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A Letter from Our CEO

Ready for a Fast-Moving Future

We are in an unprecedented moment in history. The COVID-19 pandemic has rearranged lives and shifted priorities across the globe, and healthcare is at the center of the whirlwind.

But American healthcare is used to rapid change. Throughout 2019, market forces, government activity, and the expectations of new generations of patients and clinicians were already speeding us toward a world in which our industry must evolve quickly to succeed.

It’s a world that’s pushing us to share information more efficiently, securely and transparently. As part of the 21st Century Cures Act, the federal government drafted new rules on information blocking and interoperability. The latest data from the Office of the National Coordinator for Health Information Technology shows just 46% of U.S. hospitals and 10% of office-based physicians are able to electronically find, send, receive and integrate patient health information from outside sources.1, 2 Clearly, there is more work to be done as provider organizations and technology vendors focus on meeting these new regulatory requirements throughout 2020.

With drug pricing a hot topic across the nation, the federal government also issued a rule requiring that Medicare Part D plans adopt real-time prescription benefit tools by 2021. Patients and prescribers too are demanding prescription price transparency: 4 in 10 providers say prescribing would be more efficient with more information at their fingertips, particularly cost and coverage data.3 Meanwhile, 61% of patients say they’d be willing to spend extra time, effort or money in order to have informed prescription cost conversations with their doctor—one signal that consumerism is finally taking hold in U.S. healthcare.4

It’s also a world where healthcare costs, data and outcomes are more intertwined than ever. One insurer predicts that 59% of healthcare payments will be value-based by 2021.5 But as of 2017, 24% of healthcare executives said they lacked the external interoperability needed for value-based care.6

Controlling costs is further complicated by the rise of specialty drugs, which now account for nearly half of prescription drug spending.7 And cost is not the only barrier for the patients who need them. For many critical specialty medications, treatment can be delayed by days or weeks due to factors such as prior authorization.

As you navigate our 2019 National Progress Report, you might ask: Are we ready to navigate these changes and see our way through to better, safer, less costly care?

What I see indicates that we are making true progress on each of these fronts. Through a robust and trusted network, continual innovation and the deep engagement of partners across the Surescripts Network Alliance™, we are delivering actionable intelligence to transform more healthcare interactions and patient outcomes than ever before.

Thank you for joining us as we explore how we enhanced prescribing, informed care decisions and advanced healthcare together in 2019.



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NETWORK ALLIANCE

Connecting Healthcare with Speed and Precision

Today, the Surescripts Network Alliance links virtually all electronic health records (EHR) vendors, pharmacy benefit managers (PBMs), pharmacies and clinicians—plus health plans, long-term and post-acute care organizations, specialty hubs and specialty pharmacy organizations—with health data for the vast majority of U.S. patients and virtually all prescribers.

  • 1.78 million healthcare professionals and organizations connected (+11% in 2019)
  • 0.04 seconds, on average, to retrieve an accurate patient match
  • 314 million patients in our master patient index, representing 95%* of the U.S. population

*This includes patient data provided by both pharmacies and PBMs. In previous years, we only included patient data provided by PBMs. The data has been adjusted to account for duplication and patients with multiple coverage.

 

Maintaining a Trusted, Reliable Network

As the healthcare landscape shifted in 2019, Surescripts Network Alliance participants could count on the strength, security and availability of our network.

  • 99.999% approximate uptime
  • HITRUST CSF Certified status maintained for key platforms, demonstrating strong privacy, security and risk-management practices and placing Surescripts in an elite group of organizations worldwide
  • 10% increase in Quality Index Score for electronic prescriptions across the network (an 80% improvement since 2016)


Surescripts' Quality Index Score measures the effective use of 11 key elements of electronic prescriptions, such as Drug Description, Days Supply, and Potency Unit Code.

 

Nearing 20 Billion Network Transactions

Surescripts processed 19.15 billion transactions in 2019, an 8% increase from 2018.

Surescripts processed 19.15 billion transactions in 2019, an 8% increase from 2018. The network processed 17.7 billion transactions in 2018, 13.7 billion in 2017, 10.9 billion in 2016, 9.7 billion in 2015, 6.5 billion in 2014 and 6 billion in 2013.

