Medicare Part D final rule includes EHR, e-prescribing requirement

The Trump administration on Thursday finalized a rule designed to increase transparency around prescription drug costs by requiring Medicare Part D plans to provide electronic access to the data.

The final rule from the Centers for Medicare and Medicaid Services requires Part D plans—after an implementation period—to provide access to a Real Time Benefit Tool to be integrated into clinicians’ electronic prescribing or electronic health records systems.

The tool, which must be capable of integrating with at least one prescriber’s e-prescribing system or EHR no later than Jan. 1, 2021, must also have the capability to inform prescribers when lower-cost alternative therapies are available under the beneficiary’s prescription drug benefit.

“Under President Trump’s leadership, CMS is delivering on price transparency, because patients have a right to know the cost of their healthcare services before they receive them,” said CMS Administrator Seema Verma in a written statement.

“Today’s rule requires Part D plans to adopt tools that provide clinicians with information that they can discuss with patients on out-of-pocket costs for prescription drugs at the time a prescription is written,” Verma added. “By empowering patients with information on the cost of their prescription drugs, today’s rule will ensure that pharmaceutical companies have to compete on the basis of price. This effort builds on new requirements for hospitals to disclose chargemaster prices and other agency initiatives to promote price transparency.”

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Seema Verma, administrator of the Centers for Medicare & Medicaid Services, speaks during a 'Conversations with the Women of America' event at the Eisenhower Executive Office Building in Washington, D.C., U.S., on Tuesday, Jan. 16, 2018. Republican leaders in Congress are angling for another short-term funding measure to avert a government shutdown at the end of this week while trying to keep a dispute over immigration separate from their attempts to get agreement on spending priorities. Photographer: Al Drago/Bloomberg

Also See: Rule on Medicare Advantage, Part D reduces provider burden

While CMS said in its announcement Thursday that the agency is “encouraged” that some Part D plans currently offer these electronic tools, the new policy will require all plans to provide clinicians with access to price information for different prescription drugs via the Real Time Benefit Tools.

“Getting more information on out-of-pocket costs for prescription drugs to patients and their clinicians early in the process is critical, as there should be no surprises at the pharmacy counter,” states the announcement.

A CMS fact sheet on the final rule is available here.

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