Federal lawmakers hammered the Drug Enforcement Administration yesterday, calling the federal agency a hindrance to widespread adoption of electronic prescriptions and charging it with stalling on a long-awaited regulation that would allow pharmacists to electronically prescribe certain controlled drugs.
"Everyone seems to support the notion that it is time for the DEA to issue regulations permitting e-prescription of controlled substances," said Sen. Sheldon Whitehouse (D-R.I.), who chaired the Senate Judiciary Committee meeting. "The only two questions we have to explore … are when and how?"
Joseph Rannazzisi, deputy assistant administrator for the DEA's Office of Diversion Control, however, failed to give the senators an answer that would satisfy them. In an often-contentious back-and-forth, Rannazzisi said that the agency has made the issue a top priority, yet declined to commit to a deadline or even offer an estimate of when a regulation would free up physicians to e-prescribe drugs like Vicodin and other medications that are easily abused.
Sen. Tom Coburn (R-Okla.) called the answer "a little bit frustrating," and cited it as a key reason why physicians have been reluctant to adopt e-prescribing.
Federal rules now prohibit the electronic prescription of scheduled drugs, including some painkillers, antidepressants and some asthma drugs, which the DEA regulates. Roughly 10% of drugs are considered scheduled, or "controlled," and thus require pen-and-pad prescriptions. Physicians can electronically prescribe medications for the remaining 90%.
According to federal data, nearly 7 million Americans abuse prescription drugs, up 84% from 3.8 million in 2000.
Whitehouse said that as a result, most doctors refuse to prescribe any medication electronically because it would require them to use two separate systems—an electronic one for regular prescriptions and a paper one for controlled drugs.
"The inevitable result is that most doctors simply refuse to prescribe any medication electronically," Whitehouse said.
The hearing was held on the same day that health information technology advocates released their report on the current status of electronic prescribing in the U.S. The National Progress Report on E-Prescribing, published by SureScripts, stated that by year-end, 35 million prescriptions will have been routed electronically in the U.S., and estimated that the number of e-prescriptions will nearly triple in 2008. And while findings show that there are 35,000 providers and 40,000 pharmacies e-prescribing, the report seems to agree with Whitehouse's argument, as only 6% of office-based physicians are currently e-prescribing.
Rannazzisi, however, countered that the DEA faces added challenges because developing specific criteria means having to reach across several different agencies. The DEA, for instance, has been working with HHS and Robert Kolodner, the physician who heads the Office of the National Coordinator for Health Information Technology at HHS, to help shape a workable policy.
The Pharmaceutical Care Management Association said that overall adoption of e-prescribing may be hindered by something altogether different—a lack of urgency in the physician community. In a written statement, the association said that while 80% of doctors know the benefits of e-prescribing, fewer than one-in-10 actually use it.
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