We use cookies to better understand how you use our site and to improve your experience by personalizing content. Please review our updated Privacy Policy and Terms of Use. If you accept the use of cookies, please click the "I accept" button.I acceptI declineX
Skip navigational links

New E-Prescribing Final Rule


Email Alert

April 3, 2008
By Robert Wilson*

In case you missed Alan Goldberg's listserve posting yesterday afternoon, CMS released a new final rule on e–prescribing entitled "Medicare Program; Standards for E–Prescribing Under Medicare Part D and Identification of Backward Compatible Version of Adopted Standard for
E–Prescribing and the Medicare Prescription Drug Program." We have provided below redacted content from the CMS Press Release:

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 rule adopts four standards for use in e–prescribing:

  • Formulary and benefits: This standard will allow doctors and other prescribers to communicate with Part D sponsors about which drugs are covered by a Medicare eligible individual's prescription drug benefit plan and also learn about options for generic drugs for the individual.
  • Medication history: This standard will allow doctors and other providers, as well as dispensers and Part D sponsors, to communicate among themselves about prescribed medications a beneficiary has taken or is taking, including those prescribed by other providers.
  • Fill status notification: This standard will allow doctors and other providers to receive an email notice from pharmacy or other dispenser telling them that a patient's prescription has been picked up, not picked up, or has been partially filled.
  • Provider identifier: The final rule requires providers, dispensers, and Part D sponsors to use the National Provider Identifier (NPI) to identify individual healthcare providers in Part D e–prescribing transactions.

The standards adopted under the rule will apply to all Part D sponsors, as well as to prescribers and dispensers that electronically transmit prescriptions and prescription–related information about Part D—covered drugs prescribed for Part D eligible—individuals. Part D sponsors include freestanding Prescription Drug Plan sponsors, Medicare Advantage–Prescription Drug Plans, and other Part D sponsors. The new
e–prescribing standards will be effective on April 1, 2009.

The latest Part D e–prescribing standards supplement a set of "foundation" standards, published in November 2005, which took effect with the start of Part D on January 1, 2006, and address 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.

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 The Federal Register version is slated for publication on April 7, 2008.

*The HIT Practice Group would like to thank Robert Q. Wilson, Esquire (Bogatin Law Firm PLC, Memphis, TN) for providing this email alert.

© 2018 American Health Lawyers Association. All rights reserved. 1620 Eye Street NW, 6th Floor, Washington, DC 20006-4010 P. 202-833-1100 F. 202-833-1105