What electronic prescribing software does
E-prescribing (eRx) software lets a prescriber create a prescription, check it against the patient's allergies and other medications, and send it electronically to the patient's pharmacy. Most products also support refill and change requests from the pharmacy, medication history and, when connected to payer data, formulary and benefit checks.
There are three layers to understand:
- Embedded eRx engines. Companies such as DoseSpot and DrFirst supply the prescribing module inside many EHRs, telehealth platforms and dental systems.
- What you actually use. For most practices this is the eRx screen in their EHR. Some use standalone prescribing applications such as DoseSpot's TreatRx, RXNT's eRx or DrFirst's products.
If you are choosing an EHR at the same time, compare e-prescribing as part of that decision. Our EHR software guide and shortlist of EHRs for small practices cover the broader choice.
EPCS: e-prescribing controlled substances
EPCS is governed by DEA rules (21 CFR Part 1311). The software must pass a third-party audit or certification for EPCS. Each prescriber must complete identity proofing, and every controlled substance prescription must be signed with two-factor authentication: two of something you know, something you have and something you are. Practices also need logical access controls so that two people approve who can sign controlled substance prescriptions.
Federal and state requirements now push most prescribers toward EPCS:
- Medicare Part D. Under the CMS EPCS Program, prescribers must send at least 70% of their Part D Schedule II-V prescriptions electronically. Prescribers who write 100 or fewer qualifying prescriptions a year are exempt automatically. As of measurement year 2026, the penalty for non-compliance is a notice from CMS, and further penalties would require new rulemaking.
- State laws. Many states, including New York, require electronic prescribing of controlled substances, sometimes of all prescriptions, with limited exceptions. Check your state board's rules.
How to choose e-prescribing software
- Surescripts connectivity, including new prescriptions, renewals, change requests and cancellations.
- EPCS included or priced clearly, with a workable identity-proofing process and a second factor your prescribers will actually use, such as a phone app or biometric.
- Clinical decision support: drug-drug, drug-allergy and dose checks that warn without overwhelming.
- Medication history and benefit checks, so you can see fill history and patient cost before sending.
- PDMP access. Many states require checking the prescription drug monitoring program before prescribing certain controlled substances. Integrated PDMP lookup saves clicks.
- EHR integration. Prescriptions should write back to the chart's medication list automatically.
- Compounds and specialty pharmacies if you prescribe them. Not every system handles compounded prescriptions.
E-prescribing software pricing
Prescribing is usually included in an EHR subscription, sometimes with an extra charge for EPCS. Standalone eRx is usually priced per prescriber per year. As of 2026, RXNT sells ePrescribing on yearly plans only and lists EPCS identity proofing and biometric authentication at $85 per year. ICANotes' prescribing plan for a full-time clinician is $213 per month, compared with $75 for its non-prescribing plan, which shows how much prescribing can add inside a specialty EHR. DoseSpot and Surescripts quote pricing. DocVilla advertises EHR and PM plans starting at $100 per month, but confirm which tier includes eRx and EPCS before you buy.
Implementation pitfalls
- Identity proofing delays. Every prescriber must complete identity proofing and set up a second factor before writing controlled substance prescriptions. Do this before go-live.
- Lost authentication devices. If a prescriber's phone or token is lost, EPCS stops for that prescriber. Have a recovery process.
- Medication list migration. When switching systems, active medications may need to be reconciled by hand so that refill requests match.
- Pharmacy directory errors. Make sure staff pick the correct pharmacy location. Wrong-pharmacy sends are a common, avoidable support issue.
Specialty considerations
Psychiatry and behavioral health prescribers write many Schedule II stimulant prescriptions and benefit most from smooth EPCS, PDMP integration and medication history. Behavioral health EHRs such as ICANotes and Valant include prescribing. Telehealth and concierge practices often use standalone or embedded eRx. Dental practices commonly get prescribing through an embedded engine in their practice software. Therapists and other non-prescribers do not need eRx and should avoid paying for prescriber tiers.
How we evaluate e-prescribing software
We check each product for Surescripts connectivity, EPCS support, decision support, medication history, PDMP access, EHR integration and pricing transparency, using vendor documentation and public pricing pages as of the update date. We do not publish hands-on test scores. PracticeAll helps small practices set up EPCS, including identity proofing and second-factor devices. Contact us if you need help.