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Systems with integrated Electronic Prescribing for Controlled Substances (EPCS) functionality have been slowly improving the nation’s medication safety thanks to improved tracking, history, and security. Here’s where the progress stands for EPCS implementation and usage in 2026.
Since the early 2000s, federal and state authorities have been working to decrease the number of drug-associated deaths in the United States, and in the past decade have bolstered those efforts in order to slow the deadly opioid epidemic impacting the nation since 1999.
While 2018 saw the United States’ first drop in drug-associated deaths in nearly 20 years, since then, additional challenges have arisen. For example, in 2022, the nation’s life expectancy dropped for the second year in a row due to drug overdose deaths and the COVID-19 pandemic. The good news: 2023 and 2024 were more positive, with a promising 27% decrease in overdose deaths in 2024 and some states—Louisiana, Michigan, New Hampshire, Ohio, Virginia, West Virginia, Wisconsin, and Washington, D.C.—experiencing declines of 35% or more.
What is the history of EPCS?
EPCS began in 2010 as a proposal by the Drug Enforcement Administration (DEA) to block the abuse of controlled substances by creating a more transparent and accountable system for prescribers and pharmacies. In 2017, the Every Prescription Conveyed Securely Act (H.R.3528) introduced a mandate that Schedule II-V controlled substances under Medicare Part D be prescribed electronically by January 1st, 2021. In late 2020, due in part to COVID-19, the United States federal government’s Centers for Medicare and Medicaid Services (CMS) issued a final ruling, delaying enforcement of compliance penalties by one year, until 2022. A year later, CMS again delayed enforcement of federal ECPS compliance for Medicare Part D until 2023.
On January 1st, 2023, CMS finally began enforcing the use of Electronic Prescriptions for Controlled Substances (EPCS) for all Schedule II, III, IV, and V medication drugs prescribed under Medicare Part D. CMS requires that “Part D sponsors, prescribers, and dispensers…support electronic prescribing” for controlled substance prescriptions, or risk facing compliance enforcement actions.
What is the current state of EPCS adoption in the United States?
In 2026, more than half of U.S. states have some form of state-level controlled substance legislation. However, according to SureScripts, nearly 16% of prescribers are still not enabled for electronic prescribing. Pharmacies have done a much better job of adoption, with only 2% nationwide still without EPCS enablement.
With EPCS functionality now allowed in all 50 states—whether state law currently requires it or not—EPCS technology can and should be implemented by practices and pharmacies nationwide. In today’s digital-oriented healthcare landscape, it’s clear that EPCS provides a level of safety and visibility that’s immensely beneficial to providers and the patients they serve. We’re hopeful that these benefits will lead to a continued expansion and improvement of EPCS systems, including more state-level legislation requiring their implementation.
With or without state laws in place, using EPCS-enabled E-Prescribing software will help any practice build greater trust with patients and future-proof against any possible mandates. The process should be undertaken proactively, as—depending on the size of your organization—it may take days, weeks, or longer to gather all of your necessary information and find a certified, compliant E-Prescribing software solution.
Electronic prescribing (or E-Prescribing) tools are much more than an efficient and transparent method to prescribe; they’re also an effective means of preventing drug overdoses. Providing a “paper trail” of comprehensive medication history at providers’ and pharmacists’ fingertips, EPCS helps to inform and improve prescribing decisions while reducing overprescribing, overuse, and resulting drug addiction. EPCS also improves the security of controlled substance prescriptions, helping to reduce fraud and diversion.
Which individual U.S. states have EPCS legislation in 2026?
In 2011, Minnesota was the first state to enact legislation addressing EPCS. Other states have since followed suit with their own EPCS regulations—such as New York in 2016—paving the way for adoption. Just two years later, in 2018, New York state saw its first decline in drug-related deaths since 2009, with a 4.1% year-over-year reduction.
The following list includes the U.S. states with existing EPCS legislation and the date their respective mandates went into effect:
- Arizona – January 1, 2020
- Arkansas – January 1, 2021
- California – January 1, 2022
- Colorado – July 1, 2023
- Connecticut – January 1, 2018
- Delaware – January 1, 2021
- Florida – July 1, 2021
- Illinois – January 1, 2024
- Indiana – January 1, 2022
- Iowa – January 1, 2020
- Kansas – July 1, 2021
- Kentucky – January 1, 2021
- Maine – July 1, 2017
- Maryland – January 1, 2023
- Massachusetts – January 1, 2021
- Michigan – January 1, 2021
- Minnesota – January 1, 2011
- Missouri – January 1, 2021
- Nebraska – January 1, 2022
- Nevada – January 1, 2021
- New Hampshire – January 1, 2022
- New Jersey – May 1, 2021
- New Mexico – April 1, 2021
- New York – March 27, 2016
- North Carolina – January 1, 2020
- Ohio – September 23, 2022
- Oklahoma – January 1, 2020
- Pennsylvania – October 24, 2019
- Rhode Island – January 1, 2020
- South Carolina – January 1, 2021
- Tennessee – January 1, 2021
- Texas – January 1, 2021
- Utah – January 1, 2022
- Virginia – July 1, 2020
- Washington – January 1, 2022
- Wyoming – January 1, 2021
A number of U.S. states—including Alabama, Alaska, Georgia, Hawaii, Idaho, Louisiana, Mississippi, Montana, North Dakota, Oregon, South Dakota, Vermont, West Virginia, and Wisconsin—don’t have comprehensive statewide EPCS mandates for prescribers beyond the nationwide federal Medicare Part D requirements.
Others, like New Jersey and Ohio, have enacted limited, phased, opioid-specific, or software-level EPCS requirements rather than comprehensive prescriber mandates.
How can practices add EPCS-compliant electronic prescribing?
Getting started with EPCS requires finding the right software partner, compiling necessary documentation, and training staff on a new software tool.
Every practice has unique needs and challenges when it comes to serving patients, so it’s important to research and compare options based on your specific requirements. To find the right software for your practice, there are a few main considerations:
- The size, workflows, and complexity of your practice
- Integration with your existing software suite
- Whether your state-level requirements are met
- Cost and budgetary concerns
- Compliance with HIPAA and certifications such as ONC-ACB
- Availability of customer support and training resources
Once you’ve identified the right software, make sure you have all the necessary information available to get started with EPCS. The required documentation is typically a government-issued photo ID, your National Provider Identifier (NPI) number, and Drug Enforcement Administration (DEA) registration. Depending on the provider, you may be required to complete an identity-proofing process in order to begin prescribing electronically—a step often facilitated in partnership with your software provider.
Whether you’re transitioning away from pen-and-paper prescriptions or to a different e-prescribing platform, your team will need to get up to speed on the new tool. Most EPCS software comes with some form of training materials or resources, so make sure to take advantage of them.
If you’re ready to get started, RXNT can help. Our award-winning, certified E-Prescribing software with EPCS has been the gold standard for over 25 years. It’s secure, compliant with all DEA requirements, provides direct access to your state’s PDMP/PMP, and is available standalone or integrated with our comprehensive suite of clinical and billing software. Learn more or schedule a demo now to see how you can start enjoying the benefits of EPCS.
The information in this article is current as of May 2026 and is for general information purposes only. RXNT makes no warranties or representations of any kind, express or implied, about the accuracy, completeness, or reliability of the information in this article. RXNT assumes no liability for any damages caused by inaccuracies in this content. All users should consult with their jurisdiction for the most up-to-date and accurate information about any existing or pending legislation.
