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Windsor and e-Prescribing

Increasing the security and accuracy of the prescribing process

Windsor Health Plan (WHP) uses strategic methods to increase formulary compliance and generic utilization while reducing potential medication errors and addressing patient non-compliance. Electronic prescribing (e-prescribing) is one method we use because it has been shown to increase both the efficiency of plan practices (through reduction in pharmacy phone calls and fax traffic) and the accuracy of the prescribing process. This efficiency and accuracy can reduce the number of preventable adverse drug events. WHP supports the e-prescribing incentives defined by the US Department of Health and Human services. As of April 1, 2009, WHP has selected SureScripts® to work with in supporting the prescriber. SureScripts® operates the largest network of electronic communications between pharmacies and physicians, which allows the electronic exchange of prescription information. This system is available to all Windsor prescribers and network pharmacies. There is no cost for transactions that WHP prescribers send as long as they have an appropriate Electronic Medical Record System or e-prescribing system.

Frequently Asked Questions

• What is e-prescribing and how does it work?

  E-prescribing is an electronic way for the prescriber to send and receive information from the pharmacy and/or payers without faxing, calling or writing paper-based prescriptions. All controlled substance medications still require a handwritten prescription. The security and accuracy of the prescribing process is greatly increased because the chance of miscommunication and error is reduced. The most common errors seen in paper, voice or fax-based prescriptions are hard-to-read handwriting, blurry faxes or sound-alike issues. E-prescribing technology use allows the prescriber to review the medication history of the patient and determine what medications are on the member’s formulary.

  Our e-prescribing system is broken down into five major transaction types:

  1. E-prescribing of new prescriptions – prescription information is prepared using a prescribing application and is sent directly to the computer at the pharmacy through a secure network (like the Pharmacy Health Information Exchange).
  2. E-refills - refill requests are sent to the prescribers’ prescribing application by the pharmacy without using fax or phone.
  3. Eligibility check - allows the prescriber to electronically check WHP's eligibility and plan information.
  4. Formulary download - allows WHP to provide formulary information for a prescriber to download when needed.
  5. Medication history transaction - allows the prescriber to electronically retrieve patient medication therapy from WHP or a retail pharmacy. Safeguards are in place to block all sensitive drug information.
• Are e-prescribing and an automated electronic fax to the pharmacy the same thing?

  No, although the ability to send an electronic fax can be more accurate than a paper prescription, pharmacies must still manually key in information received over the fax machine, which can lead to error. Faxes can also experience transmission problems that can blur or make text difficult to read. Fax technology also does not allow the pharmacy to send messages back to the prescriber. E-prescribing provides two-way communication allowing pharmacies and prescribers to send clarifying questions, changes, or comments. Although all efforts to reduce medication errors are a good start, it is only a stepping stone to the total acceptance of e-prescribing.

• Why should YOU participate in e-prescribing?

  There are seven major reasons YOU should join in the e-prescribing revolution:

  1. Increased safety: The Institute of Medicine projects that at least 1.5 million Americans are sickened, injured or killed each year by medication errors. E-prescribing reduces potential errors due to misread prescriptions or medications with similar sounding names. Systems also ensure the accuracy of prescriptions by electronically checking for harmful interactions.
  2. Increased efficiency: Time spent phoning and faxing to clarify prescriptions and authorize renewal requests is minimized. Doctors and pharmacists enjoy more time to counsel patients. Pharmacies can send back clarifying questions or changes because e-prescribing allows for two-way communication.
  3. Increased formulary adherence: Allows the prescriber to view Windsor’s formularies at the point of prescribing to assure minimal impact on the patient at the point of filling. Formulary updates are done in real time.
  4. Improved role for prescribers in medication therapy: Allows doctors to access patient information that will assist them in making decisions and providing health information resources at the point of care. The information available includes medication histories for medication therapy management.
  5. Increased prescriber understanding of a patient’s pharmacy benefit: Allows confirmation of eligibility, copays, deductibles, covered pharmacies and patient drug histories.
  6. Increased prescriber convenience: Renewal requests can be reviewed and responded to in much less time than with phone or fax. New prescriptions are sent directly to the pharmacy computer, quickly, accurately and securely. Fewer requests are made to physician practices for clarifications.
  7. Improved patient satisfaction: Through rapid, streamlined prescription filling with fewer errors and less time spent tracking down drug utilizations issues.
• Has CMS mandated the use of e-prescribing for Medicare members?

  No, CMS does not require prescribers to use e-prescribing. Those that do participate are required to follow the NCPDP guidelines for the transaction sets.

• Does the member pay for e-prescribing?

  No, the member does not pay for e-prescribing. Although the prescriber does not pay any transaction charges, they need to have a certified e-prescribing system to connect to a network that connects them with pharmacy computers. Some of these are paid and installed by the plan or state or federal agencies, but most are built into their Electronic Medical Record (EMR) system. Standalone electronic prescribing systems are also available. In most cases it is an extra charge to have these features added into the EMR system. Prescribers can utilize free systems; however, these systems usually allow minimal e-prescribing functionality.

• Does the prescriber need to contract with the EMR system vendor to allow them to perform this service for WHP members?

  No, although many EMR system vendors will contact WHP to see if they will pay (to defer the cost to the prescriber for the EMR system); WHP is not under any obligation to do this. In most cases the vendor will be adding all customers at no cost (since the viability of their products is based on usage).

• Can the prescriber enter prior authorizations through the e-prescribing system?

  Not at this time, however the National Council of Prescription Drug Programs (NCPDP) recently approved a standard transaction type that would allow connectivity between the EPR systems and WHP. Windsor is enthusiastic about this new standard and hopes to implement it in 2010.

For more information:
Pharmacies call 866-930-7597, 7 days a week, 24 hours a day
Prescribers call 800-264-1587, Monday through Friday, 7am – 5pm (CST)