Common use of Electronic Prescription Program Clause in Contracts

Electronic Prescription Program. The conference agreement requires the Secretary to develop electronic prescription standards. The standards apply to prescriptions for covered part D drugs and required information that are transmitted electronically under an electronic prescription drug program conducted by a PDP or MA plan. The program must provide for the electronic transmittal of information on eligibility and benefits (including formulary drugs, any tiered formulary structure, and prior authorization requirements), information on the drug being prescribed and other drugs listed in the patient’s medication history (including drug-drug interactions), and information on the availability of lower-cost, therapeutically appropriate alternative drugs. The conferees intend for prescribing health care professionals to have ready access to neutral and unbiased information on the full range of covered outpatient drugs available. Disclosure of information must meet the requirements of the HIPAA privacy rule and, to the extent feasible, be on an interactive, real-time basis. The conferees do not intend for the provision relating to “interactive, real-time” transmission of information to preclude an individual or entity from complying with the standards under this part by virtue of such individual’s or entity’s inability to transmit information on an interactive, real-time basis. The standards must be consistent with the objectives of improving patient safety and the quality and efficiency of patient care. To the extent practicable, the standards must be designed so that they do not impose an undue administrative burden on prescribing physicians and pharmacists. The standards must also be compatible with the HIPAA Administrative Simplification standards and other health information technology standards, and must permit the electronic exchange of drug labeling and drug listing information maintained by the FDA and the National Library of Medicine. Finally, the standards must accommodate the messaging of information about appropriate prescribing of drugs and allow a beneficiary (consistent with their prescription drug plan) to designate a particular pharmacy to dispense a prescribed drug. The conference agreement requires the Secretary to promulgate initial standards by September 1, 2005, taking into account recommendations from the National Committee on Vital and Health Statistics (NCVHS). The NCVHS is required to develop such recommendations in consultation with standard setting organizations, practicing physicians, hospitals, pharmacies, practicing pharmacists, pharmacy benefit managers, state boards of pharmacy and medicine, and appropriate federal agencies. Prior to the promulgation of final standards, the Secretary must enter into voluntary agreements with physicians, pharmacies, hospitals, and PDP sponsors and MA plans to conduct a pilot project to test the initial standards. The pilot project must be conducted during the 1-year period that begins on January 1, 2006, except that pilot testing is not required where there is adequate industry experience. The Secretary must then evaluate the pilot project and report to Congress not later than April 1, 2007. Based on the evaluation and not later then April 1, 2008, the Secretary must promulgate final standards to take effect within one year. The electronic prescriptions standards shall supercede any contrary state laws. The agreement requires the Secretary, in consultation with the Attorney General, to provide a safe harbor from both criminal sanctions under Section 1128(b)(1 and 2) of the Act and the self-referral prohibition under Section 1877 of the Act with respect to the provision of nonmonetary remuneration necessary and used solely to receive and transmit electronic prescription information in accordance with Part D standards. Nonmonetary remuneration includes hardware, software, or information technology and training services. This safe harbor is to apply: 1) in the case of a hospital by the hospital to members of its medical staff; 2) in the case of a medical group practice by the practice to prescribing health care professionals who are members of the practice; and 3) in the case of a PDP sponsor or MA organization, by the sponsor or organization to pharmacists and pharmacies participating in its network and to prescribing health processionals. The conferees intend for electronic prescribing to serve as a vehicle to reduce medical errors and improve efficiencies in the health care system, but not for it to be used as a marketing platform or other mechanism to unduly influence the clinical decisions of physicians.