the electronic prescribing mandate to the Board of Pharmacy or the prescriber’s professional licensing board.

Q: Does the electronic transmission mandate apply to hospital pharmacy?

A: It depends.

  • Iowa Code 155A.27 and 124.308 require electronic transmission of “prescriptions.” In the hospital setting, when prescribers issue medication “orders” for inpatient administration, they are not subject to the electronic transmission mandate.
  • If the prescriber is issuing a prescription for the patient at discharge, for the patient to have the medication to self-administer in an ambulatory (i.e. home, not LTC, etc.) setting, then the prescription would be subject to the electronic transmission mandate.

Q: What does this mean for prescribers?

A: Step-by-step instructions on the actions prescribers will need to take to complete the process of enrollment into Duo Security, and/or BioKey, will be provided via email over the next three months. Communication will be delivered on a phased schedule. No actions are required until a prescriber receives this email.

Have more questions? More information, including FAQs for prescribers and pharmacies, are available on the Iowa Board of Pharmacy website.