Medicare Compliance & Reimbursement

One thing is for sure: You'll still be on your own with prior authorization.

Looking for information about how electronic prescribing might help you? The feds' test flight of related standards provides a few insights.

Basics: The goal of the government's five pilot projects on e-prescribing was to explore how the proposed standards worked--or didn't work--in a variety of practice settings, across a number of geographic areas, and using several different e-prescribing technologies. Researchers also looked at how well the standards handled Part D claims information and the standards' effect on prescribing behavior, work flow and patient safety. In addition, the programs evaluated whether the new standards would work well with the so-called foundation standards for e-prescribing implemented last year.

Here's a look at the progress--and problems--related to e-prescribing and the related standards so far:

• The proposed formulary and benefits standards work, but some kinks remain. For the most part, research demonstrated the interoperability of the proposed formulary and benefits standard, but some issues need to be resolved. The main concern: In some cases, it was difficult to match patients correctly to their health plans, the report stated.

• Paper prescriptions didn't disappear. Another important finding from these groups is that in almost no setting did e-prescribing replace the need for paper-based prescribing, researchers note. Why? Factors cited in the report include the inability to manage future orders electronically, the inability to submit Schedule II controlled substance prescriptions using the SCRIPT standards, and the time pressures that prescribers feel.

• Not all workflow changes were positive. E-prescribing had the potential to dramatically change pharmacy work flow, and researchers allow that in several cases the consequences were negative. For example, two sites mentioned that pharmacies were unable to transfer received SCRIPT messages to their pharmacy system. "Additional studies of outpatient pharmacies, with communication to pharmacy information systems vendors, are needed," the researchers conclude.

• The standard for handling patients' instructions for medication use did not fare well during testing. In part, that's because there is little consensus on a standard vocabulary for such instructions, the report stated. The standard, known as "Structured and Codified SIG," is not ready for implementation under Part D.

• The standard used to identify drugs didn't pass the test. The standard, RxNorm, relies on National Drug Code (NDC) identifiers to create a uniform way to identify drugs and dosages. The pilot programs encountered errors in identifying drugs through RxNorm, the report notes, and the system was unable to deal consistently with pharmacy-compounded preparations.

• Prior authorization standard will take time. Part D needs are so complex that researchers may be in for a long wait on this standard.

• Patients aren't convinced. Pilot project participant SureScripts addressed patient satisfaction using a combination of focus [...]