Retailers rarely lead the way with new technology, but they are doing just that with e-prescribing, the electronic transmission of prescriptions between the computers at a physician's office and a pharmacy.
According to the National Progress Report on E-Prescribing, issued by SureScripts, Alexandria, Va., last December, 97% of chain pharmacies (both drug and supermarket) were accepting electronically generated prescriptions, with much of the adoption taking place in 2007. About 70% of all U.S. pharmacies can take electronic prescriptions. Mail-order medication services are also accepting e-prescriptions.
In sharp contrast, just 6% of office-based physicians in the U.S. were e-prescribing medication last year, said the SureScripts report. As a result, only 2% of prescription transactions — about 35 million — were transmitted electronically.
E-prescribing saves pharmacists time — they don't have to decipher or fact-check illegible paper prescriptions — and helps ensure that medications are accurately dispensed. The system also provides doctors access to a patient's medication history and insurance coverage, helping to prevent harmful drug interactions and reduce costs. For consumers, e-prescribing conveniently transmits prescriptions to their local pharmacy before they leave the doctor's office.
“The biggest benefit is the legibility of the script, because it comes in electronically and pops onto a computer screen,” said Brad Dayton, director of pharmacy systems for Ahold divisions Stop & Shop, Quincy, Mass., and Giant Food, Landover, Md., which have been accepting e-prescriptions for four and six years, respectively, via the SureScripts network. “It's a much safer and secure way for a pharmacy to receive a prescription.”
What largely remains is for more physicians to adopt the system. “Everything being done now is to close the gap [between retail and physician adoption],” said Rob Cronin, a spokesman for SureScripts, which operates the Pharmacy Health Information Exchange, the primary standard-based e-prescription network, created and used by major national supermarket and drug chains.
Many independently owned pharmacies, including those run by independent food retailers, also have yet to get on board, with only 27% receiving e-prescriptions, according to SureScripts. “Independents tend not to focus on e-prescribing until one or more of their local [physicians] adopt the technology,” said Ken Whittemore, senior vice president of clinical practice integration for SureScripts.
But as a result of several industry and governmental initiatives, the prospects for growth of e-prescribing in 2008 appear strong. SureScripts estimates that the number of doctors e-prescribing will more than double this year to 85,000 while the number of e-prescription transactions will almost triple to 100 million, or 7% of the total. The number of pharmacies (chain and independent) accepting e-prescriptions is expected to grow to 45,000 in 2008 from 40,000.
CONSUMER CAMPAIGN
In late April, SureScripts worked with 10 prominent retailers, including Ahold USA, Supervalu, Wal-Mart Stores and such major drug chains as CVS, Rite Aid and Walgreens, to launch a national marketing campaign to boost consumer awareness of electronic prescriptions.
The campaign — the first to target consumers — features signs on doors, walls and counters of pharmacies saying “e-prescriptions filled here” and “give your prescription a head start.” Consumers were also given a new online resource — www.LearnAboutEprescriptions.com — which provides information on the process and allows patients to determine if their physician and local pharmacy are currently e-prescribing.
“The goal is to educate patients in the hope that they will ask their physician about e-prescribing and encourage more doctors to look into it,” said Cronin.
Supervalu, which has been receiving e-prescriptions at all of its 900-plus stores with pharmacies since February, displays signage promoting the service in the pharmacies and plans to display an e-prescribing decal at the entrance to the stores, said Randy Mound, vice president of pharmacy systems, process redesign and strategy, Supervalu Pharmacies, Franklin Park, Ill.
In addition to posting signs in their stores, Stop & Shop and Giant also notify local physicians that it is electronically enabled to receive prescriptions, said Dayton. “We have a message on our fax form that says we are able to receive e-prescriptions.”
Supervalu also reaches out to prescribers to “explain the benefits and steps for migrating to electronic prescriptions,” said Mound.
In March, another industry initiative created under the auspices of the Center for Improving Medication Management launched a website — www.GetRxConnected.com — where doctors can follow a step-by-step process to convert from paper-based prescribing to e-prescribing.
E-prescribing is also being pushed by government on the federal and state levels. Starting on Jan. 1, 2009, computer-generated prescriptions covered under the Medicare Part D program that were being faxed to pharmacies must instead be sent electronically.
In addition, the latest Medicare bill in the U.S. Senate, which was expected to be acted on by early July, would provide incentives to doctors for e-prescribing, and, eventually, penalties for not e-prescribing. Private insurers also are beginning to provide physicians incentives to e-prescribe, said Cronin.
But the government is acting as a barrier to e-prescribing via rules set by the Drug Enforcement Agency that do not allow physicians to e-prescribe controlled substances such as pain killers. “So if doctors adopt e-prescribing, they can't use it all the time and a lot are saying, ‘Why bother?’” said Cronin. However, he noted, the Senate Judiciary Committee has asked the DEA to change its policy on e-prescribing controlled substances. “Everybody is waiting to see what happens.”
TRANSACTION COSTS
For retail pharmacies, the primary cost of e-prescribing is a per-transaction fee of about 25 cents per new prescription or renewal request, paid to a processor or software provider, said Whittemore of SureScripts. For example, Stop & Shop and Giant pay a fee to RelayHealth, Atlanta, which serves as an intermediary to the SureScripts network, said Dayton.
Typically, the software required by retailers to process e-prescriptions is already part of their pharmacy management system and just needs to be switched on, or is made available as part of regular software updates. “In most cases, the pharmacy system vendors don't charge pharmacies a setup charge to be enabled to receive e-prescriptions,” he added.
Offsetting its costs, e-prescribing creates labor savings by eliminating a number of manual processes. “The process of prescribing a medication is much more efficient as time spent on the phone to clarify a handwritten or faxed prescription or authorize a refill is minimized,” said Cathy Polley, vice president of pharmacy services at the Food Marketing Institute, Arlington, Va. “This allows pharmacists to spend more time counseling patients.”
There is a time savings associated with inbound and outbound refill requests,” said Maria Brous, spokeswoman for Publix Super Markets, Lakeland, Fla. “There is no additional work associated with contacting the provider for clarification on drug and/or dosage.”
In a study of retail operations sponsored by SureScripts and conducted by Michael Rupp, managing partner, Desert Mentors, Glendale, Ariz., the per-prescription savings in pharmacy labor costs created by e-prescribing was found to be $1.07 for new prescriptions and 41 cents for renewals.
While security emerges as a concern whenever sensitive personal information such as medication prescriptions is transmitted electronically, Dayton said he considers e-prescribing to be more secure than paper prescriptions. “When we receive an electronic prescription, I'm 99.999% sure that it's coming from a physician,” he said. “Paper can always be forged.”
Additional reporting by Christina Veiders