Electronic prescribing may not be so voluntary

June 5, 2006

The Medicare Modernization Act (MMA) does not require pharmacies to participate in the electronic prescribing that is mandatory for Part D drug plans. But that doesn't mean plans can't make e-prescribing a provision in their pharmacy network contracts, warned a federal government pharmacist.

Under MMA, electronic prescribing is voluntary for physicians and pharmacists, but a lot of pharmacists want to know whether Part D plans could put out contracts requiring them to do e-prescribing, said Gregory Dill, Pharm.D., a health insurance specialist and pharmacist representing region V for the Centers for Medicare & Medicaid Services.

"Basically, the answer is Yes. Plans could make that a condition of participation," Dill told attendees at the recent American Pharmacists Association annual meeting in San Francisco. "It's not likely that they'll make that a condition right out of the box. Right now it's voluntary, but down the road it may not be. Seventy-five percent of pharmacies can pretty much do e-prescribing in some format already, but it's important for the other 25% that cannot."

"In other words, it's the complete Medicare universe," said Dill. "If those beneficiaries come into your pharmacy and you're working with a prescriber who wants to use e-prescribing, it means you have to follow these regulations."

Long-term care (LTC) pharmacies are exempt from the e-prescribing mandate for now, but that may change when a pilot test in Minnesota is completed, said Dill. The exemption was granted after LTC providers pointed out that the ambulatory e-prescribing model doesn't work in nursing homes. "They said that if it were made mandatory, it would not allow a facility to do its regulatory duty of drug review," he said. "We created the exemption, but I have a sense that's only temporary because we said we'd also do an LTC study to see how e-prescribing could be implemented. As we gather data, LTC will probably be involved in e-prescribing sooner rather than later."

The final rule also exempted computer-generated faxes after CMS considered public comments stating that a physician who uses computer software to create and fax prescriptions to a pharmacy is not really doing e-prescribing. CMS agreed that if those physicians were required to convert to e-prescribing, they would most likely just revert to paper scripts.

One area that is not exempt is state law, which is trumped by the MMA e-prescribing rule. Areas of federal preemption include state laws requiring handwritten signatures or the notation "dispense as written" on the face of the script. "As we find other issues, we will preempt them too," said Dill. "We want to move along the continuum from HIPAA [Health Insurance Portability and Accountability Act] to e-prescribing to electronic health records and the states are not going to get in the way."

Dill urged pharmacists to lobby their pharmacy boards to get them to adjust their state regulations to avoid a so-called Medicare silo, where pharmacists would have to handle scripts for Medicare-eligible patients under the federal set of rules and for other patients under the state's regulations.

"We urge states to enact legislation consistent with and complementary to the goals of the MMA e-prescribing provision and remove existing barriers," said Dill. "We really want you to work with your boards of pharmacy to educate them and make them aware of what preemption is. Let them know you don't want a Medicare silo."

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