CMS proposed rule updates e-prescribing standards to reduce provider burden

Doctor computer
The Centers for Medicare & Medicaid Services' proposed rule would implement new prior authorization transaction standards for the Part D e-prescribing program beginning in January 2021. (Getty/andrei_r)

The Centers for Medicare & Medicaid Services (CMS) plans to push forward on updates to electronic prescribing standards and the prior authorization process for Medicare Part D, the program that provides coverage for prescription drugs beneficiaries pick up at a pharmacy counter. 

A proposed rule released this week would implement key provisions of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. President Donald Trump signed the SUPPORT for Patient and Communities Act in October 2018 aimed at combating the opioid crisis.

CMS is proposing to update the Part D e-prescribing program by adopting standards that ensure secure transmissions and expedite prior authorizations, the agency said.

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The proposed rule would implement new prior authorization transaction standards for the Part D e-prescribing program beginning in January 2021. If finalized, all Medicare Part D plans would be required to support electronic prior authorization transaction standards that were developed by the National Council for Prescription Drug Plans (NCPDP).

These standards are currently in use by pharmacies and prescribers, CMS said.

Under the proposed change, clinicians would be able to complete prior authorizations online, reducing burden for providers through a more streamlined process for performing prior authorization for Part D prescriptions, CMS said. Clinicians who select the electronic option will typically be able to satisfy the terms of a prior authorization in real time and before a prescription is transmitted to a pharmacy.

RELATED: Congress reaches consensus on opioid epidemic legislation package

This change will help ensure patients do not arrive at a pharmacy counter only to find that their prescription cannot be filled, CMS said.

"The NCPDP SCRIPT Standard was designed  to support medication electronic prior authorization, the standard also supports features that minimize what the prescriber is asked, creating a customized experience based on earlier answers or data pulled using automated functions from their EHR system, which would  reduce the amount of time a prescriber or their staff spend reviewing  and responding  to the  PA questions," CMS said in the proposed rule.

As of Jan.1, 2020, plans will already be required to use the same standard for certain Part D specified transactions, CMS said. Giving plans an additional year to add electronic prior authorization to that list of other transactions would not be overly burdensome and will help ensure that the SUPPORT for Patients and Communities Act is implemented, the agency said.

"Improving patients’ access to prescription drugs is a top priority for CMS,” CMS Administrator Seema Verma said in a statement. "This proposed rule would reduce the time it takes for a patient to receive needed medications and ease the prescriber burden by giving clinicians the flexibility and choice to complete prior authorization transactions electronically.”

Industry leaders and drug safety experts have advocated for a mandate for e-prescribing for controlled substances as a way to combat the opioid epidemic. 

Mandatory e-prescribing was one of several recommendations outlined in a report released in October 2017 by the Johns Hopkins Bloomberg School of Public Health and the Clinton Foundation. According to the report, only 1 in 5 providers were able to prescribe electronically, and fewer than 15% of controlled substances were e-prescribed.

Twenty states have passed legislation requiring e-prescribing for all controlled substance prescriptions, and many other states are considering similar proposed mandates.

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