By Donielle Tigay Stutland, J.D.
With the goal of reducing provider burdens, CMS proposed new e-prescribing standards under Medicare Part D.
On June 19, 2019, CMS published a proposed rule to update e-prescribing standards. The proposed rule sets forth new prior authorization transaction standards for the Part D e-prescribing program. This change would implement key provisions of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act). Section 6062 of the SUPPORT Act requires the adoption of transaction standards for the part D e-prescribing program to ensure secure electronic prior authorization (ePA) request and response transactions between prescribers and part D plan sponsors no later than January 1, 2021 (Proposed rule, 84 FR 28450, June 19, 2019).
The changes would allow prescribers to complete prior authorizations online, giving a more streamlined process to the prior authorization requirement under Part D. This will allow clinicians who select the electronic option with a prior authorization to satisfy terms in real time, before a prescription is sent to a pharmacy. Ultimately, this will result in quicker access to prescriptions and less wait time for patients.
Transaction standards. Currently, Part D requires that providers use the National Council for Prescription Drug Programs (NCPDP) SCRIPT standard. The proposal would have Part D plan sponsors implement version 2017071 of the NCPDP SCRIPT standard. Upon moving to the NCPDP SCRIPT standard version 2017071, the rule would include four transactions that allow clinicians to initiate medication ePA requests at the time of a patient’s visit. The four transactions include: the PA initiation request/response, PA request/response, PA appeal request/response, and PA cancel request/response. If finalized, all Part D plans would need to support these standards, which would ensure secure electronic prior authorization requests and responses.
The proposed rule highlights the ease of the new ePA transaction standards. The ePA transaction standard would allow a prescriber using an electronic prescribing (eRx) system or an electronic health record with eRx capability to determine whether the beneficiary’s plan requires a PA for a given medication. If the prescriber enters such a prescription into an eRx system, a message will be returned to the provider indicating that a PA is required. Use of the ePA transactions would then enable the prescriber to submit the information required to fulfill the terms of the PA in real time.
CMS noted that the key goals of the new rules would be to reduce provider burdens and reduce waiting times for patients to get needed medications. Comments on the proposed rule are due to CMS by August 16, 2019.
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