More than one-third of dispensed prescriptions sent electronically in 2011, report finds

BY Alaric DeArment

ARLINGTON, Va. — The number of prescriptions being sent electronically jumped by 75% between 2010 and 2011, while almost all of the retail pharmacies in the country are connected for e-prescribing, according to a new report by the country’s largest e-prescribing network.

According to a report scheduled for release Thursday, Surescripts found that the number of pharmacies connected to the Surescripts network has become almost total. Nearly 57,000 retail pharmacies — out of the 62,461 chain and independent pharmacies in the country overall — are connected to Surescripts’ network, compared with 46,000 in 2008. The current figure represents more than 98% of chain pharmacies and 79% of independents.

In all, 570 million prescriptions, or 36% of the total, were routed electronically by prescribers to pharmacies by the end of 2011, compared with 326 million, or 22% of the total, in 2010. Meanwhile, 58% of office-based physicians were e-prescribing in 2011, compared with 1-in-10 in 2008.

The report also showed an improvement in medication adherence due to e-prescribing, with 76.5% of electronically routed prescriptions being picked up, compared with 69.5% of those sent through traditional means, with a "consistent" increase in first-fill adherence of 10%, creating potential savings of between $140 million to $240 million over 10 years.

"This remarkable growth in adoption and use has transformed one of the most common transactions in health care into a mainstream electronic healthcare tool," Surescripts president and CEO Harry Totonis wrote in the report. "Electronic routing of prescriptions on the Surescripts network accounted for more than 1-in-3 prescriptions that were picked up by patients at community pharmacies. As states implement e-prescribing for controlled substances … these new types of transactions will drive additional use of e-prescribing."

One major contributor to growth is government incentives for electronic health records and e-prescribing under the Health Information Technology for Economic and Clinical Health, or HITECH, Act, which is providing up to $30 billion in incentives for prescribers who adopt electronic health records and meet the government’s "meaningful use" requirements. According to the report, of a cohort of physicians who adopted and began using e-prescribing in 2008, as many as 60% of them have met the initial stage of meaningful use, while 38% would meet the proposed second stage; e-prescribing is one of the core objectives of stage 1 meaningful use, which requires a provider to route more than 40% of prescriptions electronically. So far, the Centers for Medicare and Medicaid Services has doled out almost $4 billion in payments to providers and hospitals.

CORRECTION: An earlier version of this story stated that the incentives for adoption of electronic health records are given out by the Centers for Disease Control and Prevention. The incentives are granted by the Centers for Medicare and Medicaid Services. The story has been corrected.

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A.DeArment says:
May-18-2012 01:03 pm

Ahier: Thank you for pointing out the error in the story, which we have now corrected. Alaric DeArment Associate Editor, Drug Store News

B.Ahier says:
May-17-2012 01:11 am

The incentives are not paid by CDC! The $4 billion comes via CMS, a separate agency...



CMS warns against protocol violations of Medicare Part D prescription transfers

BY Michael Johnsen

BALTIMORE — The Centers for Medicare and Medicaid Services earlier this month released a memo to all Part D sponsors, warning them that the agency has "observed an increase in beneficiary complaints related to the transfer of prescriptions from retail pharmacies to either mail-order or specialty pharmacy without their explicit consent."

According to the memo, the transferring of a prescription from one pharmacy to another that is not initiated by the patient is prohibited without the patient’s consent. Unsolicited phone calls made by the plan or pharmacy seeking permission from beneficiaries to transfer a prescription are not permitted.

Also not permitted is the use of prior authorization forms. "The use of other mechanisms, such as prior authorization forms, to steer a beneficiary into a mail-order pharmacy is against CMS requirements and should be discontinued immediately," wrote Cynthia Tudor, director CMS’ Medicare Drug Benefit and C & D Data Group. "The choice of which network pharmacy to use is at the sole discretion and convenience of the beneficiary."

"This action by CMS is a step in the right direction," noted Kevin Schweers, SVP public affairs for the National Community Pharmacists Association, in a blog posted Wednesday. "Hopefully, the agency continues to take this issue seriously and applies greater oversight in the future."

