Government proposes electronic-prescribing rules

March 7, 2005

The federal government has proposed rules for electronic prescribing in the Medicare prescription drug benefit and the verdict from the folks putting the technology together is that the bureaucrats got it right.

The federal government has proposed rules for electronic prescribing in the Medicare prescription drug benefit and the verdict from the folks putting the technology together is that the bureaucrats got it right.

Issued seven months ahead of the deadline set by the Medicare Modernization Act, the proposed e-prescribing rules will adopt standards for transactions between prescribers and pharmacies for new Rxs, refill requests and responses, Rx change requests and responses, Rx cancellation requests and responses, and related messaging and administrative transactions. The standards will also cover eligibility and benefit inquiries and responses between pharmacies and Rx plan sponsors, as well as formulary and benefit coverage information, including information on the availability of lower-cost, therapeutically appropriate alternative drugs.

The Centers for Medicare & Medicaid Services has backed the SCRIPT Standard developed by the National Council on Prescription Drug Programs (NCPDP) as a foundation standard for electronic prescribing. CMS also proposed setting next Jan. 1 as the compliance date for the foundation standards. Such a short deadline is feasible because there has been enough real world experience with the standards to skip the pilot-testing phase, according to the agency.

"The proposed rules are good news for us and good news for pharmacy," said Hutchinson. "After looking at the experience pharmacies and the industry have today, it's nice of CMS to accept that experience as the proposed standards and move on. If CMS had required pilots, people would take a pause. Before pharmacy would roll it out en masse, they would want to know for sure what the standard is going to be so they wouldn't have to retrofit. Now that we know that the standard will be the one we deployed, it enables us to accelerate our rollout."

The proposed rule is the starting point for electronic prescribing, and CMS cautioned that additional standards would be required to enable other functionality envisioned by the Medicare law. For example, the issue of how to identify providers and pharmacies has not been settled.

CMS is seeking comments on the proposed e-prescribing rule, posted on the Web at http://a257.g.akamaitech.net/7/257/2422/01jan20051800/edocket.access.gpo.gov/2005/05-1773.htm. The deadline for comments is April 5.