New players in electronic prescribing

Insurers and pharmacy benefit managers are investing in or developing systems to reduce costs and increase compliance with drug formularies.

By Tyler Chin, amednews staff. Feb. 25, 2002.

As several managed care companies and pharmacy benefit managers are getting involved in the electronic prescribing system business, some doctors are wary about what they see as a means for plans to muscle their way further into the prescribing process.

Some companies, including Aetna Inc. and Tufts Health Plan, are in the early stages of testing electronic prescribing technology or collaborating with makers of handheld prescribing systems to offer doctors access to their drug formulary at the point of care.

Handing it over

Others have acquired electronic prescribing technology from companies that hit a financial wall partly because doctors wouldn't use and pay for their services. Last year, for example, Rx-Connect, a division of PacifiCare Health Systems, Santa Ana, Calif., bought the technology assets of Parkstone Medical Information Systems at a federal bankruptcy court auction for $1.15 million in stock and cash.

Some physicians wonder whether these moves could give insurers and PBMs too-easy access to their prescribing patterns. Insurers and PBMs are being pressured by corporate payers and others to put a lid on the 17% to 20% annual increases in drug costs.

"The only thing that stops them from doing that a lot more is the amount of work that it would take them to retroactively question every prescription," said Andre S. Chen, MD, a family physician at a 130-doctor group in Austin, Texas. "If they can do it in a much more efficient [and less expensive] manner, then I think they will."

6% of physicians used a handheld for prescribing in 2001, up 2% from 2000.

Although he frequently uses a handheld for coding and references, Dr. Chen does not use it for prescribing because he says it would make the process more complex. By handwriting prescriptions, he doesn't have to worry about the handheld or personal digital assistant being hooked up to the server, the server hooked up to the network, the pharmacy being hooked up to the network or whether the pharmacy's fax is working.

"With pen and paper, I know the patient can get that prescription filled somewhere, but with a PDA, there's too many places where it can fail. If it fails 5% or 10% of the time, it creates a huge headache and a lot of rework," Dr. Chen said. "Sometimes simpler is better."

Completely electronic?

Today, few doctors are prescribing electronically or using "true e-prescribing solutions" because most prescriptions they write on handhelds are not electronically transmitted to pharmacies, according to a study by consulting firms Fulcrum Analytics and Deloitte Research. Instead they are being printed for the patient or faxed to the pharmacy.

The study estimated that 6% of the country's practicing physicians prescribed "electronically" last year, up from 4% in 2000.

To get doctors to prescribe electronically, some firms are offering their technology at no cost to doctors.

For example, PacifiCare's Rx-Connect offers its prescribing system at no cost to large group practices in return for their agreement to use the company's technology exclusively for up to five years. It plans to make money from fees paid by pharmaceutical companies interested in getting doctors to prescribe their drugs over their competitor's drugs, said David Grant, president of Rx-Connect. The company also plans to make money from PBMs and from companies that want to advertise their products on prescriptions that physicians print out for their patients, Grant said.

So far, insurers are not offering any financial incentives to encourage physicians to adopt electronic prescribing. But Aetna says it will consider offering such incentives. Its decision will depend on the results of a test scheduled to begin later this year of a prescribing system from Libertyville, Ill.-based Allscripts Healthcare Solutions, said Jeff Taylor, the insurer's lead of regional pharmacy operations.

Doctors who use the Allscripts system and agree to participate in the test will be able to electronically transmit prescriptions to patients' chosen pharmacies and have access to Aetna's formulary before they write a prescription, Taylor said.

That will save doctors time because it will reduce the number of telephone calls from pharmacists asking them for substitutions or illegible prescriptions, he said. In turn, it also will help Aetna lower its administrative costs.

ADDITIONAL INFORMATION:

Handing it over

Movement on the electronic prescribing technology front:

Aetna Inc. expects to test electronic prescribing with doctors using a handheld system from Allscripts Healthcare Solutions, this fall.
Tufts Health Plan and AdvancePCS are testing a handheld prescribing system from PocketScript Inc., with 140 physicians. When the test ends, Tufts will evaluate the program and decide whether to expand it.
In January, AdvancePCS acquired the technology of iScribe Inc. Terms were not disclosed.
PacifiCare Health Systems, in October 2001, won a bankruptcy court auction for technology assets of Parkstone Medical Information Systems.