Monday, July 7, 2008

The Surescripts/RxHub merger

Last week, I spoke with the Associated Press and Wall Street Journal about the recent merger of Surescripts and Rxhub.

My basic message was:

"The merger of Surescripts and RxHub provides a single medication data stream, supporting medication safety. It also provides an easy e-prescribing implementation path for electronic health record vendors and an enhanced medication workflow for clinicians nationwide."

Here's the reason I made these comments. In the world of e-Prescribing, the stakeholders are

- the patient
- the physician writing the prescription
- the retail pharmacy or mail order pharmacy
- the payer
- the pharmacy benefit manager (PBM), which acts on behalf of the payer to adjudicate claims
- RxHub: the connection to most PBMs
- SureScripts: the connection to most retail pharmacies

Here's the data flow:

1. A clinician begins to e-Prescribe and electronically queries for the patient's insurance eligibility and the appropriate payer's formulary. Before the merger, both RxHub and SureScripts had eligibility services but RxHub processed the majority of these transactions.

2. The clinician queries for medication history to check for drug/drug interactions. RxHub has medication history based upon claims data and SureScripts has the actual dispensed information from the pharmacies (which includes cash, third party claims and $4 generic programs). Before the merger, the clinician's EHR would have to issue separate queries via two separate interfaces to get a complete history.

3. The physician completes the prescription. Retail pharmacy transactions are transmitted to SureScripts for delivery to community pharmacies and smaller mail order firms. Mail order transactions served by one of the 3 large PBMs are transmitted to RxHub for fulfillment. Again, two separate interfaces were required.

As SureScripts-RxHub integrates its services, there will no longer be a need to send out 2 queries for eligibility/formulary, medication history or routing. Also, the two sources of medication history data will be de-duplicated, providing an accurate and usable medication data flow to all stakeholders.

In addition to the Surescripts-RxHub merger, two other important events will accelerate e-Prescribing in 2009.

1. Regulatory changes proposed by the Drug Enforcement Agency will enable electronic prescribing of scheduled/controlled medications. Having separate workflows for controlled medications verses all others has been a real barrier to process change in many medical care settings. I look forward to the regulatory change.

2. Incentives to adopt and use e-Precribing via the Medicare Electronic Medication Safety Protection Act of 2007. Clinicians have been reluctant to adopt electronic prescribing because of the investment and time commitment to change change their workflow. Currently only 4% of the clinicians in the country e-prescribe (although Massachusetts is at 13% and BIDMC is at 50%). A one time payment when e-prescribing is implemented helps a physician acquire the technology. An ongoing incentive ensures they continue to use it.

Let's hope 2009 is the year of e-prescribing. Everyone wins through reduced cost, enhanced quality and better workflow.
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