Medicare Compliance & Reimbursement

If this year's Medicare prescription-drug legislation becomes law, expect the country to shift wholesale to electronic prescribing within a few years. Both the House and the Senate legislation call for quick initiation of a standards-setting process for electronic prescribing. Senate legislation would give plans, providers, and patients significant leeway to delay or avoid making the shift. But the House bill would require health plans that deliver the drug benefit to Medicare beneficiaries to implement electronic prescribing in short order. Under the House bill, in entities offering the drug benefit "prescriptions must be written and transmitted electronically" - but not by fax machine - "except in emergency cases and other exceptional circumstances." Health plans would need e-systems that could provide docs with prescription-relevant information "to the extent feasible ... on an interactive, real-time basis." Prescribers would get drug information; "information relating to the medical history or condition of the patient that may be relevant to the appropriate prescription"; any cost-effective alternatives to a proposed prescription; and formulary information. Under the Senate bill, plans wouldn't have to participate in e-prescribing, nor would providers or patients, though their participation would be encouraged through federal standards development. If Senate language were adopted, patients could get a written prescription by asking and couldn't be charged more for it. And standards would have to be developed that "do not impose an undue administrative burden on the practice of medicine, pharmacy, or other health professions," a loophole that appears large enough to drive your neighborhood CVS through. People and organizations that did opt for e-prescribing would have 24 months after finalization of standards to comply with them; small health plans would have 36 months. Under the House bill, standards would be promulgated and the requirements would begin on January 1, 2006 for Medicare plans providing drug coverage, the same time as the drug benefit proper is scheduled to commence. So far, interest groups haven't zeroed in on the provision as a major source of concern. The National Association of Chain Drug Stores has noted some worries, however. One is whether we're technically up to the quick implementation time frames Congress envisions. NACDS is concerned "that technology today will not support real-time transmittal of information." The druggists also worry about pharmacists' potentially declining clout in an e-system. NACDS's outline of Medicare-bill issues notes that final language shouldn't allow "interference" in "the physician-pharmacist-patient relationship" by third-party health plans or pharmacy benefit managers, and shouldn't encourage transmission of so much information to doctors that it "burden[s] physicians with information or responsibilities that are more appropriately the role of the pharmacist."