BCBSA Issues Key Principles For Vendors Participating In Blue-Sponsored Medicare E-Prescribing Programs

October 3, 2008

WASHINGTON – To help ensure that electronic prescribing (e-prescribing) products help Medicare beneficiaries and physicians make the right choices at the point-of-care, the Blue Cross and Blue Shield Association (BCBSA) today released key principles on functionality, interoperability and reliability to govern all vendors participating in e-prescribing systems sponsored by Blue Cross and Blue Shield companies.

"Medicare's new e-prescribing requirement will help reduce costs, mitigate medical errors, and save lives," said Scott P. Serota, BCBSA President and CEO.  "As the first and largest family of health plans to call for enactment of a Medicare e-prescribing requirement, Blue Cross and Blue Shield companies are committed to making implementation of Medicare e-prescribing go as smoothly as possible for seniors, physicians, and the Medicare program.  With today's announcement of key principles for e-prescribing vendors, we are now one step closer to a workable e-prescribing program in Medicare and the private sector."

BCBSA believes it is important to ensure that e-prescribing products are reliable and meet Medicare's requirements for Part D e-prescribing and new payment incentives for any Medicare e-prescribing physician.  BCBSA strongly supports certification of e-prescribing products for both stand-alone and electronic health record-integrated e-prescribing systems to ensure that either approach can provide a high standard of functionality, interoperability and reliability.

BCBSA and the Blue Cross and Blue Shield companies have developed the following set of e-prescribing functionality principles for all vendors participating in programs sponsored by Blue Cross and Blue Shield companies.  BCBSA believes the Blue companies' e-prescribing standard should include application of clinical decision support at the point-of-care, allowing the physician and the patient to make fully informed decisions.  These principles are:

1. E-prescribing systems must ensure patient safety.
   
   a. Drug – Drug Interaction Check:  E-prescribing systems must have the ability to alert providers to the possibility of at least severe interaction with patients' other active medications and dispensed drug history and to guard against duplicate medication therapy.
   
   b. Drug – Allergy Check:  E-prescribing systems must inform providers of potential conflicts with or patient allergies to prescribed drugs.  Together, the physician and the patient can make an informed – personalized – decision based on the potential side effects and specific conditions.
   
   c. Drug Dosing Decision Support:  E-prescribing systems must provide a safety check to offer providers maximum dose checking and drug instructions (i.e. route of administration).
   
   d. Drug and Dosing Guidance:  Preferred e-prescribing systems also provide drug and dosing guidance based on age, weight, pregnancy, and lab results.
   
   
2. Patient Medication History:  E-prescribing systems must be able to check available sources in real-time and make a patient's medication history available to the provider at the time the prescription is written at the point-of-care.  This includes all active medication, as well as dispensed drug history.
   
   
3. Formulary Status:  E-prescribing systems must ensure that providers have access to the up-to-date formulary and insurance information (including patient eligibility and authorization), allowing them to prescribe preferred therapeutic and generic alternatives, as well as get coverage information such as co-payments and relative cost.
   
   
4. Renewals:  E-prescribing systems must ensure that providers can easily refill existing prescriptions and be able to accept electronic renewals from pharmacies.
   
   
5. Electronic Transmission:  E-prescribing systems must be able to transmit prescriptions electronically to and from pharmacies whenever possible.  Faxed prescriptions should be used only as a back-up method but should include all aspects of a fully informed decision support tool before faxing (including drug – drug interaction, drug – allergy checks, adult and pediatric dosing checks, and medication history).
   
   
6. Drug Reference Guide:  E-prescribing systems must provide access to an accurate, comprehensive drug database with the ability to look-up dosing and usage guidelines, side-effects, indications and contraindications at the time the prescription is written at the point-of-care and can be printed for the patient.
   
   
7. Transaction Certification:  E-prescribing systems must be certified by a recognized e-prescribing connectivity entity.
   
   
8. Utilization management (UM):  Preferred e-prescribing systems have the ability to assist the physician in administering step-therapy, quantity limits, and other UM programs through incorporation of information from the pharmacy benefit manager (PBM) and decision support within the application.
   
   
9. Mail Order:  Preferred e-prescribing systems enable providers to send prescriptions electronically to the patient's mail order pharmacy.

These principles are examples of how Blue Cross and Blue Shield companies nationwide are addressing the cost of care and improving healthcare quality – a key component of BCBSA's five-point plan for healthcare reform, "The Pathway to Covering America:  Ensuring Quality, Value and Access."  These principles highlight the third recommendation of the Pathway proposal to promote better quality care, keep healthcare affordable and improve access to coverage.  The Pathway proposal can be found on the BCBSA Web site at: www.bcbs.com/issues/uninsured/pathway-to-covering-america/.