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New RxHub concept sparks some interest, some questions
A surprise move by the nation's three largest pharmacy benefit managers to create an industrywide electronic prescribing standard and data exchange is winning cautious support. The new company, dubbed RxHub LLC by founders AdvancePCS, Express Scripts, and Merck-Medco Managed Care, has also raised a flurry of questions.
"From a PBM standpoint, it sounds good," said William Lockwood, president of the American Association for Automation in Pharmacy. "But is it actually executable? Will physicians buy into electronic prescribing? Are pharmacists going to pay more transaction fees?" Lockwood credited PCS with the basic conceptlinking physician offices with PBMs the same way pharmacies and PBMs now communicate electronically. Using a wireless handheld device or a desktop computer, the physician would check the patient's drug plan formulary, eligibility rules, and drug history before writing a script, then submit it to the pharmacy electronically.
The problem: There are no standards for e-prescribing and no infrastructure to connect physicians with PBMs or pharmacies. The answer: a joint venture company, RxHub, backed by $20 million each from the three founding PBMs. Their announced goal is to create both standards and infrastructure within 12 months. There's also a standing invitation to other PBMs and players in pharmaceutical and medical care to join the venture. The projected results: fewer telephone calls from R.Ph.s to physicians to switch products because of drug plan rules or drug interactions, no more medication errors due to illegible Rxs, shorter patient wait times in pharmacies, more time for R.Ph.s to spend with patients, and lower drug distribution costs.
RxHub parallels many of the technology policy proposals up for debate at the American Pharmaceutical Association annual meeting in San Francisco this month. "Pharmacists currently are spending too much time puzzling out formulary and plan details rather than counseling their patients," said Lucinda Maine, APhA senior v.p. of professional affairs. "The players are ready for a change."
Richard Fry, senior director of pharmacy affairs at the Academy of Managed Care Pharmacy, said RxHub looks promising. "It's a step to reducing medication errors," he said. "That the PBMs have tried to develop standards as opposed to having them imposed from the outside is a strong plus."
The Institute for Safe Medication Practices also liked the RxHub concept. ISMP has called for the elimination of handwritten Rxs by 2003. "This should have a very positive effect because you eliminate that handwriting step," said ISMP executive director Allen Vaida.
But even groups that like the RxHub concept had concerns. Delbert Konnor, president and CEO of the Pharmaceutical Care Management Association, said the idea is wonderful, but he's worried about competition and confidentiality. Among them, the three companies backing RxHub process more than one billion Rxs annually, they claim. Their health plan clients cover more than half of all Americans with a prescription drug benefit. "There is a concern that these three could come to control the entire Rx drug industry," Konnor said. There is also concern about costs. In announcing RxHub, the three founding firms said they expect to recoup their $60 million investment through transaction fees. Pharmacies, PBMs, and others are expected to shoulder these costs.
State regulation is another immediate issue. Vaida noted that some pharmacy boards do not recognize electronic signatures. Others require paper backup for some or all electronic Rxs. According to the National Association of Boards of Pharmacy, 12 states restrict e-prescribing in some or all situations. Another 11 states have yet to address e-prescribing. "This will force states to address the issue," Vaida said. "They'll have to come up with regulations to deal with technology."
There are also questions about freedom of pharmacy choice. The National Association of Chain Drug Stores lauded the use of technology to streamline the prescribing process but warned against using physician-pharmacy links to direct prescriptions to specific distribution channels or outlets. "It's important that patients be able to continue to use the pharmacy of choice and maintain the relationships they have formed," said NACDS v.p. of public relations Phil Schneider. "The more you can utilize technology to free time, the better, but you can't let technology run health care. You still have to have that personal interaction among patient, pharmacist, and physician."
Fred Gebhart. New RxHub concept sparks some interest, some questions.