Merger, Medicare reform could mean broader e-prescribing adoption

August 11, 2008

The merger of e-prescribing networks RxHub and SureScripts may go a long way toward accelerating e-prescribing adoption, which could lower pharmacists' transaction fees, according to one expert.

Electronic prescribing took two big steps forward in July, most notably the merger of e-prescribing networks RxHub and SureScripts.

The merger combines the eligibility data of the 200 million people that are managed by the three biggest pharmacy benefit management (PBM) companies-CVS Caremark, Express Scripts, and Medco Health Solutions-with the SureScripts data that are related to electronic prescription routing from physicians to pharmacies.

Pharmacists react to merger

"So they have a monopoly now," Julie Schrantz, R.Ph., director of pharmacy services at Clinton Memorial Hospital in Saint Johns, Mich., said. "No one seems to realize we pay the cost of these transactions. This is happening on the backs of pharmacists."

The merged health information network functions as what organizers call a "cost-recovery model," based on the 21.5-cent transaction fee charged to software vendors for each new prescription and renewal. Those charges, at varying rates, are passed on to pharmacists, who also pay fees to PBMs and health plans for formulary inquiries.

"This is what concerns us," Schrantz said. "Physicians seem to have no idea that we pay for all this."

Streamlining that process, including initial application costs, will save time and money for the vendors and may make transaction fees passed to pharmacists more competitive, Little said. Several of the large chain drugstores have their own proprietary software, but independent pharmacists choose which software to purchase.

Studies have shown that e-prescribing saves pharmacists time on calls to physicians and improves workflow efficiency. "Pilots gave good indication that return-on-investment is there," Little said.

"We've been dating for a long time," Ratliff added. "There's been lots of conversation, it's been an on-again, off-again relationship. Now we have a marriage. The resulting large volumes will lead to decreased transactions fees."