On Nov. 7, the Centers for Medicare & Medicaid Services (CMS) issued a final rule adopting standards for electronic prescribing (e-prescribing) trans actions under the Medicare Modernization Act. The rule mandates that Part D plan spon sors establish and maintain an e-prescribing program employing these standards by Jan. 1, 2006, and requires that any e-prescribing con ducted by providers after Jan. 1 be undertak en using the standards set forth in the rule.

The regulations define e-prescribing as the transmission, using electronic media, of pre scription or prescription-related information between a prescriber, dispenser, pharmacy benefit manager, or health plan. In a notable departure from the proposed rule, CMS expanded the scope of coverage for e-pre scribing transactions from individuals en rolled in a Part D plan to any individual who may be eligible for Part D benefits. The spe cific standards address three areas: 1) new prescriptions, renewals, cancellations, changes, ancillary messages, and administra tive transactions; 2) eligibility queries between prescribers and Part D sponsors; and 3) eligi bility inquiries between dispensers and Part D sponsors. The named standards are from the National Council for Prescription Drug Programs and the Accredited Standards Committee. CMS also notes that there are not established standards in the areas of formulary and medication history transmission, and will test standards in those areas as part of its 2006 e-prescribing pilot project.

Exemptions to the required use of these standards fall into three categories. First, so as not to create incentives for a return to the use of paper faxes, CMS will not require computer-generated faxes containing prescription or prescription-related information to use these standards. Second, for prescriptions transmitted within a legal entity, the entity may use the e-prescribing standards or may continue to use HL7 transactions that are commonly employed within “closed” networks. Finally, when a non-prescribing provider must be involved in the prescription transaction, the parties are not required to use the e-prescribing standards. This exemption addresses the complexities of prescribing in the long term care setting, where the nursing facility is required by law to conduct concurrent and retrospective Drug Regimen Review.

GNYHA will continue to monitor the piloting and testing of these standards and will keep members informed regarding the safe harbors for e-prescribing that were proposed recently by CMS and the Office of the Inspector General.