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Medicare Drug Program News
Medicare Says New Rule Supports More Generics, Less
Drug Danger, Better Communications
Rule establishes Part D e‑prescribing standards for
four types of information
April 4, 2008 – Senior citizens and others eligible
to enroll in Medicare’s prescription drug program are expected to
experience greater safety, increased use of lower-cost generic drug
equivalents, and better communication between their doctor and pharmacy
as a result of a new regulation issued yesterday, according to the
Centers for Medicare & Medicaid Services (CMS).
The final rule establishes Part D e‑prescribing
standards for four types of information: formulary and benefits,
medication history, fill status notification, and identification of
individual health care providers.
“Establishing standards for e-prescribing under
Medicare’s prescription drug program will help pave the way for
widespread adoption of e-prescribing throughout the medical community.
Broader use of e-prescribing offers beneficiaries safer and more
efficient care at lower costs,” Health and Human Services Secretary Mike
Leavitt said.
Prescribers, dispensers and other providers are not
required to implement e‑prescribing, but those who do must comply with
the new Medicare standards when using e-prescribing to send
prescriptions and prescription related information for covered drugs
prescribed for Part D eligible individuals.
“The Part D e‑prescribing standards final rule
moves us closer to achieving interoperable health information
technology, one of the cornerstones of the Administration’s Value-Driven
Health Care Initiative,” said CMS Acting Administrator Kerry Weems.
“Converting from a paper-based system to e‑prescribing promises
improvements that will help prescribers, pharmacies, and all who are
eligible for Medicare’s prescription drug benefit. Most importantly,
e‑prescribing can help reduce the number of adverse drug events, which
have been estimated at 530,000 a year for Medicare beneficiaries.”
The rule adopts four standards for use in
e-prescribing:
● Formulary
and benefits: This standard
will allow doctors and other prescribers to communicate with Part D
sponsors about which drugs are covered by a Medicare eligible
individual's prescription drug benefit plan. Prescribers can also learn
which generic prescription drugs might offer lower-cost options for the
individual.
● Medication history: This standard will allow
doctors and other providers, as well as dispensers and Part D sponsors,
to communicate among themselves about prescribed medications a
beneficiary has taken or is taking, including those prescribed by other
providers. This information can help reduce the number of adverse drug
events that result from drugs negatively interacting with other drugs a
beneficiary is already taking, and can ensure that the doctor or other prescriber has the necessary information about a beneficiary’s current
prescription medications.
● Fill status notification: This
standard will allow doctors and other providers to receive an e-mail
notice from pharmacy or other dispenser telling them that a patient’s
prescription has been picked up, not picked up, or has been partially
filled. These notifications can help health care providers monitor
patients with chronic conditions, such as diabetes or hypertension, by
providing an indicator as to whether they are taking their medicines.
● Provider identifier: The final rule
requires providers, dispensers, and Part D sponsors to use the National
Provider Identifier (NPI) to identify individual health care providers
in Part D e‑prescribing transactions. Adoption of the NPI will speed
workflows by eliminating call-backs by pharmacies to medical offices to
verify the identity of individual prescribers.
“Use of these e‑prescribing standards by Part D
plan sponsors, providers, and dispensers will directly benefit Medicare
eligible individuals,” said Weems.
“They will save time both in their doctor’s office
and at the pharmacy counter. They may even see lower out-of-pocket
costs as a result of formulary and benefit information becoming
available at the point of care. Prescribers and dispensers will benefit
through workflow improvements -- freeing up time for interaction with
patients.”
The standards adopted under the rule will apply to
all Part D sponsors, as well as to prescribers and dispensers that
electronically transmit prescriptions and prescription-related
information about Part D covered drugs prescribed for Part D eligible
individuals.
Part D sponsors include freestanding Prescription
Drug Plan sponsors, Medicare Advantage-Prescription Drug Plans, and
other Part D sponsors. The new e-prescribing standards will be
effective on April 1, 2009.
The latest Part D e‑prescribing standards
supplement a set of “foundation” standards, published in November 2005,
which took effect with the start of Part D on January 1, 2006. Those
standards addressed the exchange of information among prescribers,
dispensers, and Part D sponsors on such matters as eligibility inquiries
and responses; new prescriptions; and changes, renewals, and
cancellations of existing prescriptions.
Testing of the new standards by providers and
pharmacies has shown that the standards can be easily incorporated into
existing e-prescribing systems and has also demonstrated their potential
to promote safer, more efficient prescribing practices.
This final rule on Part D e‑prescribing standards
(CMS-0016-F/CMS-0018-F) and the earlier final rule establishing
e‑prescribing foundation standards (CMS-0011-F) are available online at
http://www.cms.hhs.gov/EPrescribing/.
More information on HHS various health IT
initiatives is available at
http://www.hhs.gov/healthit.
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