The Who, What, Why, When, and Where of the

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					    The Who, What, Why,
    When, and Where of the
         MMA 2006
     E-Prescribing Pilots

      Ken Whittemore, R.Ph., MBA
     VP, Professional and Regulatory
                  Affairs




1
Electronic prescribing provisions of the 2003
Medicare law

   Included in Medicare Prescription Drug Improvement
    and Modernization Act that was signed into law on
    12/08/03
   Establishes standards for an electronic prescribing
    program to be used by all physicians, pharmacies, and
    pharmacists who serve Medicare beneficiaries with Part
    D benefits
   Creates a grant program for physicians to assist them in
    implementing electronic prescribing for Medicare
    patients
Medicare electronic prescribing standards

   Standards will provide for the HIPAA-compliant
    transmission of information on:
        • Eligibility and benefits (including formulary, tiered formulary,
          and prior authorization requirements)
        • The drug being prescribed or dispensed and other drugs on
          the medication history, including drug-drug interactions,
          warnings or cautions, and when indicated, dosage
          adjustments
        • The availability of lower cost, therapeutically appropriate
          alternatives (if any) for the drug prescribed
        • Patient’s medical history related to a covered part D drug
          being prescribed or dispensed, upon request of prescriber or
          pharmacist involved
        • Transmission will be on an interactive, real-time basis to the
          extent possible
Input to the creation of Medicare electronic
prescribing standards
   The National Committee on Vital and Health Statistics
    (NCVHS) developed recommendations for uniform
    standards in consultation with:
    •   Standards setting organizations
    •   Practicing physicians
    •   Hospitals
    •   Pharmacies and practicing pharmacists
    •   Pharmacy benefit managers
    •   State boards of pharmacy and medicine
    •   Experts on electronic prescribing
    •   Other Federal agencies
   Letter recommending both ―foundation standards‖ and
    other initial e-prescribing standards for Medicare sent by
    NCVHS to HHS Secretary on September 2, 2004
   CMS published proposed rule on February 4, 2005
E-prescribing “Foundation Standards” adopted by
CMS in final rule published November 7, 2005

(1)The NCPDP SCRIPT Standard for new prescription,
   prescription refill request and response, prescription
   change request and response, prescription cancellation
   request and response, and ancillary messaging and
   administrative transactions between prescribers and
   pharmacies.
(2)The ASC X12N 270/271 Health Care Eligibility Benefits
   Inquiry and Response for eligibility and benefit inquiries
   and responses between prescribers and Part D
   sponsors.
(3)The NCPDP Telecommunication Standards and
   equivalent Batch Standard for eligibility and benefits
   inquiries and responses between pharmacies and Part D
   sponsors.
Testing the Medicare electronic prescribing
standards

   Beginning 01/01/06, the HHS Secretary shall conduct a
    one-year pilot project to test the initial standards
    • Purpose is to provide for the efficient implementation of the
      standards
    • This is not required in areas that there is already adequate
      industry experience (i.e., for the foundation standards)
    • Participation in the pilot project is voluntary for physicians and
      pharmacists
    • The HHS Secretary shall conduct and evaluation of the pilot
      project and report to Congress on it no later than 04/01/07
    • Based upon this evaluation, the Secretary shall finalize
      standards no later than 04/01/09
CMS asked the Agency for Healthcare Research and
Quality (AHRQ) to run the MMA e-prescribing pilots

   AHRQ published an RFA (request for applications) titled: ―Pilot Testing
    of Electronic Prescribing Standards – Cooperative Agreements‖ on
    September 15, 2005
   Two goals of pilots:
     • Assure that a format or code set actually works, i.e., it can effectively and
       unequivocally communicate the necessary information.
     • Assess how the information communicated flows into business processes
       and how use of initial standards affects those processes.
   Stated that $6 million was being made available for up to 9 grants
    between $500,000 and $2 million
   Research must be completed in calendar 2006
   Applications were due October 25, 2005
   30 letters of intent, 14 applications received, 10 evaluated, 4 awarded
Initial standards to be tested as specified in
the RFA
   NCPDP SCRIPT Standard Version 5.1
   NCPDP SCRIPT cancellation and change functions
   NCPDP Telecommunication Standard Guide, Version 5.1 and
    equivalent NCPDP Batch Implementation Guide, Version 1.1
   ASC X12N 270/271
   Formulary and benefit information (NCPDP Formulary & Benefit Standard,
    V1.0)
   Exchange of medication history – Pilots should determine readiness of the
    NCPDP's standard medication history message that was developed using
    the RxHub protocol, now rolled into SCRIPT 8.1.
   NCPDP SCRIPT fill status notification function
   Structured and Codified Sigs
   Clinical drug terminology – Pilots should determine whether RxNorm
    terminology translates to NDC for new prescriptions, renewals and changes
   Prior authorization messages – Pilots should determine functionality of new
    versions of the ASC X12N 278; evaluate economic impact of automation
    and impact on quality of care; Support standards development
    organizations development of work flow scenarios
The Successful Grant Awardees

