CMS finalizes Medicare e-prescribing standards

December 12, 2005

The foundation standards that will govern electronic prescribing in Medicare have been finalized by the Centers for Medicare & Medicaid Services.

The foundation standards that will govern electronic prescribing in Medicare have been finalized by the Centers for Medicare & Medicaid Services.

The final e-prescribing foundation standards cover transactions between prescribers and pharmacies for new scripts; refill requests and responses; prescription change requests and responses; prescription cancellation requests and responses; and related messaging and administrative transactions. The rule applies to the Medicare Part D prescription drug program and will take effect Jan. 1. It mandates that drug plans must support the standards but makes e-prescribing voluntary for physicians and R.Ph.s.

The foundation standards are a "huge step" for the electronic prescribing industry, said Kevin Hutchinson, president/CEO of the e-prescribing firm SureScripts, which was created by the National Community Pharmacists Association and the National Association of Chain Drug Stores.

Another plus for SureScripts is that the final rule preempts state laws, which have been a barrier for the company in trying to do business in some jurisdictions. "The finding that a network, such as SureScripts, will be allowed in the states for processing transactions is great news," said Hutchinson. "In some states there were some issues with the word 'intermediary' that prevented SureScripts from launching its service. The final rule clears that up and allows us to launch in those markets now."

The 27-page final rule, which was published in the Nov. 7 Federal Register, also banned commercial messaging during the e-prescribing process. "In the regs, they used the example that pharmacies could not advertise or provide commercial messages to try to influence [a prescriber's] decision-and that includes mail order," said Hutchinson. "They specifically reference those types of messages as inappropriate in the prescribing process."

The downside for SureScripts is that the rule left wiggle room for continued use of faxes instead of mandating true computer-to-computer e-prescribing. "My disappointment is that they still allow faxes," said Hutchinson. "When you're trying to enforce the use of standards, it's very important to not have the out that a fax is still OK. I believe their intent is to allow that during a transition period. Ultimately there will be enforcement of the use of the standard."

The CMS final rule on the e-prescribing foundation standards applies only to health plans in the Medicare Part D drug benefit. But in reality the standards are the solution for the industry as a whole, said Lynne Gilbertson, NCPDP director of standards.

"There weren't any real surprises in the final rule, and everybody is getting ready to roll," said Gilbertson. "We did an informal poll at a recent meeting, and most were coding or finishing coding and starting to test. Everyone has known it was coming and saw the benefits. Sometime in December, people are supposed to be notified about the e-prescribing pilots for all the information that wasn't named in the final rule. In January or February, all those pilots will start executing."

The medication history transaction and formulary and benefit standard developed by RxHub were not named as foundation standards, although they had been vetted by NCPDP, said Gilbertson. "However, they are both published and ready to go for the pilots," she added.

Questions remain about which version of SCRIPT the industry should use. The foundation standard names version 5.0, but the industry has already moved on to version 8.1. "As we learned from HIPAA (the Health Insurance Portability & Accountability Act), it can take about four years to get a version named-and that is not acceptable in the e-prescribing world," Gilbertson said.