Electronic Prescribing (e-prescribing, or eRx), allows a prescriber to electronically send an accurate, error-free and understandable prescription directly to a pharmacy. It also provides the ability to verify eligibility and formulary data for a patient, prior to and during the prescribing process, and view medication history for the previous 12 month period. This is enabled with the authorized exchange of data from the PBM or Payer and the prescriber.
As providers dive into all of the benefits of their electronic health record (EHR) technology, electronically prescribing medications for patients will most likely be one of the first programs put into use, as it is also part of the requirements for the Meaningful Use of the EHR Incentive Program. E-prescribing will help providers save time, money and, most importantly, help eliminate medication confusion.
Full support of e-prescribing is available for Vendor Drug Program claims (via SureScripts) and for Medicaid managed care pharmacy claims.
In order to submit an electronic prescription that meets CMS requirements for “brand medically necessary” dispensing, the prescribing physician should submit the following on the electronic prescription transaction that is sent to the pharmacy:
- Select the option for “Dispense as Written” (DAW) on the electronic prescription pad. If the system defaults to “Substitution allowed”, make sure this is checked prior to sending the prescription.
- Type “Brand Medically Necessary” in the “Notes to Pharmacy” field. This is generally a free-form text field for the pharmacy to receive additional information on SIG or other notes. Some systems may have this as a separate field to choose a reason why the prescription is DAW.
If an e-prescription is received by a pharmacy with DAW indicated but without the free text message or additional note, the pharmacist must contact the prescriber for a new prescription. Once the pharmacy receives the e-prescription with both of these data elements, the prescription may be transmitted to Vendor Drug in the standard NCPDP Billing Request format with the following:
- “1” in “Dispense as Written” (Field 4Ø8-D8).
- “3” in “Prescription Origin Code” (Field 419-DJ).
The presence of “Brand Medically Necessary” in the free text field is subject to review by the Vendor Drug Program effective September 1, 2011.
Failure of the pharmacy to produce electronic records that indicate the proper DAW and “Brand Medically Necessary” in the free text message for the prescription will result in the claim subject to recoupment. All non-electronic “Brand Medically Prescriptions” (for controlled and non-controlled substances), must continue to comply with the current policy as outlined in the VDP Pharmacy Provider Procedure Manual with applicable Texas State Board of Pharmacy rules.
Prescription Origin Code
Pharmacies should ensure they are submitting “Prescription Origin Code” (Field 419-DJ) on all billing submissions in support of e-prescribing transactions. While the field was optional for NCPDP B1 transactions in version 5.1, it is now required for D.Ø B1 transactions. The Vendor Drug accepted valid values can be found in the D.Ø payer sheets.