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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.

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