Senate looks to boost e-prescribing


New federal leglsation would mandate electronic prescriptions, dividing healthcare providers even the practice gains more acceptance.

An increasingly diverse collation of groups is pushing hard to increase adoption of electronic prescriptions. The uncommon alliance of pharmacy organizations, pharmacy benefit managers, and consumer organizations is pushing the Centers for Medicare & Medicaid Services, the Drug Enforcement Administration, and federal lawmakers to take steps to increase the use of e-prescriptions.

The bill stops short of mandating e-prescribing and instead focuses on providing additional incentives for physicians to use the new technology. According to the bill, prescribers could receive a $2,000 bonus to cover start-up costs after reaching a threshold number of e-prescriptions that would be determined by CMS. In addition, physicians would be in line to receive a 1% higher reimbursement for using e-prescriptions.

For now the focus is on getting prescribers on board. "We support any incentives the government can provide," said Kevin Nicholson, VP of pharmacy regulatory affairs at the National Association of Chain Drug Stores. "E-prescribing has the potential to provide so many benefits. It streamlines the prescribing process, prevents transcription errors at the pharmacy level, and patients are more compliant," said Nicholson.

Other groups had been hoping the bill would move from providing incentives to mandating the use of e-prescriptions. The Pharmaceutical Care Management Association has been pushing for legislation to mandate the use of e-prescriptions by running television and print advertisements. In addition, the American Health Information Community, an advisory panel convened by Department of Health & Human Services Secretary Michael Leavitt, has joined the chorus, urging Leavitt to mandate the use of e-prescriptions in the Medicare program.

The lack of DEA policies regarding e-prescribing of controlled substances (EPCS) is considered a key hurdle to more widespread adoption. Many e-prescription advocates note that doctors are unlikely to adopt the technology wholeheartedly before a system can be put in place that also satisfies DEA requirements. At a December Senate Judiciary Committee hearing, Joseph T. Rannazzisi, deputy assistant administrator of the DEA office of diversion control, assured the committee that DEA was dedicated to issuing e-prescription rules but refused to set a timeline.

Following the hearing, Senator Sheldon Whitehouse (D, R.I.) wrote a letter co-signed by 18 other Senators urging Attorney General Michael Mukasey to take action. "DEA regulations permitting electronic prescribing have been delayed for years," he insisted. "We urge your prompt attention to this matter, and request that DEA issue regulations for electronic prescriptions for controlled substances as quickly as possible."

CMS overcame a different hurdle for e-prescribing by taking another step in establishing standards for the technology. CMS recently proposed implementing new standards governing formulary and benefits data and medication history. The move keeps CMS on track to have a final standard ready to be implemented by April 1, 2009, as required by the Medicare Modernization Act.

The rule has drawn positive responses from e-prescription companies. "When CMS puts a stake in the ground and says we view this standard as ready for prime time, that encourages the industry," said Ken Whittemore, R.Ph., SureScripts' senior VP clinical practice integration.

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