E-Prescribing

E-Prescribing

E-prescribing enables a prescriber to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point-of-care and is an important element in improving the quality of patient care. The inclusion of electronic prescribing in the Medicare Modernization Act (MMA) of 2003 gave momentum to the movement, and the July 2006 Institute of Medicine report on the role of e-prescribing in reducing medication errors received widespread publicity, helping to build awareness of e-prescribing's role in enhancing patient safety.  Adopting the standards to facilitate e-prescribing is one of the key action items in the Federal government’s plan to expedite the adoption of electronic medical records and build a national electronic health information infrastructure in the United States.

E-Prescribing and Related Standards in Proposed Rule CMS-4205-P

The proposed rule “Medicare Program; Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Health Information Technology Standards and Implementation Specifications,” (88 FR 78476) published November 15, 2023, contained provisions related to e-prescribing standards at 42 CFR 423.160, specifically:

  1. Withdrawing proposals from the proposed rule CMS-4201-P, “Medicare Program; Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, Medicare Parts A, B, C, and D Overpayment Provisions of the Affordable Care Act and Programs of All-Inclusive Care for the Elderly; Health Information Technology Standards and Implementation Specifications,” (87 FR 79452) published December 27, 2022, including:
    • After a transition period, requiring the National Council for Prescription Drug Plans (NDPDP) SCRIPT standard version 2022011 proposed for adoption at 45 CFR 170.205(b), and retiring the current NCPDP SCRIPT standard version 2017071, as the e-prescribing standard for transmitting prescriptions and prescription-related information (including medication history and electronic prior authorization (ePA) transactions) using electronic media for covered Part D drugs for Part D eligible individuals; and
    • Requiring the NCPDP Real-Time Prescription Benefit (RTPB) standard version 12 proposed for adoption at 45 CFR 170.205(c) as the standard for prescriber real-time benefit tools (RTBTs) supported by Part D sponsors.
  2. Requiring the NDPDP SCRIPT standard version 2023011 proposed for adoption at 45 CFR 170.205(b), and retiring the current NCPDP SCRIPT standard version 2017071, as the e-prescribing standard for transmitting prescriptions and prescription-related information (including medication history and electronic prior authorization (ePA) transactions) using electronic media for covered Part D drugs for Part D eligible individuals. This proposal includes a transition period beginning on the effective date of the final rule during which either version of the NCPDP SCRIPT standard may be used. The transition period would end on January 1, 2027, which is the date that the Office of the National Coordinator for Health IT (ONC) has proposed that NCPDP SCRIPT standard version 2017071 would expire for the purposes of U.S. Department of Health and Human Services (HHS) use.
  3. Requiring the NCPDP Real-Time Prescription Benefit (RTPB) standard version 13 proposed for adoption at 45 CFR 170.205(c) as the standard for prescriber real-time benefit tools (RTBTs) supported by Part D sponsors beginning January 1, 2027; 
  4. Requiring use of NCPDP Formulary and Benefit (F&B) standard version 60, proposed for adoption at 45 CFR 170.205(u), and retiring use of NCPDP F&B version 3.0 for transmitting formulary and benefit information between prescribers and Part D sponsors. This proposal includes a transition period beginning on the effective date of the final rule and ending January 1, 2027, during which entities would be permitted to use either NCPDP F&B version 3.0 or NCPDP F&B standard version 60. If finalized as proposed, starting January 1, 2027, only NCPDP F&B standard version 60 would be permitted for use in Part D electronic prescription drug program;
  5. Revising current regulatory text to cross-reference the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations at 45 CFR 162.1202 for requirements related to standards for eligibility transactions; and
  6. Making multiple technical changes to the regulation text throughout § 423.160 by removing requirements and incorporations by reference that are no longer applicable, re-organizing existing requirements, and a technical correction.

The public comment period for the proposed rule closed January 5, 2024. 

 

 

Page Last Modified:
02/22/2024 08:51 AM