United States e-Prescription Services

The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) (1993) required Medicare Part D to support an electronic prescription system, with a planned implementation date of April 2009. Over the course of 2008 and 2009, two acts incentivized the use of both ePrescribing and the electronic health record (EHR). In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act provided $19 billion dollars to incentivize healthcare providers’ meaningful use of EHR, with ePrescribing considered a key component of meaningful use. The Medicare Improvement for Patients and Providers Act (MIPPA) offered financial bonuses for qualified prescribers who sent prescriptions electronically using a certified system. These financial bonuses were available from 2009 until 2013, with the amount decreasing annually.

Electronic prescribing (e-prescribing) is an important part of the United States’ push to enhance the safety and quality of the prescribing process. E-prescribing has been defined as the computer-based electronic generation, transmission, and filling of a prescription, taking the place of paper and faxed prescriptions. Most prescribing occurs in the outpatient care setting, where paper-based prescribing is most heavily used, so this type of community-based setting holds the greatest potential for e-prescribing to be achieved.

In 2011, the United States spent $263 billion on prescription drugs, which was a 2.9 percent increase from 2010. With this growth in the prescribing of pharmaceutical drugs, e-prescribing is expected to enhance the exchange of patient prescription information among many organizations including physician offices, pharmacies in retail settings, prescription benefit management companies, and insurance providers.

E-prescribing has also helped to involve patients in the prescription process by automatically sending e-mails, text messages, or voice mails to the patients confirming a physician’s order and pharmacy of choice; pharmacies can then notify patients by the same pathways when a prescription is ready.

E-prescribing is also expected to increase the safety and quality of prescribing, enable patients to have more cost-effective medication choices, and enhance the efficiency of the ambulatory care workflow. Growth in e-prescribing came with the passing of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003.

The MMA included the establishment of prescription drug coverage under Medicare as of January 2006. This Medicare Part D prescription plan has supported eprescribing as a voluntary program for providers and pharmacists. It has the capability to make prescribing through Medicare more efficient and well-organized by reducing prescribing errors and coordinating patients’ treatments.

To spur the use of e-prescribing for Medicare recipients, the Medicare Improvements for Patients and Providers Act (MIPPA) was passed in 2008. Additionally, the HITECH Act and the meaningful use standards set by CMS have also increased the overall use of e-prescribing in the United States.

Some e-prescribing systems also include advanced features that allow health care providers to access generic medication alternatives, drug formularies (insurance benefit information), and patients’ medication lists and histories (to check for drug allergies and interactions). These advanced features have the potential to enhance physicians’ decision-making capabilities and increase their use of e-prescribing.