E-PRESCRIBING TOOLS TO HELP PREVENT ADVERSE DRUG INTERACTIONS
NEW MEDICARE STANDARDS WILL HELP DOCTORS OFFER LOWER-COST GENERIC OPTIONS WHEN WRITING A PRESCRIPTION

People who are eligible to enroll in 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 today 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 health care 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,” Health and Human Services Secretary Mike Leavitt said.

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. 

“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.   Most importantly, e‑prescribing can help reduce the number of adverse drug events, which have been estimated at 530,000 a year for Medicare beneficiaries.”

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

• Formulary and benefits: This   standard will allow doctors and other prescribers to 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 for the individual.
• Medication history: This standard will allow doctors and other providers, as well as dispensers and Part D sponsors, to 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 other prescriber has the necessary information about a beneficiary’s current prescription medications.
• Fill status notification: This standard will allow doctors and other providers to receive an electronic notice from the 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 health care providers monitor patients with chronic conditions, such as diabetes or hypertension, by providing an indicator as to whether they are taking their medicines.  
• Provider identifier: The final rule requires providers, dispensers, and Part D sponsors to use the National Provider Identifier (NPI) to identify individual health care 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.

“Use of these e‑prescribing standards by Part D plan sponsors, providers, and dispensers will directly benefit Medicare eligible individuals,” said Weems.   “They will save time both in their doctor’s office and at the pharmacy counter.  They may even see lower out-of-pocket costs as a result of formulary and benefit information becoming available at the point of care.  Prescribers and dispensers will benefit through workflow improvements -- freeing up time for interaction with patients.”

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.   Part D sponsors include freestanding Prescription Drug Plan sponsors, Medicare Advantage-Prescription Drug Plans, and other Part D sponsors.   The new e-prescribing standards will be effective on April 1, 2009.

The latest Part D e‑prescribing standards supplement a set of “foundation” standards, published in November 2005, which took effect with the start of Part D on January 1, 2006. Those standards addressed the exchange of information among prescribers, dispensers, and Part D sponsors on such matters as eligibility inquiries and responses; new prescriptions; and changes, renewals, and cancellations of existing prescriptions. Testing of the new standards by providers and pharmacies has shown that the standards can be easily incorporated into existing e-prescribing systems and has also demonstrated their potential to promote safer, more efficient prescribing practices. 

This final rule on Part D e‑prescribing standards (CMS-0016-F/CMS-0018-F) and the earlier final rule establishing e‑prescribing foundation standards (CMS-0011-F) are available online at http://www.cms.hhs.gov/EPrescribing/.

More information on HHS’ various health IT initiatives is available at http://www.hhs.gov/healthit.

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