Pharmacists rally for tougher e-prescribing rules

By Bernie Monegain
10:34 AM

The country's community pharmacists are calling on the government to strengthen e-prescribing requirements, arguing the standards are too low.

The National Community Pharmacists Association (NCPA) testified Monday at a workgroup of the Health Information Technology Policy Committee Information Exchange on the experiences of independent community pharmacies in accepting e-prescriptions from physicians.

"Community pharmacists have a vested interest in making e-prescribing work because it potentially provides more accurate and faster electronic transmittal to pharmacists of computerized prescription information than written prescriptions," said Bruce T. Roberts, NCPA executive vice president and CEO. "However, challenges remain in the adoption and implementation of this technology, which is why I hope our recommendations to the Information Workgroup and the HIT Policy Committee are ultimately embraced."

CMS should strengthen e-prescribing requirements

NCPA told the panel that there is a related equity and effectiveness concern regarding standards that providers have to meet in CMS' Physician Fee Schedule and Part B Rule for CY 2010 to be considered "successful e-prescribers," and thus eligible to receive incentives/avoid penalties.

CMS now requires that a prescriber has to e-prescribe 25 times during the 2010 reporting period to be eligible for the incentive of 2 percent of all total estimated allowed charges covering all professional services furnished during the same period.

"That level of e-prescribing is too low," the NCPA noted in its written testimony.

The group gave several reasons why:

  • It is not balanced to reward providers with a generous e-prescribing bonus for conducting minimal levels of e-prescribing, while pharmacies and pharmacists receive no federal bonus for doing so;
  • It is an unsound use of taxpayer funds to provide such large sums of money for what might be an overall very small driving force to promote e-prescribing;
  • The physician e-prescribing eligibility level is so low that it might actually discourage an increase in e-prescribing by some providers, as some physicians might have been prepared to conduct much higher levels of epPrescribing, but would now be glad to be able to continue with their traditional paper and fax prescribing methods (except for in a very limited number of cases); and
  • The low physician e-prescribing eligibility level will likewise discourage both more participating pharmacists, and also greater participation by those pharmacists, as they will be discouraged from spending the funds and taking the time necessary to e-prescribe, when they believe - perhaps correctly - that physicians will not significantly increase their level of e-prescribing, and thus the pharmacy's efforts will not be worthwhile and will provide no real benefit to the patient.

Also, the NCPA said pharmacists were disappointed that government incentives were directed solely at physicians and not at pharmacists.

"E-prescribing is intended to foster better, quicker, safer, more efficient and less costly communications between providers and pharmacies/pharmacists regarding patient prescriptions," wrote the NCPA. "We hope the workgroup can therefore understand that pharmacists - particularly independent pharmacists - were disappointed that MIPPA (Medicare Improvements for Patients and Providers Act) provided incentives in 2009 - 2013 for physician providers to e-prescribe (and penalties in 2012 - 2014 for failure to do so), yet did nothing to encourage or facilitate e-prescribing on the pharmacist side of the relationship. The imbalance is of concern not only on the basis of equity and fairness, but also in light of effectively encouraging a robust system of e-prescribing. This lack of a parallel incentive for pharmacists in effect may create disincentives to them working with prescribers to promote e-prescribing."
NCPA's statement started by saying, "NCPA has always been a strong advocate for e-prescribing and we have spearheaded its growth by forming, along with NACDS, Surescripts, which is the nation's largest electronic prescribing network.

"While the volume of electronic messaging has increased from 120 million to 800 million over the last three years, Surescripts reports that the percentage of independent pharmacies that can currently accept electronic prescriptions (i.e., are connected) is only 60 percent."