Common use of Electronic Prescription Program Clause in Contracts

Electronic Prescription Program. The provision would establish a new Part D in Title XI of the Social Security Act. The new Section 1180 would mandate the development or adoption of standards for transactions and data elements for such transactions, to enable the electronic transmission of medication history, eligibility, benefit and other prescription information. In developing the standards, the Secretary would be required to consult with representatives of physicians, hospitals, pharmacists, standard setting organizations, pharmacy benefit managers, beneficiaries, information exchange networks, technology experts, and representatives of the Departments of Veterans Affairs and Defense and other interested parties. The standards developed or adopted by the Secretary would be consistent with the objective of improving patient safety and improving the quality of care. Standards would be required to comply with certain requirements. Patients could request a written prescription and not be charged for such request. The standards would accommodate the electronic transmittal of a patient’s medication history, eligibility, benefit and other prescription information among prescribing and dispensing professionals at the point of care. The information that could be transmitted using the standards would include: information on the drugs prescribed for the patient; cost-effective alternatives (if any) to the drug prescribed; information on eligibility and benefits (including the drugs included in the applicable formulary and any requirements for prior authorization); information on potential drug interactions; and other information to improve the quality of care and to reduce medical errors. The standards would be designed so that, to the extent practicable, they did not impose an undue administrative burden on the practice of medicine, pharmacy, or other health professions. The standards developed or adopted by the Secretary would be consistent with Federal regulations (concerning the privacy of individually identifiable health information) promulgated under section 264(c) of the 1996 Health Insurance Portability and Accountability Act (HIPAA), and would be compatible with HIPAA’s Administrative Simplification standards. The Secretary would be required to adopt standards for the appropriate data elements needed for the electronic exchange of prescription drug information among prescribers, insurers, and other entities. The Secretary would have to adopt the standards by Jan. 1, 2006, and would be permitted to modify them, but in a manner that minimized the disruption and cost of compliance. Individuals that transmit or receive prescriptions electronically would be required to comply with the standards. However, individuals would not be required to transmit or receive electronic prescriptions. The standards would preempt state electronic prescription laws. Entities covered by the standards would have 24 months to comply. Small health plans, as defined by the Secretary, would have an additional 12 months to comply. The Secretary would be required to consult with the Attorney General to ensure that the standards resulted in the secure electronic transmission of prescriptions for controlled substances.