Ten states and the District of Columbia don't permit electronic prescribing but are making moves to allow it; two states have regulations in place that are flat-out unfavorable to the technology; but the remaining 39 states are "good to go," according to a pharmacy consortium pushing e-prescribing.
"We've had a lot of progress in the last two years," said Kenneth Whittemore, vice president of professional and regulatory affairs at SureScripts, Alexandria, Va. "This time last year, I would say we were clear on about 17 states."
SureScripts was founded in 2001 as a for-profit joint venture of the National Association of Chain Drug Stores and the National Community Pharmacists Association. It recently published an online map of the states and their regulatory climates toward e-prescribing.
Whittemore said the call for electronic prescribing standards in the Medicare Modernization Act of 2003, and last year's appointment by President Bush of a national coordinator for healthcare information technology "definitely raises the visibility" of the technology. That higher level of awareness has made it easier for state authorities -- chiefly state pharmacy boards and legislatures -- to approve the rules and regulations needed to make e-prescribing lawful, he said.
South Carolina and Wyoming are the two states SureScripts identifies as having "regulations unfavorable" to e-prescribing.
According to a statement by Jim Knight, a spokesman for the South Carolina Board of Pharmacy, SureScripts appeared before the board and was denied approval because in that state, "electronic prescribing is only permissible if it goes directly from the doctor's office to the pharmacy of the patient's choice.
"Most e-prescribing companies that have come before the board send the e-prescribing through a routing company; it does not go directly from the physician's office to the pharmacy," as South Carolina rules require.
Knight said the board has drafted language that it will propose to the South Carolina Legislature that would allow e-prescribing to use that routing configuration if the routing company applies for a permit with the board.
"The board's concern with the routing company is confidentiality of information, HIPAA requirements, patients' choice and the potential to sell information," Knight said. "We are waiting on the South Carolina Department of Health and Environmental Control to let us know if they are OK with the language . . ." Knight said.
Whittemore said the sticking point with Wyoming is its insistence on using the technologically challenging digital signature format as opposed to the more widely used electronic signature format to identify an authorized prescriber. Most e-prescribing tools use electronic signature technologies, he said.
The National Committee on Vital and Health Statistics, which is required under the MMA to develop recommendations for e-prescribing standards, sent a 22-page letter to HHS Secretary Michael Leavitt on March 4, a portion of which dealt with these dueling signature standards. It noted that the Drug Enforcement Administration currently requires a "wet" signature on a paper prescription form for Schedule II controlled substances and will not accept e-prescriptions for those drugs.
The NCVHS recommended that HHS and the DEA work together to find a compromise "without seriously impairing the growth of e-prescribing" and that they, along with state pharmacy boards, "should recognize the current e-prescribing network practices . . . as a basis for securing electronic prescriptions."