Progress Reports

Prescription Benefit

ELECTRONIC REQUESTS FOR PRESCRIPTION BENEFIT INFORMATION GREW 284% BETWEEN 2008 AND 2009.

Surescripts works with the nation's payers and PBMs to offer prescribers access to their patients' prescription benefit - formulary and eligibility information - in real time during an office visit. Prescribers access prescription benefit information using software provided by a vendor that is certified by Surescripts for this service.¹

¹ Click here for more information about Surescripts certification.

² According to the National Ambulatory Medical Care Survey, an estimated 994 million visits were made to office-based physicians in 2007 (data released 2009).

Prescription History

THE NUMBER OF PRESCRIPTION HISTORIES DELIVERED ELECTRONICALLY GREW FIVE FOLD BETWEEN 2008 AND 2009

With a patient's consent³, Prescription History allows a prescriber to review a more complete record of a patient's prescriptions by electronically requesting and receiving history information from payers and community pharmacies. Surescripts works with payers and community pharmacies to make prescription history information available to prescribers in all 50 states and the District of Columbia. Prescribers access prescription history information through software provided by a vendor that is certified by Surescripts for this service.

³ For information on how Surescripts handles personal health information, please review our Privacy Policy.

⁴ According to the National Ambulatory Medical Care Survey, an estimated 994 million visits were made to office-based physicians in 2007 (data released 2009).

Prescription Routing

OVER 190 MILLION PRESCRIPTIONS WERE ROUTED ELECTRONICALLY IN 2009, A 181% INCREASE OVER 2008.

Prescription Routing allows new prescriptions to be sent electronically to the computer system at the pharmacy of the patient's choice, as opposed to sending it by fax or on paper. Renewal authorization requests can be sent electronically from a pharmacy's computer to a practice's e-prescribing software.

Prescribers can review and respond electronically to pending requests with a few keystrokes. Prescribers exchange prescription information with pharmacies electronically and bi-directionally using software provided by a vendor that is certified by Surescripts for this service.

⁵ Requests for prescription renewals are not represented in this section, as prescription renewal requests do not lead directly to the issuing of prescription orders.

⁶ This calculation is based on the 190 million new prescriptions and renewal responses electronically transmitted in 2009 and the 1.63 billion new prescriptions and renewals eligible for electronic routing in 2009 in the U.S., according to NACDS. (Note: These 1.63 billion prescriptions do not include controlled substances, as they are not eligible for e-prescribing under current DEA regulations. That figure also excludes preauthorized refills on existing prescriptions, as they do not require communication between a physician and a pharmacist.)

EMR vs. Standalone E-Prescribing Software

23% OF CERTIFIED AND DEPLOYED EMR SOFTWARE WAS DEPLOYED FOR ALL THREE E-PRESCRIBING SERVICES IN 2009.

Prescribers e-prescribe using either electronic medical record (EMR) software or standalone e-prescribing software. Stand alone e-prescribing software performs only the e-prescribing function. By comparison, e-prescribing is integrated as a component within EMR software as one of many functions such as documentation and charge capture.

⁷ Certification for all three e-prescribing services is comprehensive of certification for Prescription Benefit, History and Routing services. Routing services include connectivity to retail and mail order pharmacy and the ability to manage prescription renewals electronically.

Prescribers

156,000 PRESCRIBERS WERE ROUTING PRESCRIPTIONS ELECTRONICALLY AT THE END OF 2009 VS. 74,000 AT THE END OF 2008.

Prescribers using electronic prescribing in the United States include physicians, nurse practitioners and physician assistants. Prescribers use either standalone e-prescribing software or an electronic medical record (EMR) to e-prescribe. All prescribers described in this section of the Report used Prescription Routing services. A portion of these prescribers also use Prescription Benefit and Prescription History services.

⁸ Total number of prescribers represents approximately 503,000 office-based physicians, 60,000 office-based nurse practitioners and 41,000 office-based physician assistants. These figures are Surescripts-estimated based on data supplied by the American Medical Association, the American Academy of Nurse Practitioners, and the American Academy of Physician Assistants. AMA figures are from Physician Characteristics and Distribution in the US. 2009 ed. (Chicago, IL: American Medical Association). Surescripts' estimate of office-based physicians does not include the following specialties: anesthesiology, diagnostic radiology, emergency medicine, pathology, and radiology.

Payers

AT THE END OF 2009, SURESCRIPTS WAS ABLE TO PROVIDE ACCESS TO PRESCRIPTION BENEFIT AND HISTORY INFORMATION FOR MORE THAN 65 PERCENT OF PATIENTS IN THE U.S.

The nation's public and private payers and their associated pharmacy benefit managers (PBMs) provide prescription benefit and prescription history information to help inform prescribers when they select medication therapy. Surescripts gives prescribers access to this information through its electronic connections to PBMs, which represent connections to thousands of health plans. See a list of Surescripts' connected payers and PBMs.

⁹ Calculated by taking the number of records less 15 percent for patients who have more than one source of prescription benefit coverage, and dividing it by the U.S. population figure. Figures include the District of Columbia, Puerto Rico and U.S. territories. U.S. population figures are from "Annual Estimates of the Resident Population for the United States and Puerto Rico," Population Division, U.S. Census Bureau Release, July 1, 2009.

¹⁰ Surescripts suggests that payers can provide a prescription history for an estimated 95 percent of the patients for whom it can provide prescription benefit information. This is because some pharmacy benefits, when offered as a carve out, are not associated with a claims-based prescription history.

¹¹ This figure is inclusive of records from all 50 U.S. states, and the District of Columbia.

Pharmacies - Community and Mail Order

85% OF COMMUNITY PHARMACIES AND SIX OF THE LARGEST MAIL ORDER PHARMACIES ARE ABLE TO RECEIVE PRESCRIPTIONS ELECTRONICALLY.

There are approximately 62,000 community pharmacies in the United States, representing both chain and independently-owned pharmacies. In addition, PBMs and some chain pharmacies operate mail order pharmacies. Surescripts works with these pharmacies to provide prescription routing connectivity with prescribers - the ability to send new prescriptions electronically to the computer system at the pharmacy of the patient's choice and the ability for pharmacies to send prescription renewal requests to the practices' e-prescribing software for their review and electronic response.

¹³ See a list of e-prescribing pharmacies.

¹⁴ CVS Caremark, Express Scripts, Medco Health Services, Prescription Solutions, Prime Therapeutics (Prime Mail), Walgreens Mail Service and WellPoint (NextRx).

No matter your industry, background or position - you are a stakeholder in the future of health care in this country.

Let us know what you feel is needed to continue growing and promoting e-prescribing. We invite you to provide us with your suggestions and feedback by completing this brief form.