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A Push for E-Prescriptions Nationwide

A wide-ranging coalition of consumer and labor groups has begun a last-ditch lobbying effort to add a provision to the Medicare bill that would require doctors to electronically prescribe medications when treating Medicare patients.

Led by the Pharmaceutical Care Management Association, the 45-member coalition last week launched a series of television and print ads inside the Beltway and held meetings with key lawmakers and staff on the Hill.

Their message: that e-prescriptions are far clearer than traditional scrip and that more than a million medical errors annually could be prevented if there was electronic prescribing on a national scale.

On May 1, the group sent a letter to the chairmen and ranking members of the Senate Finance Committee, House Ways and Means Committee, and House Energy and Commerce Committee stressing that point and urging support for a bill that would mandate all physicians use e-prescriptions by January 2011 or face a 10 percent penalty in Medicare payments.

The e-prescription debate is part of the broader, ongoing Medicare bill negotiations and has been viewed positively by Republicans and Democrats in the tight budget environment because it would offset costs of other programs. The Congressional Budget Office has projected that the changeover would save $1.5 billion in five years and $3 billion in 10 years.

“The time is right, right now, because there are a lot of things that need to be funded, and this is a perfect issue because it saves money and helps finance other things that need to go through,” said Mark Merritt, president of PCMA, which represents pharmacy benefit managers like CVS, WellPoint and US Script.

The coalition –– made up of groups such as the AARP, the National Association of Chain Drug Stores, the American Medical Group Association and companies like Dell, AT&T, and Oracle –– formed last year to push for the legislation.

The issue of e-prescribing has been on the table since 2003, when it narrowly missed getting included in the Medicare Modernization Act.

Promoters did, however, get a provision that directed the Department of Health and Human Services to establish standards for electronic prescribing in that bill. The agency proposed the regulations last November, clearing away many of the regulatory issues for implementing the new process.

HHS Secretary Michael Leavitt also signaled while testifying on the Hill earlier this year that the Bush administration would support an e-prescription measure in the future.

This renewed push comes after stand-alone legislation was introduced in the Senate and House by Sens. John Kerry (D-Mass.), John Ensign (R-Nev.), Debbie Stabenow (D-Mich.) and Reps. Allyson Schwartz (D-Pa.), Jon Porter (R-Nev.) and Lois Capps (D-Calif.) in December.

Now, the coalition is planning to blanket the Hill in the coming weeks as the Medicare bill is finalized.

Coalition members argue that the need for e-prescribing is imminent given the number of medical errors that occur from written prescriptions. Medication errors kill more than 7,000 patients yearly, according to a report by the National Academy of Science’s Institute of Medicine. Additionally, the institute estimates that 1.5 million medical errors could be prevented if the country adopted a nationwide e-prescribe system.

Paul Kelly of the National Association of Chain Drug Stores says pharmacists also have the technology in hand — about 95 percent of pharmacies are equipped to handle e- prescriptions, he said.

One hurdle for e-prescriptions is a rule by the Drug Enforcement Administration that does not allow controlled substances to be prescribed electronically.

Currently, 20 percent of all prescriptions are for controlled substances, Kelly said, adding that his group is trying to pressure Congress and the administration to have the DEA issue regulations for e-prescribing controlled substances.

The American Medical Association and physicians groups have argued against the measure in its current form.

While the groups say they aren’t against e-prescribing in and of itself, they are arguing against a mandatory switchover that includes punitive penalties against physicians who do not comply.

AMA Chairman Edward Langston, in an e-mail statement, said his group is working with Congress to address “operational issues” including “the establishment of consistent e-prescribing standards, financial incentives for adoption, [and] a transitional period for physicians to adopt the technology.”

Yet even some physician groups concede that their opposition is seen by many as obstructing a transition that is all but inevitable.

“It does make physicians look like they’re sort of saying ‘no’ to the ocean coming in on the beach, but the reality is that you just can’t place all of those punitive things on them without providing some means for them to do it,” said Julius Hobson of Powell Goldstein, who represents the American Academy of Family Physicians.

The American College of Physicians’ Bob Doherty has also argued that the e-prescription component should be in a larger e-health record bill, not in the Medicare bill.

Yet, Kelly says the time is now, even if the language needs to be massaged a bit to appease physician groups.

“They are figuring out what is the best policy, we’re not wedded to [the language],” Kelly said. “But it is important to have a system of carrots and sticks. Otherwise you might not get full compliance.”

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