In December, NCPA communicated to CMS possible abuses of the protocol Part D plans must follow to document a patient’s affirmative decision to switch from one pharmacy to another. In a letter to CMS, NCPA noted: "We have learned that a number of Part D plans across the country are calling and harassing beneficiaries to transfer their prescriptions to a preferred network pharmacy (most commonly a mail-order pharmacy). These plans repeatedly call beneficiaries to make the change. Some plans are even moving patients to mail order without telling them, such that the patient fills a prescription at their community pharmacy and receives a duplicate prescription in the mail.”

For Schweers’ full blog post, click here.


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CVS Caremark study: Focus on Rx adherence saved PBM clients $2.4B in 2011

BY Antoinette Alexander

WOONSOCKET, R.I. — CVS Caremark has aggressively set its sights on enhancing medication adherence, and the initiatives are paying off as the company estimates that its PBM clients saved nearly $2.4 billion in 2011 because of improved medication adherence for chronic conditions, according to findings of its annual Insights Report.

The report, released on Wednesday, reviews drug trend and highlights key issues in pharmacy care. 

The report also found that, in 2011, the drug trend for the company’s PBM employer clients (2.1%) and health plan clients (2.2%) represented the company’s lowest recorded trend for the past seven years.

"Over the past several years, CVS Caremark has conducted research on the causes and impact of medication nonadherence, and we know that taking medications for chronic diseases as directed keeps patients healthier and helps avoid extra costs associated with nonadherence," stated Troyen Brennan, EVP and chief medical officer of CVS Caremark. "Based on our research, we have implemented programs to help our customers and members improve their adherence, and in 2011, the results of these programs increased optimal adherence rates for our clients, resulting in nearly $2.4 billion in overall healthcare savings across our book of business."

"Last year, even consumers with insurance continued to feel the impact of a sluggish economic recovery and responded by rationing their healthcare spending, resulting in relatively flat utilization of pharmacy services," added Per Lofberg, president of CVS Caremark’s PBM business. "As a company focused on helping people on their path to better health, we worked closely with our clients to find opportunities to control costs through formulary management and increased utilization of generic drugs while also continuing to promote programs to improve medication adherence and keep members healthy."

During 2011, the generic dispensing rate for the company’s book of business grew to 74.1% because of the combination of a stream of patent expirations for blockbuster branded drugs and the company’s implementation of formulary and plan design strategies to encourage the use of cost-effective generic drugs.

Another trend driver in 2011 was continued growth in the utilization of complex specialty pharmaceuticals. CVS Caremark’s book of business analysis showed that while specialty drugs may make up as little as 2.5% of a payer’s total prescriptions, they can add up to 31% of overall pharmacy spend. Over the next few years, the impact of specialty medications on pharmacy spend will continue to grow as more specialty drugs enter the market and higher cost per unit prices continue. In 2011, specialty drug trend ranged from 16.5% for employer clients to 19.1% for our health plan clients.

Drug price also was one of the largest drivers of trend in 2011 for CVS Caremark commercial clients, with average wholesale price per day trend showing price increases across both specialty and nonspecialty branded drugs. In fact, since 2007, brand-drug price inflation has increased 27%, the company stated. CVS Caremark noted that it takes these types of market developments into account when developing its formulary and plan design strategies, which promote the use of generic drugs whenever possible and provide for the appropriate use of single-source brand drugs when necessary. CVS Caremark stated that it works with clients to address the impact of price and drug mix by implementing narrower formularies, dispense-as-written penalties and step therapy plan designs to help promote the use of clinically appropriate and cost-effective medications.

The cost savings because of improved adherence was calculated using the company’s pharmacy care economic model, which enables CVS Caremark to calculate the financial value of improved pharmacy care by taking a holistic approach and reviewing adherence, gaps in care and use of generic alternatives. The company’s pharmacy care programs, such as Pharmacy Advisor for diabetes, are succeeding in moving a significant portion of PBM members to optimal levels of medication adherence. The savings calculated using the PCEM are because of medical cost avoidance, drug cost savings and productivity loss avoidance.


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