E-prescribing optional in latest Medicare bill

FRAMINGHAM (11/18/2003) - The Medicare prescription drug bill -- largely complete and now the subject of a sales effort to gain congressional support -- doesn't mandate electronic prescribing. Instead, officials at physician groups said, it offers a set of incentives designed to help spur the uptake of the technology. House and Senate negotiators earlier this fall agreed the bill needed language supporting e-prescribing, but they left open the question of whether to require the practice by later this decade. The version originally passed by the House included a mandate for e-prescribing; the Senate bill didn't.

"It is a very important issue for us, and our understanding is that the voluntary language of the Senate will be in the conference report," said Rich Trachtman, director of congressional affairs at the American College of Physicians (ACP). In addition, Trachtman said, deadlines for e-prescribing standards would be pushed back.

Mark McClellan, commissioner of the FDA, also hinted that the Medicare bill won't have a mandate. In a speech last week, he celebrated the bill's efforts to boost e-prescribing but stopped short of saying the legislation would include a requirement for it.

"We've been working with Congress to build into the current Medicare legislation new programs and incentives that would help facilitate the adoption of e-prescribing standards and e-prescribing systems," McClellan said in an address to the Urban Institute. "There is strong bipartisan support for this effort, and it's another reason why passing Medicare legislation is so important."

It's unclear when the bill will come before the two chambers for a vote, and even whether the latest version, hammered out this weekend, will have enough support to pass. While President Bush has supported it, Sen. Edward Kennedy of Massachusetts predicted this weekend that the bill as it now stands won't pass.

The question of e-prescribing set off a flurry of lobbying this year. The two largest physicians' groups, the American Medical Association and the ACP, both opposed any mandate, saying an e-prescribing requirement would be financially ruinous and technologically hasty. On the other side, technology vendors and advocates pushed for a mandate, saying that the costs would not be high.

That some e-prescribing provisions remain in the bill is seen as a success for promoters of the technology. "The fact that there's language on e-prescribing at all is a good thing," said Rochelle Wooley, communications officer at RxHub, an alliance of pharmacy benefit managers (PBMs) and others seeking a standardized framework to link providers, pharmacists, payers, and PBMs.

The underlying principle -- that electronic prescriptions are vital to ensure patient safety -- remains uncontested. The 1999 "To Err Is Human" report from the Institute of Medicine highlighted drug errors as one of the most pervasive threats to patient safety, attracting attention from all corners of the healthcare industry.

Meanwhile, some states are pushing through regulations that will aid uptake of the technology. Massachusetts, for example, passed legislation last week designed to make it easier to e-mail prescriptions.

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