HHS finalizes new standards for Part D e-prescribing

The Department of Health and Human Services (HHS) has finalized two changes in its e-prescribing rules for Medicare Part D, regulations that govern the standards for communications between dispensers and drug plans and for insurance eligibility inquiries and responses.

For the latter, HHS will adopt the ASC X12 standards for electronic data interchange, technical report type 3-health care eligibility benefit inquiry and response. The department will also adopt updated standards of the National Council for Prescription Drug Programs (NPCDP) for transmitting eligibility inquiries and responses between pharmacies and Part D plans.

In commenting on the proposal for these changes, one observer noted that HHS has not yet adopted standards for a clinical drug terminology, electronic prior authorization, or a structured and codified SIG format (i.e., instructions on the prescription label). HHS responded that "several of the necessary standards are still under development," including the prior authorization and SIG standards. "Thus, it would be premature for us to propose the adoption of standards that have been not fully developed and tested."

HHS announced the e-prescribing changes as part of a package of new rules that are supposed to cut red tape and save the healthcare industry more than $5 billion over 5 years.

The department has not responded to complaints from the American Medical Association that physicians have not been given enough time to avoid penalties for non-compliance with e-prescribing regulations. The AMA recently reminded doctors they have only until June 30 to send at least 10 prescriptions electronically so they can avoid having their Medicare payments reduced in 2013.

According to Surescripts, 58 percent of office based physicians, or 317,000 providers, prescribed electronically last year, compared to 10 percent in 2009, reports Drug Store News.

To learn more:
- read the HHS final rule on e-prescribing
- see the HHS announcement
- see the AMA letter
- see the Drug Store News article

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