The Legislative Push For E-Prescribing

The Medicare Electronic Medication and Safety Protection Act

Chrissy Spicer, GP and Compliance Specialist
chrissyspicer@cis-partners.com

Electronic prescribing (e-prescribing) is defined as the use of an automated data entry system to generate a prescription, rather than writing it on paper. Over time, e-prescribing is expected to mitigate the risk of adverse drug events, provide significant cost savings, and reduce error in prescription adjudication. Despite the considerable benefits realized through the adoption of the automated e-prescribing tools, many physicians are reluctant to deploy the new standards, and in response to lack of movement to adopt e-prescribing standards, lawmakers are pushing the Medicare Electronic Medication and Safety Protection Act.

According to the report titled Findings From The Evaluation of the E-Prescribing, prepared by National Opinion Research Center (NORC) (2007), experts predict that migrating towards automated e-prescribing solutions could avoid 2 million adverse drug events annually, of which 130,000 are life threatening. Additionally, experts suggest a cost savings at $27 billion per year in the United States.

In the article “Congress Considers Mandate for Medicare E-prescribing,” Hansen (2008) suggests that congressional patience with the pace at which physicians are adopting electronic prescribing seems to be wearing thin and in response to such, House and Senate lawmakers have introduced legislation that would mandate e-prescribing for Medicare beginning in 2011.

In the Medicare Prescription Drug Improvement and Modernization Act (MMA) of 2003, Congress mandated that all health plans and pharmacies participate in the Medicare Part D program and support e-prescribing. However, the support was not enough to influence physicians to adopt the e-prescribing program. On December 5, 2007, Congress introduced the Medicare Electronic Medication and Safety Protection Act. In summary, the legislation not only supports the e-prescribing program, but mandates the use of e-prescribing tools for all prescriptions after January 1, 2011, and failure to adopt e-prescribing methods will result in fines. The Act also provides Medicare grants to physicians to help off set the start up cost of deploying e-prescribing programs.

CMS conducted pilots at 5 different sites to assess the feasibility and timing of implementing six initial standards that are potentially capable of supporting e-prescribing transactions in the Medicare Part D prescription drug benefit program.

According the Agency for Healthcare Review and Quality (AHRQ) and CMS’s review, the results demonstrated that three standards were ready and capable of supporting the Part D prescription program. The standards that are recommended as being ready to implement under the Part D program include:

Medication History: The Medication History standard is intended to provide a uniform means for prescribers, dispensers, and payers to communicate about the list of drugs that have been dispensed to a patient. This standard has proved to be useful in preventing medication errors, as well as understanding medication management compliance.

Formulary and Benefits: This provides prescribers with information about a patient’s drug coverage at the point of care, such as formulary coverage, alternative medication, step therapy, and the cost of one drug option versus another.
Prescription Fill Status Notification: The notification is an alert that is sent to the prescriber about whether a patient has picked up a prescribed medication at the pharmacy. This standard can help physicians address compliance issues with their patients.

The other three standards that were assessed are prior authorization, patient instructions for use of medication, and Rx Norm, which is a system designed for federal government entities that would provide standards for the name, dose, and form of available drugs; however, these standards were not recommended for implementation at the current state and require further development before being adopted.

Despite the overall health care industry consensus with the technological advancement and support of adopting e-prescribing tools, the report titled Pilot Testing of Initial Electronic Prescribing Standards-Cooperative Agreements Under Section 1860D-(4)(e) of the Social Security Act as Amended b6y the Medicare Prescription Drug, Improvement, and Modernization Action (MMA) of 2003, by Michael Leavitt (2007), indicates the adoption of e-prescribing tools have yielded limited results. The report mentions:

According to NCVHS testimony, in any given year physicians write over three billion prescriptions, and 65% of Americans take prescription drugs; however, according to industry surveys results provided to the NCVHS, only 5 percent to 18 percent of physicians use e-prescribing. A primary reason as to why fewer than 3 percent of all prescriptions are written with integrated e-prescribing systems is the lack of e-prescribing standards. NCVHS contends that the few standards that are available often are not published with sufficient precision to be implemented in a way that is truly standard (Leavitt, 2007, p.9).

Due to the industry-wide implications, this Act is one to keep on the radar. The bill’s sponsor said that if it did not pass in 2007, then this bill would eagerly be pursued in 2008. If passed, the bill would be a paradigm shift in the traditional prescription filling process and allow for access to information in real time to facilitate quicker and more informed decision-making at all levels.