  • 1.79 billion e-prescriptions filled
  • 2.18 billion medication history responses delivered
  • 333.8 million links to clinical document sources shared


Historically, Surescripts has reported on the number of prescriptions written electronically nationwide. Going forward, we will be reporting the number of e-prescriptions filled to more accurately reflect the state of industry progress. Surescripts estimates that 84% of e-prescriptions are dispensed.

 

SPOTLIGHT: ELIGIBILITY & FORMULARY

By giving providers the ability to check a patient’s insurance and prescription benefit coverage, Eligibility & Formulary serves as the foundation for many Surescripts solutions, including E-Prescribing, Real-Time Prescription Benefit, Electronic Prior Authorization, Medication History and Record Locator & Exchange.

  • 2.8 billion eligibility responses (+4% in 2019)

Tracking & Celebrating Prescription Accuracy

Since 2016, our Critical Performance Improvement program has convened the Surescripts Network Alliance to improve the accuracy of e-prescriptions. Surescripts Sentinel® analyzes electronic prescriptions and identifies opportunities for improvement.

In 2019, we recognized 12 health systems, EHRs and pharmacy industry leaders with the Surescripts White Coat Award for their work optimizing e-prescribing.

EHRS

athenahealth, Inc.
MDLiveCare Inc.
MEDENT

PHARMACY INDUSTRY LEADERS

CVS Health
Humana Pharmacy
KeyCentrix Inc.
Walmart Inc.

HEALTH SYSTEMS

Greater Baltimore Medical Center
MidMichigan Health
Montage Health
Northeast Georgia Health System
University of California San Francisco Health

Guiding the Industry to a New Standard

Throughout 2019, we guided the industry’s migration to the National Council for Prescription Drug Programs SCRIPT Standard Version 2017071, required by the Centers for Medicare and Medicaid Services as of January 1, 2020. Through hundreds of improvements to e-prescribing transactions, the new standard will:

  • Reduce manual processes that disrupt provider and pharmacy workflows
  • Let pharmacies electronically request prescriptions for medications they have not previously dispensed and readily transfer prescriptions to other pharmacies
  • Enrich medication history with additional data elements
  • Serve long-term and post-acute care settings with transactions that lend long-awaited clarity, automation and efficiency to this unique market

The majority of Surescripts Network Alliance participants that use E-Prescribing and Medication History had certified to the new standard by the end of 2019, ahead of the Surescripts sunset date for SCRIPT v10.6. They included organizations responsible for:

  • 43.5% of e-prescriptions sent from EHRs
  • 89.4% of e-prescriptions sent by health systems
  • 99.9% of e-prescriptions processed by mail-order pharmacies
  • 92.2% of e-prescriptions processed by retail pharmacies

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ENHANCE PRESCRIBING

DELIVERING THE RIGHT MEDICATION WITHOUT DELAY

E-PRESCRIBING

1.79 billion e-prescriptions were filled in 2019, compared to 1.64 billion in 2018 and 1.49 billion in 2017. 2.1 billion e-prescriptions were written in 2019, compared to 1.91 billion in 2018 and 1.74 billion in 2017. There were 134.2 million e-prescriptions for controlled substances filled in 2019, compared to 96.8 million in 2018 and 65 million in 2017. 159.77 million e-prescriptions for controlled substances were written in 2019, compared to 115.16 million in 2018 and 77.33 million in 2017.
1.79 billion e-prescriptions were filled in 2019, compared to 1.64 billion in 2018 and 1.49 billion in 2017. 2.1 billion e-prescriptions were written in 2019, compared to 1.91 billion in 2018 and 1.74 billion in 2017. There were 134.2 million e-prescriptions for controlled substances filled in 2019, compared to 96.8 million in 2018 and 65 million in 2017. 159.77 million e-prescriptions for controlled substances were written in 2019, compared to 115.16 million in 2018 and 77.33 million in 2017.


RATE OF E-PRESCRIBING


In 2019, 80% of all prescriptions filled were written electronically, compared to 73% in 2018 and 66% in 2017. For non-controlled substances, the rate of e-prescribing was 86% in 2019, 83% in 2018 and 76% in 2017. For controlled substances, the rate of e-prescribing was 38% in 2019, 26% in 2018 and 17% in 2017.
In 2019, 80% of all prescriptions filled were written electronically, compared to 73% in 2018 and 66% in 2017. For non-controlled substances, the rate of e-prescribing was 86% in 2019, 83% in 2018 and 76% in 2017. For controlled substances, the rate of e-prescribing was 38% in 2019, 26% in 2018 and 17% in 2017.

