Ethan Frome - MaineCare PDL



Rx PROvisions, Inc.

One Sixty Six Main Street, Suite 3

Lincoln Park, New Jersey 07035

(973) 305-8105 ♦ FAX (973) 305-8108

Paragraph 1.

Founded: 1995

Vendor Name: Rx PROvisions, Inc. Federal Tax ID: 22-3390483

Business Address: 166 Main Street, Suite 3

City: Lincoln Park State: New Jersey ZIP: 07035

TOLL FREE Number: 1-888-921-1211

Telephone: 973-305-8105 FAX: 973-305-8108

Contact Person: Joseph J. Pisano, President. E-mail: jpisano@

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Rx PROvisions, Inc. was founded in 1995 as a provider of medical forms and services for the medical and pharmaceutical markets. One of our programs for pharmaceutical marketers is our One to One™ Prescription Pad Program. The program uses prescription forms as a medium to deliver pharmaceutical advertising to practitioners and to provide those practitioners with medical forms they use in conjunction with patient care.

The forms are provided as a complimentary service to the practitioner who sees prescription drug messages as the forms are used.

In order to produce Rx forms the practice will use, the practice sends their current Rx form to Rx PROvisions, Inc. Rx forms are then reproduced in their original format as directed by the physician, and stored as electronic documents which can be retrieved, updated and used for print production.

The information on the Rx form is reproduced with the same practice logos, logotype and design preferred by the physician or by the practice. The signature lines are produced to comply with the State Board of Pharmacy guidelines.

Rx pads are perfect bound with a wrap around cover. The cover is printed as directed by the pharmaceutical sponsor.

Rx Forms are printed on tamper resistant stock, 2-part stock, regular and colored stock, as directed by the physician.

Rx PROvisions, Inc. also receives prescription pad orders directly from health care providers. The practice completes an order form and mails or faxes the order form to us. If the order is new, a proof is sent to the practice for approval before the order is produced. If the order is for Rx forms we have done before and there are no changes, the order is entered into our database and then it is sent to production for printing and shipping.

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Rx PROvisions, Inc. has been in business since 1995. In 1996, the first order for prescription pads came from a pharmaceutical company that wanted to use our Rx pads as a medium to deliver advertising for a product used to treat diabetes.

In 1996, our Rx forms were printed entirely with blue thermal sensitive ink that reacted to touch and served as a test for validity.

In 1997, Rx PROvisions, Inc was approved to provide the new security Rx form in New Jersey which was initiated to address Medicaid prescription fraud (approval letter enclosed). These Rx forms are printed in blue with a State logo on the front and in green with a State logo on the back (see blank NJ Prescription Blank, enclosed).

All of these forms must be produced and shipped with a tracking number to prove delivery directly to the practitioner. Rx PROvisions, Inc. has been providing these Rx forms to health care providers in New Jersey for the last ten years.

Historical data on any physician orders for prescriptions produced and shipped by Rx PROvisions, Inc. can be provided on demand.

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We continue to enhance our tamper resistant Rx forms by adding features to stop the fraudulent use of prescription forms.

Our Rx forms currently use the following features on the front side; a void pattern appears if copied, a thermal sensitive ink “Pharmacy Rx Symbol” in the corner, a micro print signature line that will not be legible if Rx form is copied, a six quantity check box to confirm the quantity prescribed, and a unique batch number that identifies the production date, the practitioner or health care facility and the order number. On the back we have the following features; a description of the safety features, thermal sensitive blue ink in our One to One™ logo and a security watermark that is seen at an angle. A representative sample of our current product is enclosed.

Since 1997, the paper we have used and continue to use to produce tamper proof prescriptions is made by Rx PROvisions, Inc. 

Our tamper proof paper starts with 50# or 60# opaque white stock and then the following are applied to the front side of the paper;

1.  A latent "VOID" pattern is applied to paper. This pattern will appear when the prescription is copied or faxed.

2. A second screened "blue" color ink is applied over the "VOID" pattern. This ink coat covers the "VOID" pattern and also serves to identify erasures and chemical alterations.

3. A third ink is applied to the paper.  This is the "thermochromic" blue ink that serves as a validity test for the pharmacist.  The blue thermochromic ink will fade to colorless when touched and will reappear when cooled.

4.  Under the "Address" line we print, "Prescription illegal if not blue background with thermal sensitive blue Rx square in corner. Resists erasures or alterations. VOID appears on front when copied. Security features listed on back with watermark copy and blue thermal “Rx” that will fade to colorless when warmed".

