New ePrescribe Mandates in Hospice: What’s Changed

When you’re in the business of comfort, every second counts. In hospice care, delays aren’t just inconvenient, they’re unacceptable. When it comes to how we prescribe medication in 2025, the rulebook has officially changed. If your team is still writing paper scripts, waiting on fax confirmations, or calling in refills by phone, it’s time to take a hard look at the latest ePrescribe mandates and what they mean for hospice leaders. 

Hospice is uniquely complex. Unlike a typical hospital setting, you’re often coordinating care across homes, facilities, pharmacies, and families, all while dealing with patients who are at the most vulnerable point in their lives. That’s why the shift to electronic prescribing of controlled substances (EPCS) isn’t just a compliance checkbox. It’s a fundamental shift in how we ensure care is delivered quickly, accurately, and legally. 

Let’s discuss what’s changed, what’s required, and why this isn’t just about rules. It’s about dignity. 

What's Behind the New ePrescribe Mandate? 

The push toward electronic prescriptions began years ago, but the real turning point came with the SUPPORT for Patients and Communities Act, passed in 2018. Section 2003 of this act mandated that Schedule II through V controlled substance prescriptions covered under Medicare Part D must be prescribed electronically. The goal? Reduce prescription drug abuse, prevent diversion, and make it harder for fraudulent prescriptions to slip through the cracks. 

While the law initially set a deadline of January 1, 2021, the final ruling by the Centers for Medicare & Medicaid Services (CMS) allowed for multiple extensions. But as of January 1, 2023, enforcement is in full effect. And now, in 2025, we’re past the adjustment period. Compliance is no longer optional. 

If your organization writes prescriptions for more than 100 controlled substances per year under Medicare Part D, then at least 70% of those prescriptions must be submitted through an EPCS program. That includes medications prescribed electronically for hospice patients receiving care across multiple settings. 

What Counts as Compliant in Hospice?

Let’s be clear: the term "electronic prescriptions" doesn’t mean emailing a pharmacy or typing up a PDF. It means using a certified EPCS platform that meets DEA requirements, supports dual-factor authentication, and is connected to your state’s Prescription Drug Monitoring Program (PDMP). Simply put, you need an approved system in place for prescribing controlled substance prescriptions in accordance with federal standards. 

If you’re still sending paper scripts or calling in orders without a documented exception, your organization could be flagged. And that’s not just a risk for your compliance record, it’s a risk to patient safety and to your reputation as a care provider. 

State Regulations: More Layers, More Complexity

While the federal mandate applies to Medicare Part D, more than 30 states have passed their own laws requiring electronic prescribing of controlled substances—many of which go beyond federal expectations. For example, California now requires all prescriptions to be sent electronically, regardless of whether the patient is on Medicare or the drug is a controlled substance. 

That means hospice providers operating across state lines or even near state borders need to understand the rules in every state where their patients receive care. It also means that teams need a flexible, cloud-based prescribing tool that can adapt to both federal and state requirements—without forcing providers to memorize a patchwork of laws. 

The Impact of Telemedicine and What's Coming Next

During the COVID-19 pandemic, temporary DEA policy allowed prescribers to issue Schedule II–V prescriptions without an in-person exam, as long as the consult happened via telemedicine. That flexibility has been extended through December 31, 2025. But with the clock ticking, new rules are emerging. 

The DEA has proposed a framework for a Special Registration process called the Advanced Telemedicine Prescribing Registration (ATP) that would require hospice clinicians to register for additional authorization to continue prescribing via telehealth without a prior in-person evaluation. 

Hospice organizations across the country have expressed concern. Advocates warn that the new ATP framework could severely limit timely access to medication for patients nearing the end of life. The delays and administrative burdens introduced by such a program would create real barriers in moments when every hour matters. 

We may not yet know what the final rule will look like, but we do know this: hospice leaders should be paying close attention. Stay informed. Subscribe to alerts. Speak up during public comment periods. The patients and families you serve are counting on you to clear the path, not get tangled in red tape. 

Why It Matters for Hospice

This isn’t just about ticking boxes. It’s about making sure your team has the tools to do their jobs well, and that patients can receive comfort medications without delays. When medications are prescribed electronically through a certified platform, you reduce errors, increase transparency, and ensure a more consistent experience for patients and families alike. 

It also helps your team move faster. When you're dealing with symptoms like pain, agitation, or difficulty breathing, waiting hours—or days—for a prescription to get filled is simply unacceptable. With EPCS, providers can prescribe in real time, and pharmacists can fill orders with confidence. 

That means fewer phone calls, fewer callbacks, and fewer faxes lost in the shuffle. It also means better documentation, which supports your clinical outcomes and strengthens your ability to remain audit-ready. 

What Hospice Leaders Should Do Now

First, review your current prescribing workflows. Are prescriptions being sent through a DEA-certified EPCS platform? Are your clinicians trained and comfortable with the process? Are you meeting the 70% requirement if you're over the 100-prescription threshold? 

Second, check whether your current tools are integrated with your EHR and state PDMP. If they aren’t, it’s worth evaluating whether your system is helping or hindering your team. 

Finally, build a culture of compliance that doesn’t feel like a burden. When your clinicians see how much faster and smoother electronic prescribing can be, they won’t resist and it’ll become second nature. 

How BetterRX Supports EPCS Compliance

At BetterRX, we know the nuances of hospice care. That’s why our platform is fully equipped to handle electronic prescribing of controlled substances and built specifically with hospice workflows in mind. We make sure medications are prescribed electronically, delivered efficiently, and tracked every step of the way. 

We’ve done the legwork so your team can stay focused on comfort, connection, and quality of life. 

In a world where the rules keep changing and the stakes are always high, having the right technology partner isn’t a luxury. It’s a necessity. Reach out tody and schedule a call with one of our expert team members.  

About BetterRX

BetterRX's mission is to radically change patient care by ending medication delays that cause needless suffering. BetterRX offers efficient ordering technology, medication tracking, real-time PPD & cost alerts, and committed local pharmacies. Learn more about BetterRX, our ConnectedRX technology, what makes us Better than a PBM, and our Pharmacy partnerships.