A New Push for Mandatory E-Prescribing

Sponsors of Part D plans are pressuring the Centers for Medicare & Medicaid Services (CMS) to shift its stand on e-prescribing, from encouraging physicians to voluntarily adopt the practice to mandating that they adopt it. "The time is now to require e-prescribing in Medicare. The only realistic way to rapidly accelerate adoption of e-prescribing is to require physicians to use the technology in Medicare," according to a statement released by the Pharmaceutical Care Management Association (PCMA). However, the AMA opposes such a mandate unless it includes federal grants or tax credits to help physicians pay for the necessary technology.

The desire of payers to have prescribers use e-prescribing to reduce the cost and improve the safety of ordering medications is not new. The latest lobbying effort was prompted by CMS's announcement that it is set to propose new technology standards that will enable practitioners to quickly check a patient's medication history, as well as the formulary and benefit design of his or her coverage. These standards will go hand-in-hand with those that went into effect on January 1, 2006, which covered transactions between prescribers and pharmacies.

To payers, however, the promulgation of the new standards provides CMS with the perfect opportunity to demand that they be used. The American Health Information Community, an advisory group established by HHS Secretary Michael Leavitt, also proposed making e-prescribing mandatory but would allow exceptions if HHS were persuaded that the requirement would be too burdensome for prescribers.

HHS calculates that 530,000 adverse events occur annually among the Medicare population because prescribers do not always have access to a patient's complete medication history and, as a result, order drugs that interact badly with the patient's other medications. New technology can alert physicians to such drug interactions and, HHS says, inform them when a generic form of a drug is available. But according to the PCMA, "fewer than 1 in 10 physicians have chosen to use it."

Getting CMS to mandate e-prescribing is an uphill battle. "I'm not yet to the point where we're going to use the payment system to coerce it," says CMS acting administrator Kerry N. Weems. The AMA argues that adoption figures are low because there has not been an effective push to make voluntary adoption work.

The AMA also maintains that there would be a significant increase in the number of physicians who would use the necessary equipment if practitioners received financial assistance when purchasing it; CMS adopted additional standards, thereby ensuring physicians that the equipment will not become obsolete quickly; and there is enough proof that the e-prescribing technology can live up to its claims. Another issue has affected the adoption of e-prescribing: in many areas, physicians have difficulty in getting sufficient computer bandwidth to use technology, a problem HHS says it is working on with the Federal Communications Commission.

Even without a mandate, CMS has taken another step to compel physicians to use e-prescribing. The agency has made final a rule proposed in July 2007 and set to go into effect on January 1, 2009, that will no longer allow pharmacies to be reimbursed for any Part D prescription that is delivered by computer-generated fax and that does not conform to the National Council for Prescription Drug Programs SCRIPT standard. When first proposing this rule, CMS admitted that most computer-generated fax prescriptions do not meet the standard and that by rejecting them, it hoped to encourage practitioners to move more quickly to e-prescribing.