The Magic of Electronic Prescriptions

I was recently introduced to the magic of “Electronic Prescriptions” or “E-Prescribing” — or “E-Rx” if you prefer the funky — when I last visited my doctor for a 90-day refill of Benicar for $50.00USD:

Although e-prescribing is technically regarded “optional,” you could face payment penalties starting in 2012 if you are capable of participating and decided not to do so in 2011. This is as per a Dec. 13 PQRI National Provider Call sponsored by CMS.

Between 2012 and 2014, the payment adjustment will start for practices that are unsuccessful e-prescribers. Eligible professionals who don’t e-prescribe in 2011 could collect one percent less than the Medicare Physician Fee Schedule amount in 2012, and that pay cut will go up to 1.5 percent in 2013 and two percent in 2014, said CMS’s Daniel Green, MD, during the call.

When my doctor asked me for my pharmacy information, I thought that was strange, and when I told him which local pharmacy I used, he typed a few things into his computer and told me my prescription was waiting for me at the pharmacy.

I was a little confused.  I asked him for my prescription, and he repeated what he just said, and then, sensing my wondering, he added, “No more paper. We use Electronic Prescriptions now.  The 90 day supply is waiting for you at Duane Reade.”

“Hmph,” I thought, “I’m not sure if I like not having a paper prescription in hand because I can more easily control the timing of the refill schedule.”  I like to get all the medications for our family refilled at the earliest possible date and I am always confused by the allowable refill times.  Some controlled substances can only be refilled the day before you run out of pills, while other prescriptions can be refilled 10 days in advance of a 30-day supply expiration, while 90-day prescriptions can be refilled after 61 days.

It’s a mess trying to keep track of everything and now I wasn’t able to re-confirm my latest prescription refill date because I’d been bypassed by my doctor and the pharmacy.  The patient was cut out of the medication fulfillment loop!  I’m sure some medication manufacturers would prefer to just write and fill prescriptions and not ever have to worry about having patients mucking everything up by actually swallowing the medicine.

I returned home and called my pharmacy to make sure the electronic prescription had made it through the internets.  It had not.  My pharmacist told me the electronic prescriptions are wonderful because there is no “scribble or scrawl” to interpret from the doctor.  Everything is clearly and cleanly electronically typewritten so there’s no chance for the pharmacist to misunderstand the prescription if the computers make a mistake.  “The computers handle everything,” my pharmacist assured me, “and they will automatically refill your prescriptions as soon as your healthcare plan allows.  It’s all done without human interference.”

While I was calmed by my pharmacist’s confidence in electronic prescriptions, the phrase “without human interference” rang with a Soylent Green melancholia in my head.

It turns out the reason my E-Rx didn’t arrive at Duane Reade was because a whole batch of electronic prescriptions written by my doctor’s computer were rejected by the pharmacy’s computer because his new “E-Prescribing” software failed to “electronically sign” his signature. A single click, and a batch resend later, my Benicar refill was waiting for pickup.