March 25, Office of Medical Assistance Programs eprescribing

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Liliana Lane
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1 March 25, 2 Office of Medical Assistance Programs eprescribing

2 What is eprescribing? A prescriber's ability to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point-of-care Has the potential to empower both prescribers and pharmacists to deliver higher quality care and improve workflow efficiencies. Helps to reduce the risk of medication errors associated with poor handwriting, illegible faxes and additional key strokes Increases client safety through identification of drug interactions and evaluation of patient medication history 2 February, 2

3 Pennsylvania eprescribing Today eprescribing Statistics SafeRx State Rankings, Surescripts * Ranking TBD % of Rx.7%.68% 2.46% 6.43% 2-5% * Estimated numbers; finals will be reported by Surescripts in April Surescripts Pennsylvania Statistics Estimated Number of Point-of-Care (Technology) Vendors in 2 = 55 eprescribing Events = 7,67,273 transactions in 28 Estimated Number of Physicians Utilizing eprescribing in 2= 5,648 % of Physicians Routing E-Prescriptions 6.5% % of Total Community Pharmacies in State Activated for eprescribing 83.56% 3 February, 2

4 eprescribing Overview Implementation Solutions eprescribing Payer Enablement eprescribing Provider Portal Via use of the prescribers internet access to the PROMISe Internet site Integration with EHR/EMR Systems Element of meaningful use Phased Implementation Encouraged but not required for MA Prescribers Cannot be used for Schedule 2-5 drugs at this time 4 February, 2

5 eprescribing Overview eprescribing allows for: Review of MA eligibility Review of Medication History from MA, other payers, and private pay to participating pharmacies Review of MA Preferred Drug List Electronic submission of prescriptions to recipient s pharmacy 5 February, 2

6 How Does eprescribing Work? Provider or office staff submits eligibility, formulary or medication history request from computer and/or PDA while patient is in the office Eligibility, Formulary, Claims History Request Master Beneficiary And Formulary Database PROMISe erx Portal Software Vendors (Zix, DrFirst, RxNt, etc.) Surescripts Provider will have: POC patient profile Eligibility verification Claims/Medication History PDL information Prior authorization/limitation information POC application DUR alerts POC application preferred pharmacies Payer Network PROMISe 6 February, 2 Other PBM Other Payers

7 How Does eprescribing Work? Provider submits electronic prescription while patient is in the office Electronic Prescription Request NCPDP Script 8. Physician PROMISe erx Portal Software Vendors (Zix, DrFirst, RxNt, etc.) Network (Surescripts SIG) Mail Order Provider will have: Submitted to recipients pharmacy of choice Submitted electronic prescription Ability to print electronic prescription for file Pharmacies Retail Institutional 7 February, 2

8 How Does eprescribing Work? A Total View Eligibility, Formulary, Claims History Request PROMISe erx Portal Software Vendors (Zix, DrFirst, RxNt, etc.) Network (Surescripts SIG) NCPDP Script 8. Mail Order Master Beneficiary And Formulary Database Surescripts Network (BES, WebMD, QS, RelayHealth, etc.) NCPDP 5. (Billing) Pharmacies Retail Payer Network Institutional PROMISe Other PBM Other Payers 8 February, 2

9 Considerations for eprescribing Payer (OMAP) Perspective Transaction Standards Physician/Provider Participation Budget Considerations ARRA Legislation Meaningful Use (eprescribing) Physician/Provider Perspective Financial Cost Hardware/Software Workflow Change Management Point of Care/Technology Vendor Selection MIPPA Legislation Medicare Incentives ARRA Legislation Meaningful Use (eprescribing) February, 2

10 Project Timeline Payer Enablement-Definition/Rqmt Payer Enablement-Design Payer Enablement-Construct/Test Payer Enablement-Walkthroughs Payer Enablement-Go-Live PROMISe Portal - Definition PROMISe Portal - Design PROMISe Portal - Development PROMISe Portal - eprescribe Portal - Definition eprescribe Portal - Design eprescribe Portal - Development eprescribe Portal - Testing eprescribe Portal - Go-live n p-2 g g ct- - v-2 c-2 n -2 p b ar r l- g- u u e p O o e a e ay- A u u J F M u S D M J e A A N J A S February, 2

11 Next Steps Announce to Stakeholders Solicit assistance for Phased Implementation from willing prescribers Assistance in Communicating with provider groups February, 2

Electronic Prescribing Guide. Establishing a Computer-to-Computer Connection Between Your Practice, Payers and Pharmacies

Electronic Prescribing Guide. Establishing a Computer-to-Computer Connection Between Your Practice, Payers and Pharmacies Electronic Prescribing Guide Establishing a Computer-to-Computer Connection Between Your Practice, Payers and Pharmacies Electronic Prescribing Guide This guide is provided to you by Surescripts, the Nation