 NJ Electronic Prescribing Action Coalition*
 Brigham & Womens Hospital Coalition (MA)*
 Achieve HIT LTC Pilot (MN)
 SureScripts / Brown U. / Midwestern U. Pilot
 (And a possible fifth—OH QIO)*




  *SureScripts playing a supporting role.
NJ Electronic Prescribing Action Coalition


   RAND Corporation, Santa Monica, Calif., in conjunction
    with the New Jersey E-Prescribing Action Coalition, an
    industry-academic partnership involving RAND Health;
    Horizon Blue Cross Blue Shield of New Jersey; the e-
    prescribing vendors AllScripts, Caremark iScribe, and
    InstantDx; Caremark's prescription benefit management
    plans; the electronic prescription routing companies
    RxHub and SureScripts; Caremark's mail-order
    pharmacy and Walgreen's retail pharmacies will conduct
    the pilot in New Jersey. In addition to testing the
    standards, the project will determine changes in drug
    use, clinical outcomes, and patient satisfaction as a
    result of e-prescribing.
Brigham & Womens Hospital Coalition (MA)

   Brigham and Women's Hospital, Boston, Mass., in
    conjunction with physician practices in Massachusetts
    associated with a hospital network, will use an existing
    community utility for e-prescribing called the eRx
    Gateway. The pilot will test the e-prescribing standards
    and will conduct needed research into ambulatory drug
    safety and the impact of e-prescribing on physician
    workflows.
Achieve HIT LTC Pilot (MN)


   Achieve Healthcare Information Technology, Minnesota,
    in conjunction with nursing facilities in Minnesota
    associated with the Benedictine Health System and
    Preferred Choice Pharmacy will be the first program to
    evaluate how the e-prescribing standards work in certain
    long-term care settings. The project also will assess the
    impact of e-prescribing on the workflow among
    prescribers, nurses, the pharmacies and payers.
SureScripts/Brown U./Midwestern U. Pilot—
What We Plan to Accomplish

 Evaluate  how the initial MMA e-prescribing
  standards work (or don’t work) in a variety of
  practice settings, across a number of geographic
  areas, utilizing several different e-prescribing
  technologies.
 Assess how prescriber and vendor
  characteristics influence e-prescribing adoption,
  and what "best features" of vendor software
  improve medication-related outcomes.
The Locales

 Florida
 Massachusetts
 New Jersey
 Nevada
 Rhode Island
 Tennessee
The Physician Vendors

 Allscripts
 DrFirst
 Gold Standard
 InstantDx
 MedPlus/Quest Diagnostics
 ZixCorp
The Pharmacy Partners

 Ahold  (Giant and Stop & Shop)
 Albertson’s (Sav-On and Osco)
 Brooks
 CVS
 Duane Reed
 Longs
 Rite Aid
 Walgreens
 Wal-Mart
 And a sample of independent pharmacies (?)
Other Participants

 Aetna
 BC/BS  of Massachusetts
 NaviMedix
 Partners in Care
 Walgreens Health Initiative
The Core Research Team

   Kate Lapane, Associate Professor of Medical Science,
    Department of Community Health, Brown University,
    Providence, RI (Principal Investigator)
   Catherine Dube, Senior Lecturer, Department of
    Community Health, Brown University
   Michael Rupp, Professor and Executive Director, Center
    for the Advancement of Pharmacy Practice, Midwestern
    University, Glendale, AZ
   Terri Jackson, Clinical Assistant Professor, Department
    of Pharmacy Practice & Science, University of AZ
    College of Pharmacy, Tucson, AZ
Proposed Timeframe for Testing of Standards
(Application)
January 2006 Start                April 2006 Start                June 2006 Start         September 2006 Start
Phase I                           Phase II                        Phase III               Phase IV

NCPDP SCRIPT Standard Version     ASC        X12N       270/271   NCPDP SCRIPT (cancel    Structured and Codified SIG
    5, Release 0 (Version 5.0),         004010X092/                   and        change
    May 12, 2004                        004010X092A1                  functions)



NCPDP        Telecommunication    NCPDP Formulary and benefit                             Clinical drug terminology RxNorm
    Standard Guide, Version 5,        standard v. 1.0                                           terminology
    Release 1 and equivalent
    NCPDP                Batch
    Implementation       Guide,
    Version 1, Release 1




                                  NCPDP SCRIPT (fill status
                                      notification function)



                                  NCPDP standard medication                               Prior authorization messages - ASC
                                      history messages                                           X12N 278
      Thank You for
     Your Attention…

       Questions?




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