5. The "signature line" on the front of the prescription is printed in "microprint" with the words" Rx PROvisions, Inc. Security". The “microprint” is too small to remain legible if copied.

6.  Our name "Rx PROvisions, Inc." and a "unique" batch number, beginning with the letters "RXP" are printed in the bottom corner.  The "batch" number identifies the production date, the prescriber and the order that generated the prescription.

On the back of the paper, we apply the following:

1.  First we apply the "watermark” that is faint but can be seen at an angle.

2.  A second printing pass applies our TOLL FREE phone number, our name, a list of the security features that make the prescription tamper proof and our thumb print "One to One” logo which also represents Prescription Security as the core of our mission.

3.  A third press pass applies the "thermochromic Rx" letters with blue ink that is part of our patented logo and serves as an additional validity test for the pharmacist.

The features listed above make our prescription forms tamper resistant and these features meet and exceed the Federal guidelines for State Medicaid tamper-resistant prescription forms.

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The batch number methodology is used to identify and to track every prescription form we produce. Several States, including the State of New Jersey require that all Rx forms have a unique batch number. Actually, we also print a unique batch number on all Rx forms we distribute nationwide.

The batch number starts with three letters, RXP that identifies Rx PROvisions, Inc as the producer of the document.

The “RXP” is followed by six digits that represent the year, month and day (yymmdd), or the order date. The order date is followed by four digits (1234) that refer to the practitioner or health care facility and serve as a locator number for our database. The last two digits (01) refer to the number of orders produced for the healthcare provider so far that year.

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We currently provide our services to pharmaceutical companies and to health care providers. We receive payment from the pharmaceutical companies by check and we also accept American Express, MasterCard, Visa and Discover credit cards for our health care provider accounts.

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The paper stock used by Rx PROvisions, Inc. for tamper resistant prescriptions is 50# or 60# offset opaque white stock.

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We will offer several tamper resistant prescription blanks for both single product entry and for multiple entries (samples enclosed). Our standard single sheet Rx form is trimmed to 4.25” x 5.5”. Our computer sheets are 8.5 x 11”. We will respond to and produce any other custom size for any client that orders them from us.

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Samples of prototype prescription blanks for the State of Maine are enclosed and meet the requirements of the Department of Public Safety, Maine Drug Enforcement Agency Requirement for Security Prescription Blank for Schedule II Drugs (16, 230, Chap 1.).

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In our twelve years of existence we never had any security breech of any kind.

A convenient flow diagram of the company’s operational processes and safeguards for manufacturing our tamper resistant stock is provided below. Additional comments about the security of our facilities are also provided.

Tamper resistant stock is produced exclusively at one facility and that facility has the original printing plates, thermal sensitive ink and electronic files used in the tamper resistant stock production process. The facility is protected by external and internal security systems and alarm that monitor and protect the building and the safety of the stock we produce. One person at that facility has the authorization to access the printing plates, the thermal sensitive ink and the production material needed to produce our tamper resistant stock.

Tamper resistant stock inventory is produced and stored exclusively at this facility.

When tamper resistant stock is needed to produce prescriptions, the contact person at Rx PROvisions, Inc. is notified via e-mail from the prescription form production facility.

We use separate facilities to provide additional security and control. Each plant is physically separated by communication, location and distance. Our on-demand production process controls the use, inventory and security of the stock we produce.

Orders for prescription forms from our clients are received by our Main Street location where the orders are processed and sent to our prescription form production facility.

Orders for tamper resistant stock required to produce these prescriptions are directed to our Main Street office. Then, the tamper resistant stock production facility is notified to provide the required inventory for the prescription production facility where the prescription pads are printed and packed. Then the tracking numbers and shipping labels are affixed to each order. Orders are picked up at the end of each day at this facility for delivery to our clients.

The prescription form production facility sends the shipping information to our Main Street office where the orders are closed out and invoiced.

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The following describes, the record keeping and database methodology Rx PROvisions, Inc has used successfully for the last twelve years to comply with operational requirements for work we have done for the State of New Jersey, our pharmaceutical clients and for healthcare providers nationwide.

Upon receipt of an order for prescription forms via mail fax or e-mail, Rx PROvisions, Inc. enters the order data into a password protected electronic database, by healthcare provider. The entry includes the order date, practice name and practitioner, complete address, phone (fax if applicable) payment method (check, credit card), the prescription form quantity and type and the assignment of a unique RXP number or Batch Number, that corresponds to each order.

