E-Prescribing…Here to Stay?

About a month ago, an analyst was asking me about the e-prescribing legislation and trends and how that would impact the financials of the PBMs. I told her that I remained a little bit of a skeptic for several reasons:

[Basically e-prescribing is the use of a handheld device or personal computer to automate the generation of prescriptions to eliminate hand writing errors and streamline the process which is a great concept.]

  1. E-prescribing generally requires the use and adoption of new technology into a physician’s practice. The highest prescribers (due to their high patient load) are typically the older and more established physicians. They have the least likelihood of adopting the new technology.
  2. While safety is very important to the physician, the benefit to the PBM is if they can use the technology to push plan design edits to the physician. I don’t know any physicians who want to get into a conversation about plan design with their patients during their very brief office visit. They don’t want to compare copay levels. They don’t typically want to look at step therapy, prior authorization, quantity level limits, and other edits. This would require them to educate the patient and debate their options real-time with no financial benefit to them.
  3. The prescriptions could be sent electronically into the fulfillment systems for the retail and mail pharmacies, but that requires integration that doesn’t exist in many cases today and certainly doesn’t exist across the myriad of software vendors that provide this technology.
  4. The technology companies have had high turnover requiring physicians to learn new systems and leaving lots of equipment sitting in closets somewhere.
  5. There are funding issues of what (if any) hardware and software is needed and how that is financed. Why would a physician pay for this?

So, yes. E-prescribing is a great idea. It will come to fruition as the younger generation of doctors age. For them, technology is part of life not a new task. The first phase I see is physicians telling their staff what to enter into a web-based system or using a real basic handheld solution that cleans up the writing issues and has some basic clinical logic. I don’t see them doing much real-time integration with benefits information meaning that the 40% of new Rxs which have an edit still require work at the pharmacy.

One Response to “E-Prescribing…Here to Stay?”

  1. Electronic prescribing, as defined by the National Council for Prescription Drug Programs (NCPDP), has two parts:

    Part 1: Two way [electronic] communication between physicians and pharmacies involving new prescriptions, refill authorizations, change requests, cancel prescriptions, and prescription fill messages to track patient compliance. Electronic Prescribing is not Faxing or printing paper prescriptions. ePrescribing is the ability of a physician to submit a “clean” prescription directly to a pharmacy from the point of care.

    Part 2: Potential for information sharing with other health care partners including eligibility/formulary information and medication History

    Will it last – or is it just a fad? It’s here to stay. There have been more legislative, technology, and marketing advancements in 2007-2008 than ever before.

    WellPoint NextRx, an independent pharmacy benefit management (PBM) company and the nation’s largest health-plan-owned PBM, announced on Tuesday August 19th that SureScripts-RxHub connectivity is available to physicians in Rhode Island through Blue Cross & Blue Shield Rhode Island (BCBSRI) effective August 16, 2008.

    This is a big win for the ePrescribing initative. Great blog! Thank you.

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