ERx: Payer SubWorkgroup

1
E-Rx Payer Sub-Workgroup

• First Draft April 10, 2007

2
Payers Support E-Rx Use

• The current paper Rx is fraught with flaws
• Adverse drug events
• Patient inconvenience
• Costs higher than necessary
• E-Rx has potential of reducing cost and improving
  quality.
• Payers see strong upside potential to E-Rx, but
  barriers do exist.

3
Payer Perceived Barriers

• Dont want to underwrite failure due to
• Provider/retail pharmacy indifference
• Lacking connectivity
• Provider/retail pharmacy workflow challenges
• No standards for measuring success and
  implementing incentives
• Where to get numerator and denominator for E-Rx
  rates?
• How to quantify a reduction in ambulatory ADEs?

4
Barriers Continued

• Doubts remain over legal barriers
• Stark
• HIPAA
• Poor connectivity for end-to-end E-Rx
• Not all PBMs participating to provide electronic
  medication histories
• Not all retail pharmacies have turned on
  electronic systems chicken and egg.
• CCHIT does not currently certify free standing
  E-Rx vendors Will the state?

5
Draft Recommendations

• All PBMs operating in TN will need to make
  eligibility, benefit and medication history
  available electronically.
• TN will need to adopt baseline criteria for
  function, security and privacy.
• Adopt statewide metric standards for measuring
  and rewarding E-Rx success.
• Need credible and comprehensive legal review to
  assure safe harbors.