CMS issues final rule on e-prescribing

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The new e-prescribing standards will be effective April 1, 2009. Source: Physician's Weekly  

Eligible participants for the Medicare’s prescription drug program are expected to experience greater safety, increased use of lower-cost generic equivalents and more efficient communication between their doctor and pharmacy as a result of a new regulation issued Wednesday by the Centers for Medicare & Medicaid Services (CMS).

The final rule establishes Part D e-prescribing standards for four types of information: formulary and benefits, medication history, fill status notification and identification of individual healthcare providers.

“Establishing standards for e-prescribing under Medicare’s prescription drug program will help pave the way for widespread adoption of e-prescribing throughout the medical community. Broader use of e-prescribing offers beneficiaries safer and more efficient care at lower costs,” said Mike Leavitt, secretary of the department of Health and Human Services.

Prescribers, dispensers and other providers are not required to implement e-prescribing, but those who do must comply with the new Medicare standards when using e-prescribing to send prescriptions and prescription related information for covered drugs prescribed for Part D eligible individuals, according to the rule.

“The Part D e-prescribing standards final rule moves us closer to achieving interoperable health information technology, one of the cornerstones of the Administration’s Value-Driven Health Care Initiative,” said CMS Acting Administrator Kerry Weems.  “Converting from a paper-based system to e-prescribing promises improvements that will help prescribers, pharmacies and all who are eligible for Medicare’s prescription drug benefit.”

The rule adopts four standards for use in e-prescribing:

  • Formulary and benefits:  doctors and other prescribers can communicate with Part D sponsors about which drugs are covered by a Medicare eligible individual's prescription drug benefit plan. Prescribers can also learn which generic prescription drugs might offer lower-cost options.
  • Medication history:  doctors and other providers, as well as dispensers and Part D sponsors, can communicate among themselves about prescribed medications a beneficiary has taken or is taking, including those prescribed by other providers.  This information can help reduce the number of adverse drug events that result from drugs negatively interacting with other drugs a beneficiary is already taking, and can ensure that the doctor or prescriber has the necessary information about a beneficiary’s current prescription medications.
  • Fill status notification:   doctors and other providers can receive an e-mail notice from pharmacy or other dispenser telling them that a patient’s prescription has been picked up, not picked up or has been partially filled. These notifications can help healthcare providers monitor patients with chronic conditions by providing an indicator as to whether they are taking their medicines.  
  • Provider identifier:  providers, dispensers and Part D sponsors will be required to use the National Provider Identifier (NPI) to identify individual healthcare providers in Part D e-prescribing transactions. Adoption of the NPI will speed workflows by eliminating call-backs by pharmacies to medical offices to verify the identity of individual prescribers.

The standards adopted under the rule will apply to all Part D sponsors, as well as to prescribers and dispensers that electronically transmit prescriptions and prescription-related information about Part D covered drugs prescribed for Part D eligible individuals, according to CMS.

This final rule on Part D e-prescribing standards and the earlier final rule establishing e-prescribing foundation standards are available online.