Note: Percentages calculated using data from the National Association of Chain Drug Stores.



Historically, Surescripts has reported on the number of prescriptions written electronically nationwide. Going forward, we will be reporting the number of prescriptions filled by retail and mail-order pharmacies to more accurately reflect the state of industry progress. Surescripts estimates that 84% of prescriptions are dispensed.

E-PRESCRIBING UTILIZATION


98.7% of pharmacies utilized e-prescribing in 2019, compared to 98.5% in 2018 and 98.1% in 2017. 79% of prescribers utilized e-prescribing in 2019, compared to 73% in 2018 and 69% in 2017.
98.7% of pharmacies utilized e-prescribing in 2019, compared to 98.5% in 2018 and 98.1% in 2017. 79% of prescribers utilized e-prescribing in 2019, compared to 73% in 2018 and 69% in 2017.

The number of prescribers utilizing E-Prescribing increased more than 8% in 2019.

SPOTLIGHT: CANCELRX

In 2019, we saw more and more clinicians implementing workflow and technology changes, like the CancelRx transaction, to improve prescription accuracy and patient safety. By using CancelRx, prescribers can securely and reliably notify the pharmacy of the need to cancel a prescription, which stops automatic refills and eliminates the need for time-consuming phone calls and faxes.

CancelRx transactions increased 203% in 2019, totalling 35.8 million. There were 11.8 million CancelRx transactions in 2018 and 3.8 million in 2017. In 2019, 47% of prescribers were enabled for CancelRx, compared to 29% in 2018 and 13% in 2017.
CancelRx transactions increased 203% in 2019, totalling 35.8 million. There were 11.8 million CancelRx transactions in 2018 and 3.8 million in 2017. In 2019, 47% of prescribers were enabled for CancelRx, compared to 29% in 2018 and 13% in 2017.

SPOTLIGHT: RXCHANGE

Pharmacists often play a critical role in optimizing medication therapy, and RxChange gives them a quicker, easier way to collaborate with prescribers. In 2019, the Surescripts network saw considerable growth in the use of RxChange, particularly three unique use cases, including RxChange for Prior Authorization, RxChange for Therapeutic Interchange and RxChange for Generic Substitution.

There were 11.7 million RxChange transactions in 2019, compared to 84,000 in 2018. In 2019, 34% of pharmacies were enabled for RxChange, compared to 6% in 2018 and 2017.
There were 11.7 million RxChange transactions in 2019, compared to 84,000 in 2018. In 2019, 34% of pharmacies were enabled for RxChange, compared to 6% in 2018 and 2017.

ELECTRONIC PRESCRIBING FOR CONTROLLED SUBSTANCES (EPCS)

In 2019, more healthcare professionals saw the safety and efficiency benefits of EPCS—and put it into action for their patients. Compared to 2018, 51% more prescribers were enabled for EPCS.

PERCENT ENABLED FOR EPCS


In 2019, 97% of pharmacies were enabled for EPCS, compared to 95% in 2018 and 93% in 2017. 49% of prescribers were enabled in 2019, compared to 32% in 2018 and 22% in 2017.
In 2019, 97% of pharmacies were enabled for EPCS, compared to 95% in 2018 and 93% in 2017. 49% of prescribers were enabled in 2019, compared to 32% in 2018 and 22% in 2017.

TOP 5 SPECIALTIES USING EPCS


42% of psychiatrists, 40% of family practitioners and pain management specialists, 38% of orthopedic surgeons and 37% of neurologists used EPCS in 2019.
42% of psychiatrists, 40% of family practitioners and pain management specialists, 38% of orthopedic surgeons and 37% of neurologists used EPCS in 2019.

Family practice saw the largest increase, growing more than 7% in 2019.

SPOTLIGHT: OPIOIDS


In response to the nation’s opioid crisis, opioid prescribing rates have been declining for several years now.8, 9 In 2019, we saw more opioid prescriptions written electronically, helping guard against prescription fraud and abuse.

67.7 million e-prescriptions were written for opioids in 2019, a 36% increase from 2018, when they totaled 49.4 million. In 2017, they totaled 33.2 million.

Note: This data includes opioid prescriptions written electronically. Other e-prescribing data in this report considers only prescriptions filled.

67.7 million e-prescriptions were written for opioids in 2019, a 36% increase from 2018, when they totaled 49.4 million. In 2017, they totaled 33.2 million.

