e-Prescribing is the practice of writing prescriptions electronically through an EHR or similar type of software application. The e-Prescription can be electronically routed to the patient's pharmacy of choice via internal fax modem, email, or other electronic means.
e-Prescribing is considered superior to traditional paper prescriptions due to the legibility of the information. An added benefit of e-prescribing is the access to the latest drug interaction information (see DUR) as well as up-to-date payer formularies.
The physician writing the prescription
The retail pharmacy or mail order pharmacy
The pharmacy benefit manager (PBM), which acts on behalf of the payer to adjudicate claims
RxHub: the connection to most PBMs
SureScripts: the connection to most retail pharmacies
Here's the data flow:
1. A clinician begins to e-Prescribe and electronically queries for the patient's insurance eligibility and the appropriate payer's formulary. Before the merger, both RxHub and SureScripts had eligibility services but RxHub processed the majority of these transactions.
2. The clinician queries for medication history to check for drug/drug interactions. RxHub has medication history based upon claims data and SureScripts has the actual dispensed information from the pharmacies (which includes cash, third party claims and $4 generic programs). Before the merger, the clinician's EHR would have to issue separate queries via two separate interfaces to get a complete history.
3. The physician completes the prescription. Retail pharmacy transactions are transmitted to SureScripts for delivery to community pharmacies and smaller mail order firms. Mail order transactions served by one of the 3 large PBMs are transmitted to RxHub for fulfillment. Again, two separate interfaces were required.
As SureScripts-RxHub integrates its services, there will no longer be a need to send out 2 queries for eligibility/formulary, medication history or routing. Also, the two sources of medication history data will be de-duplicated, providing an accurate and usable medication data flow to all stakeholders.