Midterm Time: An MMA 2006 E-Prescribing Pilots Report Card

1. Midterm Time:An MMA 2006E-Prescribing Pilots Report Card Ken Whittemore, R.Ph., MBA VP, Professional and Regulatory Affairs SureScripts ASAP 2006 Midyear Industry & Technology Issues Conference The Breakers, Palm Beach, FL June 2006

2. Electronic prescribing provisions of the 2003 Medicare law Included in Medicare Prescription Drug Improvement and Modernization Act that was signed into law on 12/08/03 Establishes standards for an electronic prescribing program to be used by all physicians, pharmacies, and pharmacists who serve Medicare beneficiaries with Part D benefits and requires that they be piloted in 2006 Creates a grant program for physicians to assist them in implementing electronic prescribing for Medicare patients

3. Medicare electronic prescribing standards Standards will provide for the HIPAA-compliant transmission of information on: Eligibility and benefits (including formulary, tiered formulary, and prior authorization requirements) The drug being prescribed or dispensed and other drugs on the medication history, including drug-drug interactions, warnings or cautions, and when indicated, dosage adjustments The availability of lower cost, therapeutically appropriate alternatives (if any) for the drug prescribed Patient’s medical history related to a covered part D drug being prescribed or dispensed, upon request of prescriber or pharmacist involved Transmission will be on an interactive, real-time basis to the extent possible

4. Input to the creation of Medicare electronic prescribing standards The National Committee on Vital and Health Statistics (NCVHS) shall develop recommendations for uniform standards in consultation with: Standards setting organizations Practicing physicians Hospitals Pharmacies and practicing pharmacists Pharmacy benefit managers State boards of pharmacy and medicine Experts on electronic prescribing Other appropriate Federal agencies NCVHS held hearings throughout 2004 and made recommendations to HHS for initial Medicare e-prescribing standards Some identified as “foundation standards”

5. Initial standards to be tested as specified as requested by AHRQ/CMS/HHS NCPDP SCRIPT Standard Version 5.1 NCPDP SCRIPT cancellation and change functions NCPDP Telecommunication Standard Guide, Version 5.1 and equivalent NCPDP Batch Implementation Guide, Version 1.1 ASC X12N 270/271 Formulary and benefit information (NCPDP Formulary & Benefit Standard, V1.0) Exchange of medication history – Pilots should determine readiness of the NCPDP's standard medication history message that was developed using the RxHub protocol, now rolled into SCRIPT 8.1. NCPDP SCRIPT fill status notification function Structured and Codified Sigs Clinical drug terminology – Pilots should determine whether RxNorm terminology translates to NDC for new prescriptions, renewals and changes Prior authorization messages – Pilots should determine functionality of new versions of the ASC X12N 278; evaluate economic impact of automation and impact on quality of care; Support standards development organizations development of work flow scenarios

6. Piloting the Medicare electronic prescribing standards Beginning 01/01/06, the HHS Secretary shall conduct a one-year pilot project to test the initial standards Purpose is to provide for the efficient implementation of the standards This is not required in areas that there is already adequate industry experience (i.e., for the foundation standards) Participation in the pilot project is voluntary for physicians and pharmacists The HHS Secretary shall conduct and evaluation of the pilot project and report to Congress on it no later than 04/01/07 Based upon this evaluation, the Secretary shall finalize standards no later than 04/01/09

7. CMS asked the Agency for Healthcare Research and Quality (AHRQ) to run the MMA e-prescribing pilots AHRQ published an RFA (request for applications) titled: “Pilot Testing of Electronic Prescribing Standards – Cooperative Agreements” on September 15, 2005 Two goals of pilots: Assure that a format or code set actually works, i.e., it can effectively and unequivocally communicate the necessary information. Assess how the information communicated flows into business processes and how use of initial standards affects those processes. Stated that $6 million was being made available for up to 9 grants between $500,000 and $2 million Research must be completed in calendar 2006 Applications were due October 25, 2005 30 letters of intent, 14 applications received, 10 evaluated, 5 awarded

8. The Successful MMA Grant Awardees Achieve HIT LTC Pilot (MN) Brigham & Women's Hospital Coalition (MA)* NJ Electronic Prescribing Action Coalition* OH KePRO* SureScripts / Brown U. / Midwestern U. / AZ U. *SureScripts playing a supporting role.

9. Brigham & Womens Hospital Coalition (MA) Brigham and Women's Hospital, Boston, Mass., in conjunction with physician practices in Massachusetts associated with a hospital network, will use an existing community utility for e-prescribing called the eRx Gateway. The pilot will test the e-prescribing standards and will conduct needed research into ambulatory drug safety and the impact of e-prescribing on physician workflows.

10. NJ Electronic Prescribing Action Coalition RAND Corporation, Santa Monica, Calif., in conjunction with the New Jersey E-Prescribing Action Coalition, an industry-academic partnership involving RAND Health; Horizon Blue Cross Blue Shield of New Jersey; the e-prescribing vendors AllScripts, Caremark iScribe, and InstantDx; Caremark's prescription benefit management plans; the electronic prescription routing companies RxHub and SureScripts; Caremark's mail-order pharmacy and Walgreen's retail pharmacies will conduct the pilot in New Jersey. In addition to testing the standards, the project will determine changes in drug use, clinical outcomes, and patient satisfaction as a result of e-prescribing.

11. SureScripts/Brown U./Midwestern U./AZ U. Pilot—What We’re Up To Evaluate how the initial MMA e-prescribing standards work (or don’t work) in a variety of practice settings, across a number of geographic areas, utilizing several different e-prescribing technologies. Assess how prescriber and vendor characteristics influence e-prescribing adoption, and what "best features" of vendor software improve medication-related outcomes.

12. Locales, Vendors, Partners & Payers Florida, Massachusetts, New Jersey, Nevada, Rhode Island and Tennessee Allscripts, DrFirst, Gold Standard, InstantDx, MedPlus/Quest Diagnostics and ZixCorp Ahold (Giant and Stop & Shop), Albertson’s (Sav-On and Osco), Brooks, CVS, Duane Reed, Longs, Rite Aid, Walgreens, Wal-Mart and a sample of independent pharmacies Aetna, BC/BS of Massachusetts, NaviMedix, Partners in Care, Walgreens Health Initiative

13. The Core Research Team Kate Lapane, Associate Professor of Medical Science, Department of Community Health, Brown University, Providence, RI (Principal Investigator) Catherine Dube, Senior Lecturer, Department of Community Health, Brown University Michael Rupp, Professor and Executive Director, Center for the Advancement of Pharmacy Practice, Midwestern University, Glendale, AZ Terri Jackson, Clinical Assistant Professor, Department of Pharmacy Practice & Science, University of AZ College of Pharmacy, Tucson, AZ

14. The E-prescribing Pilot Experience To Date… Results, Sorry, No Can Share… At Least Not Yet Can’t We All Just Get Along? Contracts, Contracts, Contracts We Need IRB Approval? What’s An IRB? Providers, Providers, Who’s Got The Providers? What’s OMB Got To Do With It? Whoo, Whoo… We Don’t Have To Pilot What? The Esoteric Standards Catch-22 The Case of the Missing Independent Evaluator Where Does The Time Go, Or Yikes, It’s June!!!

15. Thank You for Your Attention… Questions?