Medicare Compliance & Reimbursement

Don't let costs drive you away.

Keep electronic prescribing on your Part D radar screen, or you could fall behind the times--and behind the competition.

The Centers for Medicare & Medicaid Services (CMS) and Congress are among the powerhouses pushing pharmacists, physicians and others toward a future were e-prescribing is the norm, not the exception, notes Claudia Schlosberg, attorney and partner with the Health Law Practice of Blank Rome in Washington, DC.

In April, a report from the Department of Health & Human Services to Congress pushed e-prescribing under Part D into the near future. Touting evidence that electronic prescribing cuts errors and costs, the report highlighted findings from five federally funded pilot projects and endorsed the adoption of three additional standards for the electronic submission of prescriptions under Part D.

The new standards will complement the so-called foundation standards already in place. The foundation standards provide a uniform system for communications between prescribers and pharmacies regarding new and refilled prescription processing--and also allow communication about eligibility queries among prescribers, pharmacies and Part D prescription drug plans (PDPs).

The three new standards ready for Part D prime time, according to the report, are

1. Medication history,

2. Patient health plan drug formulary and benefits, and

3. Prescription-fill status.

More to come? Implementation of three other proposed standards studied in the pilot projects should be delayed, pending further evaluation, the researchers concluded. These potentially problematic standards involve: 1) prior authorization, 2) a patient-instructions format for how much and how often a patient should take his prescribed medication and 3) standards for a drug name, dose and form.

Tripping point: The complexities of the Part D prior authorization process made the proposed prior authorization standard impractical, insiders say.

Prescription For Change

The Part D standards, the feds hope, will reduce barriers to e-prescribing adoption by helping the marketplace decide which standards are most effective, explains Schlosberg. The Medicare Prescription Drug Improvement Modernization Act of 2003 (MMA) started the move toward e-prescribing standards, calling for the HHS Secretary to adopt standards to enable e-prescribing for the Medicare Part D program.

Important distinction: The MMA doesn't mandate that Part D prescriptions be filed electronically by 2008, but the Medicare Part D final rule says that all prescribers and dispensers who choose to send or receive prescription-related information electronically for covered Part D drugs for Part D eligible individuals must comply with adopted standards.

Gear up: The final rule implementing the standards is expected no later than April 1, 2008.

Even without Part D pressures, pharmacists and others are heading toward a future of e-prescribing. In its 2006 report "Preventing Medication Errors," the Institutes of Medicine recommends that all prescriptions in the United States be written and received electronically by 2010. Managed care is also a driving force.

Paying for the right to receive a prescription (which you must do in order to process electronic prescriptions) is a stumbling block for some pharmacists reluctant to make the leap. Costs per prescription received electronically range from about 20 cents to 50 cents, but streamlining tasks can create efficiencies that often offeset those costs.

Benefits: Independent pharmacists who use e-prescribing report that benefits outweigh the costs.

E-prescribing has helped lighten administrative tasks, saved time and helped eliminate errors, reports Diana Courtney, a pharmacist and owner of Lake Shore Pharmacy in Portland, OR.

Bottom line: Prescriptions and related information for covered Part D drugs that are transmitted electronically must soon comply with final uniform standards.