Note: This data includes opioid prescriptions written electronically. Other e-prescribing data in this report considers only prescriptions filled.

Top 5 Opioid E-Prescriptions Written

In 2019, five opioids accounted for 88% of all opioid e-prescriptions written.

32% of opioid e-prescriptions were for hydrocodone, 27.4% were for oxycodone, 13.2% were for tramadol, 9.2% were for buprenorphine and 6.5% were for codeine.

EPCS Legislation On the Move

With 13 states enacting e-prescribing requirements in 2019, more than half of all states now require e-prescribing for opioids, all controlled substances or all prescriptions. As provider enablement for EPCS rises in these states, we can also expect further advances spurred by the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, which requires that controlled substance prescriptions covered under Medicare Part D be transmitted electronically as of January 1, 2021.

WHERE IS E-PRESCRIBING REQUIRED BY LAW?


More than half of all states now require e-prescribing for opioids, all controlled substances or all prescriptions.
More than half of all states now require e-prescribing for opioids, all controlled substances or all prescriptions.

EPCS STATE RANKINGS

2019 Rank 2018 Rank State Pharmacy Enablement Prescriber Enablement Controlled Substances Prescribed Electronically

New York maintained its longstanding position as the nation’s leader in EPCS enablement, having required e-prescribing for all prescriptions since 2016.

Maine and Connecticut held their ranks as second and third in the nation following controlled substance e-prescribing mandates that took effect in mid-2017 and January 2018, respectively.

Arizona delayed its e-prescribing requirement for opioids until January 1, 2020, but the state still made gains in 2019: It leapt from 11th place to fourth.

Oklahoma saw the largest rank increase in the nation, moving up 18 spots in 2019. Its e-prescribing requirement was enacted in May 2018 and became effective January 1, 2020.

How State Mandates Spur EPCS Enablement

New York, Maine and Connecticut started the year with mandates in place. So did Minnesota, though its requirement has no specific penalties for noncompliance. Pennsylvania’s mandate took effect October 24, 2019. Arizona, Florida, Iowa, North Carolina, Oklahoma and Rhode Island had mandates set to take effect January 1, 2020.
New York, Maine and Connecticut started the year with mandates in place. So did Minnesota, though its requirement has no specific penalties for noncompliance. Pennsylvania’s mandate took effect October 24, 2019. Arizona, Florida, Iowa, North Carolina, Oklahoma and Rhode Island had mandates set to take effect January 1, 2020.

New York, Maine and Connecticut started the year with mandates in place. So did Minnesota, though its requirement has no specific penalties for noncompliance.

Pennsylvania's mandate took effect October 24, 2019.

Arizona, Florida, Iowa, North Carolina, Oklahoma and Rhode Island had mandates set to take effect January 1, 2020.

ELECTRONIC PRIOR AUTHORIZATION

In 2019, Surescripts continued to focus on improving the prior authorization experience by streamlining workflows and expanding our network to include new data suppliers.

We also worked closely across the industry to build alignment around automating and improving the process for patients and providers. Just after the new year, America’s Health Insurance Plans announced that it would leverage Surescripts Electronic Prior Authorization as part of its Fast Prior Authorization Technology Highway (Fast PATH) initiative, with the potential to benefit the 60 million patients covered by participating plans.10

  • 132% increase in prior authorizations processed electronically
  • PBMs and health plans representing 95% of U.S. patients have contracted to provide data for the service
  • 82% of U.S. prescribers are served by EHRs contracted for the service
  • 58% increase in provider adoption

REAL-TIME PRESCRIPTION BENEFIT

Patients and clinicians value prescription price transparency, and data shows that far more of them experienced it firsthand in 2019.

  • PBMs and health plans covering 79% of U.S. patients have contracted to provide data for the service
  • 88% of U.S. prescribers are served by contracted EHRs (+10% in 2019)
  • <2 seconds average time for prescribers to receive cost and coverage data in their EHR

Real-Time Prescription Benefit checks increased 336% in 2019, reaching 136.1 million transactions. There were 40.5 million transactions in 2018 and 3.1 million in 2017. 251,000 prescribers used Real-Time Prescription Benefit in 2019, an increase of 233%. 107,800 prescribers used it in 2018 and 2,600 used it in 2017.
Real-Time Prescription Benefit checks increased 336% in 2019, reaching 136.1 million transactions. There were 40.5 million transactions in 2018 and 3.1 million in 2017. 251,000 prescribers used Real-Time Prescription Benefit in 2019, an increase of 233%. 107,800 prescribers used it in 2018 and 2,600 used it in 2017.

