HHS finalizes e-prescribing standards for Medicare drug plan

The Health and Human Services Department has announced the approval of a final rule to adopt foundation standards for the electronic prescribing of drugs under the new Medicare Part D plan.

The standards will be available for use when Medicare's new prescription drug benefit begins Jan. 1, 2006. HHS is expected to publish the final rule in the Nov. 7 Federal Register.

E-prescribing, which enables a physician to transmit a prescription electronically to the patient's pharmacy, can improve patient safety and reduce health care costs. It can also decrease prescription errors caused by illegible handwriting and communication errors, and automate the process of checking for drug interactions and allergies.

'These standards will allow Medicare, physicians, hospitals, group practices, other health providers, prescription drug plan sponsors and Medicare Advantage organizations to take advantage of e-prescribing technology to improve medication prescribing for Medicare beneficiaries that participate in the new prescription drug program,' said HHS Secretary Mike Leavitt in a statement.

E-prescribing also will enable pharmacies to obtain information from drug plans about a patient's eligibility. The pharmacy industry is already experienced with the foundation standards.

'We are making e-prescribing easier to implement, to accelerate the use of e-prescribing in Medicare and throughout the nation's health care system,' said Mark McClellan, administrator of the Centers for Medicare and Medicaid Services, an agency of HHS. All Medicare prescription drug plans must comply with the foundation standards.

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 created a new voluntary prescription drug benefit under Medicare. Although e-prescribing will be optional for physicians and pharmacies, Medicare will require drug plans participating in the new prescription benefit to support electronic prescribing.

The foundation standards cover:
  • Transactions between prescribers and dispensers for new prescriptions; refill requests and responses; prescription change requests and responses; prescription cancellation, request and response; and related messaging and administrative transactions

  • Eligibility and benefits queries and responses between prescribers and Part D sponsors

  • Eligibility queries between dispensers and Part D sponsors.

Medicare will test other initial e-prescribing standards for information on formularies, which are lists of the accepted drugs and their proper dosages, along with benefits, patient instructions, prior authorization messages and clinical drug terminology. These may be included in a final rule to be issued no later than April 1, 2008.

Collectively, these additional standards will make it easier to select, dispense and refill appropriate drugs reimbursed under the new Medicare drug benefit.

CMS awarded a grant to MedCo Health Solutions Inc. of Franklin Lakes, N.J., to evaluate the impact of the Southeastern Michigan Electronic Prescribing Initiative. This study will complement the pilot and should provide short-term lessons learned from one of the nation's largest e-prescribing programs.

About the Author

Mary Mosquera is a reporter for Federal Computer Week.

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