Your Doctor Refuses to Write a Paper Prescription. The Law Is On Your Side.

As technology and patient safety standards evolve, several advanced nations have transitioned to electronic prescribing, or e-prescribing, reducing the need for—and sometimes restricting the use of—paper prescriptions. And for good reason: E-prescribing facilitates the integration of prescription records into the patient's medical history, which has the potential to minimize the risk of medication errors and reduce prescription theft and forgery of controlled drugs, a significant concern in addressing opioid misuse and prescription narcotic abuse. E-prescribing simplifies the prescribing process for both doctors and pharmacies, as prescriptions are sent directly to the pharmacy, ultimately reducing patient wait times. Electronic systems have the potential to make it much easier to keep track of prescriptions and patient medication history, leading to better coordination of care, especially for patients with multiple healthcare providers. Also, by reducing the need for paper prescriptions, e-prescribing contributes to sustainability efforts by generating less paper waste. Overall, e-prescribing is seen as a way to improve healthcare quality, reduce costs, and enhance patient experience. Many countries, including the UK, the US, Sweden, Germany, Spain, Estonia, Finland, and Australia, have been actively promoting this transition as part of broader digital health strategies. 

One thing though: Access to affordable medication is a problem often alleviated through international mail order, and should a patient decide to order medicine from a foreign pharmacy, they will need a paper prescription. 

International Mail Order and Paper Prescriptions

Sending prescriptions electronically across borders is currently quite limited due to differences in healthcare regulations, data privacy laws, and prescription systems between countries. Although not yet widely available, some countries and regions are exploring cross-border e-prescribing initiatives. The European Union has begun testing systems that allow e-prescriptions to be filled across borders in participating countries as part of the eHealth Digital Service Infrastructure (eHDSI), which could pave the way for future international e-prescriptions within certain regions​. Similarly, the rise of telemedicine and digital health initiatives could lead to future innovations in cross-border e-prescribing. Until then, international online pharmacies require paper prescriptions.

Dealing with Paper Prescription Refusals

An international online pharmacy’s paper prescription requirement can present friction for a patient trying to order non-controlled medicine from another country due to high domestic prices. Accustomed to e-prescribing, a care provider might say they can't write a patient a paper prescription. Often, having an open conversation about drug prices – and explaining that a patient’s choice of pharmacy is based on price, which means having a prescription in hand to shop around for the best savings option – will help the doctor gain insight into the patient’s experience. Too many doctors are in the dark regarding the cost burden a prescribed therapy places on a patient. The benefits of e-prescribing must be balanced with the patient's freedom of choice and adherence to their prescribed drug therapy. 

If a patient cannot afford Advair or Eliquis at a domestic pharmacy, for example, they may choose to pursue ordering the medicine from abroad from a reputable online pharmacy. Laws affecting the importation of medication for personal use vary from country to country. According to PharmacyChecker (PC) International Pharmacy Verification Program (IPVP) Standards, if a medication requires a prescription in the country where a patient resides, that patient must present a valid prescription from a prescriber in that country to their chosen international online pharmacy. For example, if you live in Florida, you must obtain a prescription from a prescriber in Florida to order the medication to your residence in Florida. The PC International Pharmacy Verification Program enforces prescription requirements to ensure consumers’ safety when shopping for affordable medicine online. Pharmacies usually accept written prescriptions, faxed, uploaded, or emailed by either the patient or doctor. 

Countries Mandating E-prescribing Have Exceptions

While many countries have made e-prescribing mandatory, such as the United States, Sweden, Finland, and Denmark, none have fully banned paper prescriptions. Exceptions typically exist for cases of technical failure, patient choice, or non-participating pharmacies. 

Mandating e-prescriptions in 2012, Sweden has one of the highest adoption rates of e-prescribing globally, although paper prescriptions are allowed if a pharmacy is outside Sweden or not part of the e-prescribing system. The same applies to the Finland and Denmark prescriptions: For example, Denmark’s e-prescribing system covers nearly all pharmacies in the country, but if a patient needs a prescription for a pharmacy not connected to the Danish system—especially in cases of cross-border prescriptions—a paper prescription can be issued. Many states in the United States mandate e-prescribing, especially for controlled substances, but all that do have exceptions for paper prescriptions. Details regarding US paper prescription laws are outlined below. 

United States Paper Prescription Laws

While most states have provisions allowing e-prescribing and some have extremely strict requirements mandating its use, all have exceptions that allow consumer choice.

As of October 2024, most states mandate electronic prescribing for controlled substances, while a few also require it for non-controlled substances. However, several states still allow paper prescriptions under certain circumstances or do not have strict e-prescribing mandates at all. States continue to update these laws, so it’s essential to verify the current rules for your specific state on government websites.

States That Require E-Prescribing for Non-Controlled Substances

All of these states allow exceptions when sending prescriptions to pharmacies that are not equipped to handle electronic prescriptions, including those out of state. 

• California
• Delaware
• Florida
• Illinois
• Indiana
• Iowa
• Massachusetts
• Michigan
• Minnesota
• New York
• North Carolina
• Texas

In these states, other exceptions typically include technological failures, temporary system outages, or scenarios where e-prescribing is not feasible. Florida expressly requires a balance between e-prescribing and the freedom to choose a pharmacy, stating "electronic prescribing shall not interfere with a patient's freedom to choose a pharmacy."

Each state may have specific protocols for documenting such exceptions.

States That Require E-Prescribing for Controlled Substances Only

• Alabama
• Arizona
• Colorado
• Connecticut
• Georgia
• Kentucky
• Louisiana
• Maine (for opiates)
• Maryland
• Missouri
• Nebraska
• Nevada
• New Hampshire
• New Jersey
• New Mexico
• North Dakota
• Ohio
• Oklahoma
• Oregon
• Pennsylvania
• Rhode Island
• South Carolina
• Tennessee
• Utah
• Vermont
• Virginia (for opiates)
• Washington
• Wisconsin

States That Allow Paper Prescriptions (No Statewide Mandate)

These states allow paper prescriptions and have no mandatory statewide e-prescribing requirements. Keep in mind that even in these states, individual healthcare providers or pharmacies may still opt to use e-prescribing voluntarily.

• Alaska
• Hawaii
• Idaho
• Mississippi
• Montana
• South Dakota
• West Virginia
• Wyoming

Countries Encouraging E-Prescribing

Many advanced countries are looking to bolster patient record-keeping through e-prescriptions. Estonia is a global leader in digital government services, and e-prescribing has been a standard part of its healthcare system for years​ In the United Kingdom, e-prescribing is not universally mandatory across all healthcare settings, but it is widely implemented and strongly encouraged, particularly within the National Health Service (NHS). Germany is in the process of implementing e-prescribing mandates as part of its wider healthcare digitization. The system is becoming increasingly common, but as of now, paper prescriptions are still permitted in most scenarios. Australia is promoting the use of e-prescribing through its My Health Record system and national electronic prescription initiatives. E-prescribing has been integrated into Spain’s national health system, reducing administrative burdens and improving prescription management​

Again, despite a strong preference for electronic prescribing, paper prescriptions are still allowed in certain circumstances in these countries, especially in settings or for patients where e-prescribing may not be practical or possible (e.g., technical issues, non-participating pharmacies).