E-Prescribing is Growing Fast From Small Base

Electronic drug prescribing is growing rapidly, at long last—but it still represents only a small percentage of prescribers and the number of prescriptions being written. According to the latest figures released by Surescripts, the company that provides the connectivity between physician practices and pharmacies, the number of actively e-prescribing physicians and midlevel practitioners grew from 36,000 at the end of 2007 to 74,000 in December 2008. In the first quarter of this year, it jumped another 39 percent to 103,000 clinicians. The December figure represented only 12 percent of office-based prescribers, although that advanced again to 17 percent in the first three months of 2009.

Similarly, the number of prescriptions routed electronically to drugstores soared from 29 million in 2007 to 68 million in 2008, says Surescripts, which was formed by the trade associations of the chain and independent pharmacies. That number represents an increase from 2 percent to only 4 percent of total prescriptions. However, the percentage of prescriptions transmitted online in December was 6.6 percent, and 35 million prescriptions were routed electronically in the first quarter, a 49 percent increase over the last quarter of 2008.

The expansion of e-prescribing preceded the Jan. 1 launch of a CMS incentive program that gives e-prescribing physicians a financial incentive equal to 2 percent of their Medicare reimbursement. But the Medicare bonus clearly accounts for part of the big bump in usage toward the end of last year and at the beginning of 2009. Another factor is the prospect of lower Medicare payments to physicians who don’t prescribe electronically, starting in 2012.

The rising number of pharmacies that accept electronic prescriptions—and pay for their transmission over the Surescripts network–is also inducing more physicians to use the technology. At the end of 2008, 76 percent of U.S. community pharmacies—including nearly all chain drugstores—and six of the leading mail-order houses were accepting electronic prescriptions online. This means that in most communities, physicians could send the majority of their e-prescriptions directly to pharmacy computers, instead of having to fax them or print them out. Although prescriptions for controlled substances still can’t be sent this way (the DEA is working on new regulations), the day is approaching when practices that e-prescribe will have a single workflow for this key part of their activities.

A few other interesting facts emerged from the Surescripts report:
•    Electronic requests for prescription benefit and formulary information more than doubled to 78 million in 2008. That represents just 9 percent of patient visits. One reason is that payers and PBMs provided Surescripts with this data on just 65 percent of patients across the country.
•    As a result of its merger with RxHub, Surescripts has access to medication histories from leading PBMs and payers. In some areas of the country, it can combine that information with pharmacy sales data. But not many physicians are using these histories yet. While the number of histories delivered to prescribers nearly tripled to 16 million in 2008, that still represents only 1.8 percent of patient visits.

Overall, Surescripts’ report shows a dynamic shift in the uptake of e-prescribing. It also suggests that the use of electronic health records is growing, because many doctors e-prescribe in their EHRs. According to Surescripts, “The proportion of prescribers using EMR software versus standalone e-prescribing software for prescription routing grew from about 31 percent in 2006 to 63 percent in 2008.”