Triplicate Prescription Programs (TPP)

Description

Triplicate prescription programs (TPPs), also known as “Multiple Copy Prescriptions or “Trip (Triplicate) Scrips,” require physicians to issue prescriptions for certain controlled substances using multiple copy forms, with the extra copies either retained for record-keeping purposes or submitted to pharmacies and/or monitoring agencies. Some states used TPPs as precursors to modern PDMPs.

Objective(s)

To monitor the prescribing of controlled substances

Typical Elements

  • States can elect to use TPP to supplement their electronic monitoring programs (Simoni-Wastila & Toler, n.d.).
  • Prescription forms are pre-numbered sequentially and tinted to make reproduction and fraud more difficult (Department of Health and Human Services [DHHS], 1992).
  • Prescribers obtain their prescription forms from state-approved security printers (Simoni-Wastila & Toler, n.d.).
    • Note: Hawaii does not require use of a state-issued form, but only requires a form that is in triplicate (DHHS, 1992).
  • In triplicate programs, the prescriber keeps one copy of the prescription, another is kept by the pharmacist and the third is sent to a State agency by the pharmacist. The state agency keeps the form as data and retrospectively analyzes to identify aberrant prescribing, dispensing, or using (DHHS, 1992).

Populations

Prescribers, pharmacists

Outcomes

After the first year of the program (DHHS, 1992):

  • Texas experienced a 52% reduction in Schedule II prescriptions (and an additional 16% reduction after the second year.
  • Rhode Island experienced a 36.3% reduction.

Illinois experienced a 109% increase in Schedule II prescriptions (e.g., morphine sulfate) between 1985 and 1989 after implementation (DHHS, 1992).

In Chicago, IL, emergency room data mentioning pentazocine (narcotic analgesic) decreased by 92% after the introduction of the multiple copy prescription program (DHHS, 1992)

NY Triplicate Program for Benzodiazepines was associated with significant reductions in (Pearson et al., 2006):

  • Problematic benzodiazepine use
  • Pharmacy hopping
  • Non-problematic benzodiazepine use

Non-problematic and potentially problematic use decreased the most among African Americans, despite already having a lower baseline use rate than the white or Hispanic use (Pearson et al., 2006).

Guidelines

Multiple copy prescription programs: State experiences. 

State-issued prescription forms.

Triplicate Prescription Program.

Acknowledged by

No acknowledgements have been found regarding the role of triplicate prescription programs in preventing prescription drug misuse and/or its consequences.

References

Department of Health and Human Services. (1992). Multiple copy prescription programs: State experiences (DHHS Publication No. OEI-12-91-00490). Washington, DC: U.S. Government Printing Office.

New York Department of Health. (2016). Electronic prescribing. Retrieved from http://www.health.ny.gov/professionals/narcotic/electronic_prescribing/.

Pearson, S., Soumerai, S., Mah, C., Zhang, F., Simoni-Wastila, L., Salzman, C., . . . Ross-Degnan, D. (2006). Racial disparities in access after regulatory surveillance of benzodiazepines. Archives of Internal Medicine, 166(5), 572–579. doi: 10.1001/archinte.166.5.572

Simoni-Wastila, L., & Toler, W. (n.d.). State-issued prescription forms. Retrieved from https://c.ymcdn.com/sites/www.safestates.org/resource/resmgr/imported/Simoni%20Wastila.pdf