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CMS issues final e-prescribing rules for Part D


WASHINGTON The Centers for Medicare and Medicaid Services today released its final rule for e-prescribing standards for Medicare Part D patients. The new regulations establish standards for four types of information: formulary and benefits, medication history, fill status notification and identification of individual health care providers.

“Establishing standards for e-prescribing under Medicare’s prescription drug program will help pave the way for widespread adoption of e-prescribing throughout the medical community,” noted Health and Human Services secretary Mike Leavitt. “Broader use of e-prescribing offers beneficiaries safer and more efficient care at lower costs.”

Prescribers, dispensers and other providers are not required to implement e-prescribing, but those who do must comply with the new Medicare standards when using e-prescribing to send prescriptions and prescription related information for covered drugs prescribed for Part D eligible individuals.

“The Part D e-prescribing standards final rule moves us closer to achieving interoperable health information technology, one of the cornerstones of the Administration’s Value-Driven Health Care Initiative,” said CMS acting administrator Kerry Weems. “Converting from a paper-based system to e-prescribing promises improvements that will help prescribers, pharmacies, and all who are eligible for Medicare’s prescription drug benefit. Most importantly, e-prescribing can help reduce the number of adverse drug events, which have been estimated at 530,000 a year for Medicare beneficiaries.”

The rule adopts four standards for use in e-prescribing:

  • Formulary and benefits. Allows doctors and other prescribers to communicate with Part D plan sponsors about which drugs are covered. Also provides prescribers with information on lower-cost generic alternatives.
  • Medication history. Allows healthcare providers, dispensers and Part D sponsors, to communicate regarding a patient’s full range of prescribed medications.
  • Fill status notification. Provides healthcare providers e-mail notification prescription dispenser when Part D patient’s prescription is picked up/not picked up/partially filled.
  • Provider identifier. Requires providers, dispensers, and Part D plan sponsors use the National Provider Identifier to identify individual health care providers in Part D e-prescribing transactions.

In all, the rules are designed to streamline the flow of communication between prescribers, dispensers and plan sponsors, with an end goal of improving efficiencies, and ultimately improving patient outcomes.

“Use of these e-prescribing standards by Part D plan sponsors, providers, and dispensers will directly benefit Medicare eligible individuals,” said Weems. “Prescribers and dispensers will benefit through workflow improvements—freeing up time for interaction with patients.”

The new rules, which go into effect April 1, 2009, apply to all Part D sponsors, as well as prescribers and dispensers that electronically transmit prescriptions and prescription-related information for Part D eligible individuals.

The new Part D standards supplement a set of “foundation” standards, published in November 2005, which took effect with the start of Part D on Jan. 1, 2006. Those standards addressed the exchange of information among prescribers, dispensers and Part D sponsors on such matters as: eligibility inquiries and responses; new prescriptions; and changes, renewals and cancellations of existing prescriptions. Testing of the new standards by providers and pharmacies has shown that the standards can be easily incorporated into existing e-prescribing systems and has also demonstrated their potential to promote safer, more efficient prescribing practices.

This final rule on Part D e-prescribing standards (CMS-0016-F/CMS-0018-F) and the earlier final rule establishing e-prescribing foundation standards (CMS-0011-F) are available online at

More information on HHS’ various health IT initiatives is available at

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