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Payers Pitch Electronic Prescribing Mandate

By John Reichard, CQ HealthBeat Editor

November 15, 2007 -- The Centers for Medicare and Medicaid Services will propose new electronic prescribing standards for use in the Medicare program, leading lobbies that manage prescription drug benefits to call for a requirement for "e-prescribing" in Medicare.

The proposed standards aim to speed the use of handheld and other electronic prescribing technology to allow doctors to check a patient's prescription drug benefits, medication history, and formulary of covered drugs before prescribing a drug.

The standards would supplement those already adopted by the agency governing transactions between doctors and pharmacies to write and fill prescriptions, process refill requests, and change prescriptions, among other functions. These earlier standards took effect on Jan. 1, 2006. Medicare does not actually require doctors to prescribe electronically, but health and prescription drug-only plans that deliver the Medicare drug benefit must have the capacity to support e-prescribing and must abide by the CMS standards to do so.

The proposed regulation outlining the standards is scheduled to be published soon in the Federal Register. An estimated 530,000 "adverse events" occur yearly among Medicare patients because drugs interact badly or aren't appropriate given the patient's medication history, the Department of Health and Human Services said in a news release announcing the proposal. E-prescribing could not only reduce those errors but also save money by alerting doctors to the availability of lower-cost generic drugs, according to HHS.

Both the nation's Blue Cross–Blue Shield plans and the Pharmaceutical Care Management Association (PCMA) issued statements Wednesday saying it's time to take the next step and require doctors treating Medicare patients to prescribe electronically. Noting that the Institute of Medicine last year called for national adoption of e-prescribing by 2010, Blue Cross and Blue Shield Association President Scott P. Serota said physician adoption remains surprisingly low despite "concerted efforts" by his member plans and large employers to meet the 2010 deadline. "Seniors and disabled beneficiaries deserve to be protected from avoidable medication errors—and the solution starts with requiring e-prescribing in Medicare," Serota said.

Despite progress in developing standards that allow e-prescribing technology to function effectively, "fewer than one in 10 physicians have chosen to use it," said PCMA, which represents companies that make money by managing prescription drug benefits for insurers and employers. The lobby said the proposed standards announced by CMS "confirm that the time is now to require e-prescribing in Medicare." It added that "the only realistic way to rapidly accelerate adoption of e-prescribing is to require physicians to use the technology in Medicare."

Department of Health and Human Services officials said that adoption of e-prescribing would pave the way for adoption of other types of health information technology to reduce medical errors and duplicative testing and promote the use of the best clinical practices. Developing the e-prescribing standards "is one of the key action items in the federal government's effort to build a nationwide, interoperable electronic health information infrastructure in the United States," said CMS Acting Administrator Kerry Weems.

But Weems has said he does not support an e-prescribing requirement in Medicare. He asserted in September that the technology involved was not yet at a stage where a mandate would be appropriate. "I'm not yet to the point where we're going to use the payment system to coerce it," he said.

But groups representing consumers and senior citizens are joining with insurers and benefit managers to push hard to have a requirement for e-prescribing included in Medicare legislation to be considered later this year by Congress. AARP Policy Director John Rother said Thursday that a requirement offers an unusual opportunity to cut costs and improve quality at the same time. He predicted that such a requirement will be included in legislation under development by the Senate Finance Committee to block a scheduled 10 percent reduction in Medicare payments to physicians in 2008.

But doctors are balking at a mandate without higher Medicare payments and grant programs to help pay for the costs of the technology. In an Oct. 31 letter to Senate Finance Committee Chairman Max Baucus, D-Mont., AMA Executive Vice President Michael D. Maves outlined a legislative proposal calling for various steps to promote voluntary e-prescribing. The letter said that CMS has yet to adopt all the standards needed to promote e-prescribing, adding that such a step is necessary so that physician investments in the technology "will not be rendered obsolete overnight." Time also is needed to test e-prescribing systems to make sure they function well together. Maves predicted "more robust" adoption by doctors once those steps have been taken.

The CMS proposal takes the agency further down the road to a comprehensive set of national standards, but the AMA letter said one also is needed for "prior authorization." Such a standard would ease the use of e-prescribing to obtain health plan approval for drugs on a prior authorization list. The CMS proposal said that pilot testing "identified several issues that need to be addressed before this standard should be adopted."

Apart from the issue of standards, doctors and other providers also need greater computer bandwidth to use health information technology throughout the nation. Michael O. Leavitt also announced this week that HHS will work with the Federal Communications Commission on assuring broadband access in rural and urban areas.

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