Managed Care - February 2008 - (Page 47) seeking or transmitting prescription information for Part D drugs prescribed to Part D eligible individuals,” according to published CMS guidelines. Those standards are being developed — and it’s not easy. “We have taken an incremental approach,” says Trenkle. “Foundation transmission standards were available, based on National Committee on Vital and Health Statistics recommendations. Those standards had a history of experience that made it unnecessary to conduct pilot tests.” The three sets of foundation standards were published in the Federal Register in November 2005, and took effect for all Part D prescription drug plans (PDPs) that were implementing e-prescribing. The categories are: • Communication of prescriptions and prescription-related information between prescribers and dispensers. • Eligibility and benefits inquiries and responses between prescribers and Part D sponsors. At the same time, CMS recognized six “initial standards” for pilot testing, consistent with the MMA requirements. These were: • • • • • • Formulary and benefit information Exchange of medication history Fill status notification (named RxFill) Structured patient instructions (SIG) Clinical drug terminology (RxNorm) Prior authorization messaging New proposed law mandates Medicare e-prescribing he Medicare Electronic Medication and Safety Protection Act proposed in early December 2007 in the House and Senate would: T • Penalize doctors who write Medicare prescriptions by hand instead of electronically after Jan. 1, 2011. • Give physicians one-time Medicare grants to help offset the startup costs of e-prescribing. • Award bonuses to physicians for e-prescribing in Medicare. • Grant one- or two-year waivers to practices that face difficulties in acquiring and implementing e-prescribing technology, especially if they are rural, small, or solo practices. nicate about the list of drugs that have been dispensed to the patient. Three of the remaining initial standards (codified SIG, RxNorm, and prior authorization messaging) “require additional work before they could be proposed as final uniform standards,” Trenkle told the U.S. Senate in December. Five pilot sites were designated to test these initial standards, and as of now the results are incomplete. In November 2007, CMS told Congress that pilot testing had established that 2 of the 6 pilot-tested initial standards — formulary and benefit information and exchange of medication history — had demonstrated sufficient efficacy to be adopted. The proposed formulary and benefit standard provides prescribers with information about a patient’s drug coverage at the point of care. The goal is to enable the prescriber to take this information into account at the time of prescribing, which could reduce the amount of back-and-forth communication with the pharmacy or the health plan. The medication history standard provides a way for prescribers, dispensers, and payers to commu- Legal obstacle In addition to the development of standards, a significant legal obstacle exists: Federal law and many state laws prohibit the electronic transmission of any prescription for a controlled substance. Exemptions exist (for some cough medicines, for example), but until a uniform policy is adopted nationwide, many observers believe e-prescribing will not be universal. “We have been collaborating with the Drug Enforcement Administration in recent years to identify and adopt solutions that will allow for the e-prescribing of controlled substances consistent with the e-prescribing of non-controlled substances,” says Trenkle. In fact, CMS has been pushing the idea since July 2006 when HHS and DEA cosponsored a public meeting on e-prescribing of controlled substances and solicited input from stakeholders. “E-prescribing is a good idea,” says HealthSpring’s Sawyers. “And it will eventually be universal, I think. But getting there is arduous.” MC FEBRUARY 2008 / MANAGED CARE 47
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