Value of e-prescribing debated by independents

While electronic prescriptions offer many benefits over handwritten orders, some independent pharmacies still balk at adopting this new technology. Some say learning the new technology will pose an obstacle, while others are concerned about verification of who is sending the electronic Rx, as well as the additional costs associated with e-prescribing.

Cost is the biggest deterrent for Jerry Whitman, R.Ph., owner of a self-named pharmacy in Buckingham, Pa. So far none of the physicians in Whitman's area are sending Rxs electronically, but he is concerned about the added cost of each electronic transaction. "E-prescribing is a good idea, but we can't afford to pay to receive prescriptions electronically."

SureScripts spokesman Rob Cronin said the company is not in business to turn a profit. "We are here to serve the pharmacy community, and we hope to pass along a reduction in fees as volume increases."

According to NCPA, independent pharmacy's involvement in e-Rxs has grown rapidly, from 2% last year to an estimated 20% by year's end, but physician involvement still lags behind.

Donnie Calhoun, R.Ph., the owner of two pharmacies in Alabama, received his first e-Rx in August, after the doctor's office called to tell him to check his computer system. He is uncertain when other physicians will start using the technology, but he questioned why pharmacies should pay for the transaction. "We don't pay for the patient walking in the door with a script, we don't pay for it to be faxed, we don't pay for it to be called in. Why should we pay for it to be electronically sent to us?" he asked.

Outside of Portland, Ore., Diana Courtney, R.Ph., owns Lake Shore Pharmacy. She is looking forward to wider use of e-Rxs to help lighten the administrative burden on her staff. In her experience, e-prescribing helped eliminate errors and a lot of extra time trying to figure out what was actually being prescribed. She admitted that it's not ideal that pharmacies have to pay the fees, but agreed that it's ultimately worth it. "It is worth the extra fee to ensure the safety and accuracy of getting the right prescription to patients."

Calhoun said that he is concerned about who is sending the Rxs. He has been involved in some recent situations in which nurses were arrested for calling in unauthorized Rxs. "These are issues that we will probably always have, but electronic prescribing in the wrong hands could be a dangerous thing," he said.

Calhoun acknowledged that it's only a matter of time until e-Rxs become standard practice. Managed care organizations and the Centers for Medicare & Medicaid Services are pushing for quicker adoption of e-prescribing. CMS expects to have standards in place by 2008 for Rxs paid under Part D.

The bottom line for Calhoun is that whether or not R.Ph.s want to pay the fees or learn how to use the new technology, it will come down to market dynamics. "If the competitors are using the technology, pharmacy owners will not have a choice," he said. "The pharmacy has to use the technology or it won't be competitive anymore."

THE AUTHOR is a pharmacy journalist based in Brooklyn, N.Y.