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Prescription Pad Regulations

Some of the most potent narcotic drugs are perfectly legal in the United States - but you need a prescription to obtain them. That's why the fraudulent use of prescription pads has become a serious concern. Under legislation passed in 2007, the federal government has required that any prescription written for recipients of Medicaid, the health assistance program for the poor, be written on paper that satisfies three basic security standards. Because more than 50 million people receive Medicaid services, these rules have become the national standard.

  1. On the Paper

    • The Centers for Medicare and Medicaid Services (CMS), the federal agency that administers those two health programs, requires that security features be incorporated into the prescription paper itself. Special pen inks, decals, code words or other things applied when the prescription is written, or afterward, aren't accepted by CMS as security measures.

    Anti-Copying

    • CMS says prescription pads must have at least one "industry-recognized security feature" to thwart photocopying. A common anti-copying device is the "void pantograph" background. This is the word "VOID" printed in a slightly different ink than the rest of the paper, or concealed by a design that doesn't reproduce in a photocopy. The difference is barely perceptible to the naked eye but becomes obvious when the paper is photocopied. Other techniques include "microprinting," which is words written in type so small that most copiers can't reproduce them, and artificial watermarks on the back of the paper that most copiers can't reproduce.

    Anti-Modification

    • Prescription pads must also have a security feature designed to prevent someone from erasing or altering information on a filled-out prescription. One common solution is a colored background ink that rubs away when someone tries to rub out written words, leaving a white splotch that indicates the script has been tampered with. Other options: a "toner grip" coating that forces printer toner to bond to the page so that it can't be rubbed out without destroying the paper; and a "check and balance" system, in which a doctor must both check a box indicating the quantity of drugs to be dispensed and actually write out the quantity elsewhere.

    Anti-Counterfeiting

    • The third security requirement is an anti-counterfeiting feature. These include pads with sequentially numbered sheets, so that each prescription has a unique number, and "coin-activated" ink on the back of each sheet, which reveals a printed message when rubbed with a coin. Another option is "security-feature bands," which make messages about the security features part of the paper's design. For example, a prescription sheet might have a thick, dark blue border, with a different message printed inside the border on each side, such as "A black and white document is not valid" or "This document must have a watermark visible on the reverse."

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