To boost e-prescribing, Congress, in the 2003 Medicare Part D prescription benefit law, mandated that the government set national standards for information exchange among prescribers, pharmacists and payers. While physicians and pharmacists are not required to use e-prescribing for Part D beneficiaries, if they do they must use the government-designated standards.
An important fact about these standards, says Ken Whittemore, Jr., R.Ph., senior vice president of Alexandria, Va.-based SureScripts, is that by-and-large they are ones the industry was moving toward, or thinking about, for all of e-prescribing, anyway. SureScripts — a company that recently acquired Norcross, Ga.'s electronic prescribing network MedAvant Healthcare Solutions — carried out one of the recent trials for CMS.
Whittemore says, “Now that you have the federal government saying, ‘We like the direction that the industry has taken here, and we are throwing our weight behind it’, these standards are pretty much set nationwide.”
“None of the vendors that we certify, would we certify on anything but these standards … and I'm sure that other folks in this industry would take the same view. It really is kind of putting a stake in the ground for the entire infrastructure for e-prescribing,” he says.
For example, the three standards that just passed in the recent trials were each developed by the National Council for Prescription Drug Programs (NCPDP). Of those, the “formulary and benefit” standard displays formulary status, alternative drugs, co-pays and other status information. The “exchange of medication history” standard includes status, provider, patient, coordination of benefit, request and response segments. The “fill status notification” shows when the prescription is filled, not filled or partially filled.
The new standards are added to the three “foundational” standards which CMS deemed as having sufficient prior industry experience, published for comment and then made official in January 2006. Those standards are for eligibility communications between retail pharmacy dispensers and Part D sponsors; eligibility communications between prescribers and Part D sponsors, and for exchanging of new prescriptions, changes, renewals, cancellations and other transactions between prescribers and dispensers.
Whittemore expects CMS to publish a proposed rule and ask for comment on the latest three standards soon.
“In the meantime, I don't think the industry is waiting,” he says. “There are a lot of us using medication history and formulary benefit. And the issues around the prescription fill message are more process-oriented … . How exactly do you use that message? Is it a message you send to physicians when the patients get their prescriptions filled? Or is it when they have not gotten their prescriptions filled? And if so, how long a time delay?”
There were also three standards tested in the recent trial that were not accepted, but Whittemore feels two of those may be ready in somewhat more than a year. Those are the structure and codified signatura, which gives information like the indication, the dose, dose calculation, route, frequency and other factors. The other is the clinical drug terminology (RxNorm), which provides standard names for clinical drugs, dose forms as administered and links to other information.
He is less optimistic about quick development of the third, “prior authorization messages” which requires requester, subscriber and other information for prior authorization. Whittemore says, “There is a strong need for it, but it is a tough thing to tackle.”
The law requires a set of final, uniform standards to be promulgated by April 1, 2008, and that they be in effect not more than a year later.Kathryn Foxhall is a contributing writer based in Hyattsville, Md.