Improved Safety, Communication Underlie Part D E-Prescribing Rule
The Centers for Medicare and Medicaid Services (CMS) has issued a final rule on e-prescribing standards for the Part D prescription drug program.
The rule, which appeared in the Federal Register on April 7 and becomes effective on April 1, 2009, adopts four standards for use in e-prescribing:
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Formulary and benefits: This standard allows doctors and other prescribers to communicate with Part D sponsors about which drugs are covered by a Medicare beneficiary's prescription drug plan. Prescribers can also learn which generic prescription drugs might offer lower-cost options for the individual.
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Medication history: This standard allows 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.
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Fill-status notification: This standard allows 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, has not been picked up, or has been partially filled.
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Provider identifier: Providers, dispensers, and Part D sponsors must use their National Provider Identifier (NPI) to identify individual health care providers in Part D e-prescribing transactions.
CMS says the standards will enhance safety, increase use of lower-cost generic equivalents, and improve communication between doctors and pharmacies. In a statement released with the new standards, CMS Acting Administrator Kerry Weems said they move the health care system closer to interoperable health information technology.
“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. [Beneficiaries] 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.”
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 for Part D eligible individuals and prescription-related information for covered drugs.
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.
This final rule on Part D e-prescribing standards and the earlier final rule establishing e-prescribing foundation standards are posted at<www.cms.hhs.gov/EPrescribing/>. The final rule is also posted in the Federal Register at<http://edocket.access.gpo.gov/2008/08-1094.htm>. More information on HHS's health IT initiatives is posted at<www.hhs.gov/healthit>.▪
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Published online: 16 May 2008
Published in print: May 16, 2008
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CMS's final rule governs four types of information that can be transmitted electronically: formulary and benefits, medication history, fill-status notification, and identification of providers.
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