The RXP prefix identifies Rx PROvisions, Inc. as the producer of the prescription forms. The unique RXP number is printed on every prescription form printed for that order. Each unique RXP number has 12 digits. The first 6 digits provide the date the order was produced. The next four numbers refer to the actual order in the database. The last 2 digits are the number of orders placed by the healthcare provider during the calendar year.

The prescription form database is perpetual and holds prescription order records and financial transactions by physician for a moving 10 years. All electronic data is secured with a daily scheduled back up. Two back up copies of the electronic back-up data are produced and kept in two separate secure locations. The hard copy (order forms from clients) is filed by physician, bound and stored for a moving 5 years as hard copy. These records are kept in a secure dry site

Rx PROvisions, Inc. will make available on demand to the Department of Professional/Financial Regulation any and all data (electronic and or hard copy) relating to any order from any MAINE health care provider. In the event of a recall or any other emergency, these data can be used to reach all healthcare providers who have received prescription forms from Rx PROvisions, Inc.

Reports will be produced on demand in an electronic format to reflect the practitioner, order dates, prescription form quantities ordered, tracking number information and any additional information we have in our database from orders received from MAINE healthcare providers.

The contact person for such information is Joseph J. Pisano, President, Rx PROvisions, Inc. 166 Main Street, Suite 3, Lincoln Park, NJ 07035 or by calling 973.305.8105 Monday thru Friday, 9am to 5pm (est.). All electronic records can be produced within 24 hours.

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Rx PROvisions, Inc. has been producing prescription forms for the past twelve years. If the sample prototype is acceptable by the Maine Board of Pharmacy, Rx PROvisions, Inc. is ready to produce tamper resistant prescriptions for MAINE healthcare providers. Orders will be entered as described above and prescription forms can be produced in 24 hours.

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Our prescription form order process requests information from the healthcare provider that we use to verify their identity and authority as a Prescriber or licensed healthcare facility. We also request their current prescription form which is also used to verify, update and to format their prescription form.

Our order process also requires the name and phone number of the person who is placing the order for tamper resistant prescriptions on behalf of the Prescriber, if applicable.

Rx PROvisions, Inc. will use the Maine Board of Licensure website (), to verify the practitioner’s license status to prescribe controlled substances in Maine

Rx PROvisions, Inc also uses DEA to verify DEA numbers. The DEA database contains over 1.2 million records and is updated monthly by the DEA.

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Our current business model is designed to handle up to 200,000 healthcare providers.

Our production capacity is designed to be perfectly scalable to satisfy demand. We receive an average of two or more orders each year from over 100,000 physicians in our database.

We have additional plant capacity right now to produce tamper resistant prescriptions for an additional 10,000 physicians each month. The average time from receipt of order to shipment of the product is from 24 hours to 48 hours.

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General Statement: Rx PROvisions, Inc was incorporated on August 15, 1995 and created and patented our “Rx Fingerprint” trademark to communicate our security position in the marketplace. Rx PROvisions, Inc. is a privately held company that serves the healthcare industry nationwide. The products produced by Rx PROvisions, Inc. include; personalized tamper resistant prescription forms, diagnostic forms and other office practice forms that are used and consumed by healthcare providers in conjunction with patient care.

In 1997 when the State of New Jersey adopted a security prescription law to reduce prescription fraud, Rx PROvisions, Inc. completed and submitted a vendor application. On July 14, 1997, our firm was approved (see copy of approval letter) as a licensed vendor to provide New Jersey uniform prescription blanks in response to the new law requiring physicians to use security prescriptions. An example of the NJ Rx form is enclosed.

The fiscal impact of the new law was highlighted in an earlier report in June 1996 by the NJ Department of the Treasury. The report estimated that the NJ security prescriptions would save the State approximately $1.5 million annually by reducing fraud in the Medicaid, Pharmaceutical Assistance to the Aged and Disabled (PAAD), and general public assistance programs.

Our tamper resistant stock is our design and is produced exclusively for our use in the production of prescription forms. Our trust is at the heart of any document of value, which the counterfeiter tries to undermine not just in monetary terms but also in fundamental public confidence. To preserve that trust, Rx PROvisions, Inc. uses several security features including interactive thermal sensitive ink as part of the healthcare providers personalized prescription form production process.

We continue to search for new security features we can add to our Rx forms and we will keep you informed of the success we have in our perpetual effort to save healthcare dollars lost to prescription fraud each year.

I certify that the foregoing information provided in the above responses is true and accurate.

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Name Date

Title____________________________________

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