E-Prescribing: Opportunities for Specialty Pharmacy Efficiencies

Author: Jim Maguire

The benefits of e-prescribing have major implications for specialty pharmacy as new capabilities boldly demonstrate what is possible. 


Although it was very slow in coming, e-prescribing is effective and it is here to stay. The benefits of transmitting prescriptions are easy to understand and very well documented. They include:

• Pharmacies have fewer issues with illegibility of scripts

• Pharmacies avoid waiting for fax replies from physicians for refills

• Improved overall accuracy for the dispensing of the script

• Physicians have access to the patient’s prescription fill history

• Patients have the medications filled faster and avoid lost prescriptions

• Patients avoid multiple trips to the pharmacy

As our industry continues to build upon the success of e-prescribing, we should keep in mind the complexities of specialty pharmacy. Government regulations and data/reporting requirements from pharma and payers add to the overhead cost associated with filling a specialty prescription and quite often delay delivery to the patient. Technology can offer options for improved communication and coordination between physicians and pharmacies while still maintaining necessary privacy standards. These options should leverage existing frameworks and data pathways to electronically transmit additional patient-related information. Enhancements to e-prescribing could be a step in that direction.

Recently, the National Council for Prescription Drug Programs announced the Specialized Standard. This standard was developed for transmitting information electronically between prescribers, providers, and pharmacies. The Specialized Standard Implementation Guide addresses electronic transmission of census information about a patient between a facility and a pharmacy as well as medication therapy management transactions between providers, payers, pharmacies, and other entities. The introduction of capabilities such as these boldly demonstrates what is possible as we enhance the e-prescribing technical framework.

In the case of traditional retail or mail order fulfillment, an e-prescription is perhaps all that is required from the physician for the pharmacy to move forward with adjudication and dispensing. With specialty pharmacy, however, although the e-prescription increases the overall accuracy of the process, there still needs to be significant data collection occurring to meet requirements associated with fulfilling the prescription.

Currently, most specialty pharmacies gather this data by having the physician complete an enrolment form or by calling the physician’s office directly. They could be reduced or eliminated by utilizing the e-prescribing tool to transmit patient specific clinical data elements to the specialty pharmacy. In fact, most of these clinical items (eg, blood counts, lab values, patient weight) are already present in the physician’s EMR/EHR system. As more and more physician practices become electronically connected with the major providers of diagnostic laboratory testing, the ease of communicating and securely transmitting these important data elements will become an integral part of any patient management program.

The increased efficiencies gained through more advanced e-prescribing could have REMS benefits as well. For example, manufacturers implementing restricted distribution programs may require physicians to obtain an “authorization identification” (usually by the patient answering a specific clinical questionnaire). That authorization ID is sent with the prescription to the specialty pharmacy. The specialty pharmacy must then provide the manufacturer with the authorization ID when ordering the medication and in patient-related reporting. The coordination and communication of this type of authorization ID is just what we’d be looking for with improved specialty e-prescribing.

The opportunity to expand e-prescribing into the realm of specialty pharmacy is great. The implementation could lead to more streamlined processes, fewer physician interruptions, faster turnaround for Prior Authorizations and Medical Necessities, and more efficient dispensing. Too often patients have to wait to receive their medications as the specialty pharmacy waits to hear back from a physician regarding important clinical information. Lastly, for the physician, e-prescribing is an integral part of meeting the meaningful use requirements and an important step toward avoiding Centers for Medicare & Medicaid Services reimbursement penalties. SPT


Jim Maguire is the CEO of Biomed Intelligence, a firm specializing in health care information technology support solutions. With over 20 years of experience, Mr. Maguire was formerly the chief information officer of a top pharmacy benefit manager and also led information technology operations at a top specialty pharmacy.