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Adopted Standard and Transactions

Adopted Part D:  E-Prescribing Standards

Section 101 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) amended Title XVIII of the Social Security Act (the Act) to establish the Voluntary Prescription Drug Benefit Program. Included in the provisions at section 1860D-4(e) of the Act is the requirement that prescriptions and certain other information for covered Part D drugs prescribed for Part D eligible individuals that are transmitted electronically comply with final uniform standards adopted by the Secretary under an electronic prescription drug program.

Although there is no requirement that providers write prescriptions electronically, in the Medicare Prescription Drug Benefit final rule, Part D sponsors who participate in the Part D program are required to support and comply with electronic prescribing. Providers that prescribe or dispense Part D drugs are required to comply with the final standards only when prescription information or certain other related information is electronically transmitted.

Foundation Standards

On November 7, 2005, CMS published foundation standards that became effective on January 1, 2006. These standards apply to all electronic prescribing done under Part D of the MMA. The foundation standards cover:

  • The National Council for Prescription Drug Programs SCRIPT Standard, Implementation Guide, Version 5, Release 0; for Transactions between prescribers (who write prescriptions) and dispensers (who fill prescriptions) for new prescriptions; refill requests and responses; prescription change requests and responses; prescription cancellation, request and response; and related messaging and administrative transactions
  • The Accredited Standards Committee X12N 270/271-Health Care Eligibility Benefit Inquiry and Response, Version 4010; For eligibility and benefits queries and responses between prescribers and Part D sponsors;
  • The National Council for Prescription Drug Programs Telecommunication Standard Specification, Version 5, Release 1; for eligibility queries between dispensers and Part D sponsors.

The final E-Prescribing rule was published at the Federal Register on April 7, 2008. The final rule provides three electronic tools for use in E-Prescribing:

  • NCPDP Formulary and Benefit Standard Implementation Guide Version 1.0: gives prescribers information about which drugs are covered by a Medicare beneficiary's prescription drug benefit plan.
  • NCPDP SCRIPT 8.1 Medication History Transactions: provides prescribers with information about medications a beneficiary is already taking, including those prescribed by other providers, to help reduce the number of adverse drug events.
  • Fill Status notifications (RxFill): allows prescribers to receive an electronic notice from the pharmacy telling them that a patient's prescription has been picked up, not picked up, or has been partially filled, to help monitor medication adherence in patients with chronic conditions.
  • Retirement of NCPDP SCRIPT Version 5.0 in favor of the upgraded NCPDP SCRIPT Version 8.1.
  • The final rule also adopts the National Provider Identifier (NPI) for e-prescribing under Medicare Part D.

July 1, 2010 CMS published an Interim Final Rule with comment (IFC) allowing the voluntary use of NCPDP SCRIPT Version 10.6 for the transmission of electronic prescription related data between the prescriber and dispenser.

May 16, 2012 CMS published  a final rule, in this regulation the Medicare Part D e-Prescribing foundation standards were updated to include:  

  • The National Council for Prescription Drug Programs Telecommunication Standard Specification, Version D, Release 0 for eligibility queries between dispensers and Part D sponsors.
  • The Accredited Standards Committee X12N 270/271-Health Care Eligibility Benefit Inquiry and Response, Version 5010; For eligibility and benefits queries and responses between prescribers and Part D sponsors

To view the E-Prescribing final rule on additional standards, see the link in the "Related Links Outside CMS" section below.

To view the E-Prescribing final rule on foundation standards, see the link in the "Related Links Outside CMS" section below.

To view the Medicare Part D e-Prescribing final rule on foundation standards, see the link in the "Related Links Outside CMS" section below.

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