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Unaffordable prescription medications are among the top concerns for pharmacists and prescribers, according to a Surescripts survey. Moreover, 1 in 4 patients told the Kaiser Family Foundation that it was difficult to afford their prescription medicine. As a result, nearly a quarter of people had cut pills in half, skipped doses, or not filled a prescription, or knew a family member who did, citing cost. Medicare patients are especially burdened by unaffordable drugs, which legislators sought to address in the Consolidated Appropriations Act of 2021.

Industry Adoption of Technology to Lower Prescription Costs

In December 2022, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), issued a proposed rule, building on earlier action by CMS that required Part D drug plans to implement one or more electronic real-time benefit tools capable of integrating with at least one prescriber's e-prescribing system or electronic health record (EHR) system to help drive down medication costs for patients.

Key provisions of this policy change serve to expand industry adoption of real-time benefit tools, like Surescripts Real-Time Prescription Benefit, according to the standards provided by the National Council for Prescription Drug Programs (NCPDP) including:

  1. Requires CMS to name a single real-time prescription benefit standard
  2. Creates bonus incentives for providers who use real-time prescription benefit technology
  3. Requires vendors of certified EHR technology platforms to enable the use of real-time prescription benefit technology

The CMS proposed rule formally implements provisions of the Consolidated Appropriations Act. To comply with the rule, payers, pharmacies, prescribers and EHR vendors must adopt and enable the NCPDP Real Time Prescription Benefit version 12 standard.

A new SCRIPT standard aimed at improving patient safety, prescription accuracy and creating workflow efficiencies to limit patient and provider disruption was also included in the proposed rule and is based on provisions from the NCPDP SCRIPT version 202211. The SCRIPT standard supports transactions for new prescriptions, prescription changes, refill requests, prescription fill status notification, prescription cancellation, medication history, transactions for long term care environments and prior authorization exchanges.

All Surescripts solutions are built according to industry-defined transaction standards.

Surescripts Real-Time-Prescription Benefit gives prescribers access to patient-specific benefit plan cost and coverage information, including prior authorization flags, days’ supply options and up to five covered therapeutic alternatives that may cost less for patients or avoid prior authorization. Having this information at their fingertips means better-informed care that is less costly for patients. To wit, Surescripts Real-Time Prescription Benefit is helping patients save an average of $61.17 per prescription when used by providers.

Industry Best Practices Moving Ahead

Each day Surescripts is simplifying how health intelligence is shared, delivering 2.34 billion e-prescriptions and 2.54 billion medication histories across our network in 2022, with more than half of prescribers on the Surescripts network accessing medication pricing last year, up 22% from 2021.

And for more than two decades, Surescripts has led the health technology industry, convening experts and workgroups from across the Surescripts Network Alliance and partnering with leading industry organizations and standards bodies to advance healthcare through research, analysis, education and advocacy. Surescripts lends its expertise to leadership roles and participation on more than 35 committees with NCPDP, such as the Standardization Work Group and Work Group 11.

The fast-moving nature of technology requires organizations and leading industry partners like NCPDP and Surescripts to continuously improve standards, ensuring patient safety and quality care is at the center of every new development.

The rapid pace of this work also means the December 2022, CMS proposed rule provisions based on NCPDP standards shared a year earlier – are already outdated. As a result, Surescripts is requesting that the CMS proposed rule be updated with the newest standards: NCPDP SCRIPT 2023011 and NCPDP RTPB version 13.

Read our comments in full and learn more about how we're enhancing e-prescribing, through technologies that give prescribers patient-specific benefit information at the point of prescribing and by supporting standards that increase the quality and accuracy of prescriptions.

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Our Findings on the 2022 National Progress Report

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