AVERAGE SAVINGS PER PRESCRIPTION WHEN A LOWER-COST ALTERNATIVE IS CHOSEN


On average, family practitioners using Real-Time Prescription Benefit to find a lower-cost alternative saved their patients $56 per prescription, internists saved $35, OB-GYNs saved $78, psychiatrists saved $89 and cardiologists saved $16. The average savings per prescription when a lower-cost alternative was chosen was $73 for antimycotics for systemic use, $35 for antidepressants, $16 for lipid modifying agents, $53 for blood glucose lowering medication (excluding insulin) and $10 for beta blockers.
On average, family practitioners using Real-Time Prescription Benefit to find a lower-cost alternative saved their patients $56 per prescription, internists saved $35, OB-GYNs saved $78, psychiatrists saved $89 and cardiologists saved $16. The average savings per prescription when a lower-cost alternative was chosen was $73 for antimycotics for systemic use, $35 for antidepressants, $16 for lipid modifying agents, $53 for blood glucose lowering medication (excluding insulin) and $10 for beta blockers.

Note: Listed in order of volume. Classification based on pharmacologic class.

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INFORM CARE DECISIONS

GIVING CARE TEAMS A CLEARER VIEW

MEDICATION HISTORY

In addition to delivering more medication insights in 2019, we also introduced technical improvements to eliminate redundant records and augment medication history data, ultimately improving usability and accuracy.

Surescripts delivered 2.18 billion medication histories in 2019, a 19% increase from 1.77 billion in 2018. 1.46 billion medication histories were delivered in 2017. Surescripts also delivered 5.7 million medication histories for populations in 2019, a 198% increase from 1.9 million in 2018. 355,000 medication histories for populations were delivered in 2017.
Surescripts delivered 2.18 billion medication histories in 2019, a 19% increase from 1.77 billion in 2018. 1.46 billion medication histories were delivered in 2017. Surescripts also delivered 5.7 million medication histories for populations in 2019, a 198% increase from 1.9 million in 2018. 355,000 medication histories for populations were delivered in 2017.

Medication History for Populations lets healthcare providers proactively access medication history via their EHR or analytics platform to help identify and close gaps in care, uncover medication non-adherence and manage at-risk patient populations.

* Includes only medication history data supplied by pharmacy benefit managers.

RECORD LOCATOR & EXCHANGE


Record Locator & Exchange played a key role in enabling interoperability in 2019, helping more clinicians and their patients benefit from more complete clinical histories during care episodes.

136,000 clinicians utilized Record Locator & Exchange in 2019, a 28% increase from 106,000 in 2018. 52,000 used the service in 2017.
136,000 clinicians utilized Record Locator & Exchange in 2019, a 28% increase from 106,000 in 2018. 52,000 used the service in 2017.

Record Locator & Exchange delivered 333.8 million links to clinical document sources in 2019, a 211% increase from 107.5 million in 2018. 15.7 million were delivered in 2017. Record Locator & Exchange also delivered 143.2 million care location summaries in 2019, a 45% increase from 98.6 million in 2018. 65 million were delivered in 2017.
Record Locator & Exchange delivered 333.8 million links to clinical document sources in 2019, a 211% increase from 107.5 million in 2018. 15.7 million were delivered in 2017. Record Locator & Exchange also delivered 143.2 million care location summaries in 2019, a 45% increase from 98.6 million in 2018. 65 million were delivered in 2017.

CLINICAL DIRECT MESSAGING


In 2019, the use of Clinical Direct Messaging expanded to include more individual users and new use cases. For instance, one PBM used Clinical Direct Messaging to alert prescribers to formulary changes. Pharmacies used it to alert doctors when their patients received a flu shot at a pharmacy.

In total, more than 648,000 individuals and organizations—including nearly 24,000 pharmacies—used Clinical Direct Messaging in 2019, a 9% jump from 2018.

37.7 million clinical Direct messages were sent in 2019, a 20% increase from 31.4 million in 2018. 25.9 million were sent in 2017.
37.7 million clinical Direct messages were sent in 2019, a 20% increase from 31.4 million in 2018. 25.9 million were sent in 2017.

