If you took the Cliff Clavin high-level approach and guessed “they all involve initials”, well, you’re not wrong. But the real answer we were looking for is that they all took place on September 24 (KFC in 1952, 60 Minutes in 1968, and the FTC rule in 2024). And since the FTC rule directly impacts doctors of optometry and their practices, it’s imperative that fact be separated from fiction.

The background first: remember that this rule (along with the associated contact lens rule from 2020) requires doctors to not only provide a patient with a copy of their prescription at the end of the exam but also obtain and maintain proof that they did so. The FTC outlined four ways a practice could do this:

1. Request that the patient acknowledge receipt of the prescription by signing a separate statement confirming receipt of the prescription;
2. Request that the patient sign a prescriber-retained copy of a prescription that contains a statement confirming receipt of the prescription;
3. Request that the patient sign a prescriber-retained copy of the sales receipt for the examination that contains a statement confirming receipt of the prescription; or
4. If a digital copy of the prescription was provided to the patient (via methods including an online portal, electronic mail, or text message), retain evidence that such prescription was sent, received, or made accessible, downloadable, and printable.

Given the popularity of EHRs and the fact that many, like Uprise and the forthcoming Vision(X) EHR from HELIX, have an associated patient portal, option 4 above has deservedly received a lot of attention. But along with that attention comes the need for familiarity with the rules.

Fact or Fiction?

• Consent for electronic delivery must be obtained each time a prescription is written for that patient

Fiction. And this is one of the big benefits of electronic delivery. As noted before, most EHR systems automatically upload a signed copy of glasses and CL prescriptions to a patient portal. From there a patient can easily download and print as desired. But whether they do so or not is irrelevant to complying with the rule. A patient only needs to sign a consent to e-delivery and identify the specific method once, unless the practice changes their approach.

Relevant rule excerpt: “The Commission clarifies that if the prescriber identifies the digital method that will be used for prescription delivery and allows the patient to choose whether to consent to that delivery method (rather than making it the default), then allowing patients to sign an authorization just once would satisfy the Rule’s requirements. But as noted by the commenters, if the prescriber changes their digital delivery policies (for example, by switching from email delivery of prescriptions to access on a portal), they would need to reobtain the patient’s digital delivery consent.”

• Doctors can use a single consent form for electronic delivery of glasses and CL prescriptions

Fact. A single consent form that indicates prescriptions for glasses and contact lenses can be made available electronically would suffice.

Relevant rule excerpt: “Further, the Commission believes that prescribers could use a single document to obtain verifiable consent to digital delivery of both contact lens and eyeglass prescriptions so long as it is clear to consumers that they are consenting to digital delivery for both.”

• Doctors can elect to only deliver prescriptions electronically

Fiction. Doctors and their teams can prefer to deliver as many prescriptions as possible via electronic means but remember that the patient’s preference is the key consideration. Unless the patient provides consent for electronic delivery, an alternate method of supplying the Rx must be used.

Relevant rule excerpt: “In satisfying the Eyeglass Rule’s automatic-prescription release requirement, the patient must be given an actual choice to select an identified electronic delivery method or to receive the prescription on paper automatically. Prescribers are free to also place prescriptions on a portal, but this action would not satisfy the requirements of Section 456.2 if the patient did not opt-in to the digital delivery option.”

• Patients who consent to electronic delivery must sign something to indicate that they have actually received their prescription

Fiction. Patients must sign a consent to both the idea of electronically delivery and the specific method the doctor will use, but they do not need to sign anything else.

Relevant rule excerpt: “…prescribers would need merely to retain evidence that the prescription was sent, received, or made accessible, downloadable, and printable, which commenters have acknowledged EHRs generally are configured to do.”

In summary, the delivery of prescriptions electronically through a patient portal offers a path to compliance while simultaneously limiting additional burden on the practice. For compliance with the rule, however, patients must a) provide consent to receive the prescription electronically, and b) specify the electronic delivery method they consent to. Many practices will choose to accomplish this by adding a new consent form to their intake process that offers, but not forces, electronically delivery via a patient portal. For those patients who accept the offer and consent via signature, the form can be saved as the verifiable affirmative consent required by the rule. For those who don’t, one of the other three methods of compliance would need to be utilized.

Blueprint For Electronic Delivery Success via Patient Portal

• Evaluate internal procedures to ensure that patients are receiving access to the patient portal
• Create an intake form specifying that, with the patient’s consent, eyeglass and contact lens prescriptions can be delivered electronically
• Ensure that the consent form specifies the method of delivery as the patient portal
• Add the consent form to patient visit workflow
• Store signed and dated consent forms in associated patient records

Example Consent Language

“I understand that my eye care professional will provide me with a copy of my eyeglass and/or contact lens prescription at the completion of my examination. With my signature below, I provide consent for my prescription(s) to be delivered electronically. Further, I provide consent for the electronic delivery method to be through the patient portal.”