INSIGHTS FOR MEDICATION ADHERENCE

Insights for Medication Adherence provides patient insights with data from PBMs and others. For instance, if a patient filled prescriptions for opioid analgesics from at least three prescribers in the last 90 days, Insights for Medication Adherence could help clinicians recognize suspicious prescribing activity and intervene. It was also used to spot unsafe overuse of certain therapies, such as flagging a patient with a supply of benzodiazepines, muscle relaxants and opioids in the last 45 days.

In 2019, Insights for Medication Adherence supported more than 120,000 clinical interventions.

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ADVANCE HEALTHCARE

ADVOCATING FOR THE USE OF HEALTH IT

Working at the intersection of so many national healthcare issues gives Surescripts a unique opportunity to advance our collective knowledge through original research and data analysis. In 2019, we paid special attention to the role of EPCS in combating the opioid epidemic and opportunities to improve the process of prescribing specialty medications.

EPCS RESEARCH

With the SUPPORT Act requiring electronic prescribing for all controlled substance prescriptions covered by Medicare Part D by 2021, we’re seeing increased use of EPCS among Medicare Part D providers. We worked with the Office of the National Coordinator for Health IT to study their use of EPCS between 2015 and 2016.

During this time period, the proportion of all Medicare Part D prescribers using EPCS increased from 4% to 11% while Medicare Part D opioid prescribers using EPCS more than doubled, rising from 5% to 13%. Pain management specialists had the largest proportion of EPCS utilizers, with 21% transmitting their controlled substance prescriptions electronically.11 The results of this research help us understand which areas of medicine and the country are seeing the most EPCS use and better forecast its growth through and beyond 2021.

SPECIALTY PRESCRIBING RESEARCH

We entered 2019 well aware of the complexity of specialty prescribing, and further research illuminated the particular challenges prescribers face when prescribing specialty drugs. We surveyed healthcare providers about their experience writing specialty prescriptions and identified two primary pain points: a lack of key information in drug selection and the burdensome manual prescribing process.12

On average, providers spend more than three hours a week on paperwork—not including charting—in order to start a patient on a specialty medication. The time and administrative burden has a domino effect: Nearly 40% of providers said it typically takes one to two weeks to actually get that medication to the patient.

Unsurprisingly, only 29% of providers are extremely or very satisfied with their organization’s efficiency when prescribing specialty medication. This inefficiency can also result in wasted work for pharmacies. When physicians encounter barriers to prescribing, two-thirds simply change or reroute their orders.

Taken as a whole, our research shows ample opportunity for improving how we handle specialty prescriptions, where the costs are often as high as the impact on patients’ lives. We are already incorporating these insights into the solutions we build, and we look forward to seeing statistics like these shift as better processes take hold across the Surescripts Network Alliance.

  1. Yuriy Pylypchuk et al., “State of Interoperability Among U.S. Non-federal Acute Care Hospitals in 2018,” ONC Data Brief no. 51 (March 2020).
  2. 2. Vaishali Patel et al., “Variation in Interoperability Among Office-Based Physicians in 2015 and 2017," ONC Data Brief no. 47 (May 2019).
  3. 3. Engine Group and Surescripts, survey of 502 U.S. physicians and nurses conducted in October/November 2018.
  4. Surescripts, "Prescription Price Transparency and the Patient Experience,” February 2020, p. 3.
  5. Aetna, "2018 Health Care Trends," February 20, 2018, p. 6.
  6. Humana, "Research Report: Value-Based Payment Readiness,” HMFA.org, March 31, 2018.
  7. "2019 Drug Trend Report," Express Scripts, accessed March 23, 2020.
  8. Abigail Zuger, “Nationwide U.S. Opioid Prescribing Trends,” ,” NEJM Journal Watch, March 14, 2019.
  9. Bridget Kuehn, "Declining Opioid Prescriptions," Journal of the American Medical Association 321, no. 8 (February 26, 2019): 736, doi:10.1001/jama.2019.0647.
  10. Cathryn Donaldson, "New Fast PATH Initiative Aims to Improve Prior Authorization for Patients and Doctors," AHIP.org, January 6, 2020.
  11. Christian Johnson et al., "Electronic Prescribing of Controlled Substances among Medicare Part D Prescribers 2015–2016," ONC Data Brief no. 44 (April 2019).
  12. Surescripts, "Provider Perspectives on Specialty Prescribing," April 2019.
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