YOUR HEALTH: TAKE CHARGE!
RESTRICTIVE E-RX SYSTEMS AND THE EHR
By: Ho Luong Tran, M.D., M.P.H.
Congress passed the Health Information Technology for Economic and Clinical Health (HITECH) Act that provides incentives for physicians to computerize their health records as well as penalizes them and hospitals for non-compliance. The Act also identified e-prescribing (eRx) as a requirement. The combined use of electronic health records (EHR) and eRx will strengthen the physician-patient relationship, improve patient care by allowing physicians to coordinate care across all specialties, and facilitate improved quality management of chronic disease, thereby reducing costs.
With regard to the HITECH ACT, while NCAPIP fully supports the adoption of EHR in order to achieve significant improvements in healthcare and outcomes, we must proceed with caution. Policy makers and elected officials must always be aware that actions and interests of the insurance industry and other payers, including the government, can easily compromise the health and well-being of patients. Without strong oversight and establishment of appropriate implementation standards, there is significant opportunity for HIT abuse and ineffectiveness.
Health insurers already use protocols such as prior authorization, quantity limits, and step therapy to manage the utilization of drugs.
- Prior authorization requires a doctor to communicate with the drug plan and obtain authorization before the restricted drug will be covered. This is applied to top specialty and/or expensive drugs, rather than to more commonly used and generic drugs.
- Quantity limits restrict how long a beneficiary can use a particular drug, the dosage that can be taken during a month, or the day's supply. This is applied to the top brands, but less for specialty drugs.
- Step therapy, also known as Fail First policy, requires individuals to try a less aggressive or less expensive drug before the restricted drug will be covered. Step therapy can be done in two different ways. It is inappropriate to do step therapy whereby the insurer or health plan applies an automatic substitution, for economic or other reason, without the approval of the attending physician. In this step therapy situation, patients are forced to accept a very different drug, not just a generic version of what their doctors prescribed. Patients then potentially have to suffer through prolonged symptoms while they "fail" the drug. With a limited English proficient population that also has cultural barriers, this problem is exacerbated and the trust and bond with the physician is easily broken. However, NCAPIP fully supports the model of step therapy that is evidence-based and a best practice, and provides for physician approval. This model of step therapy is both good medicine and best for the patient.
EHR, eRx, and ePA
While the Office of the National Coordinator requires as a condition of certification that EHR technology be capable of generating and transmitting electronic prescriptions (eRx), certification does not require that EHR technology be capable of performing electronic prior authorization (ePA). NCAPIP strongly supports the concept of including and integrating ePA into EHR and eRx. This will add to the efficiency and effectiveness of the system, and will provide patients with timely access to their medications.
Closely related to EHR, eRx, and ePA is the concept of step therapy. NCAPIP strongly supports eRx, but opposes any "fail first" policy that allows automatic therapeutic substitution without the approval of the attending physician.
NCAPIP believes that quality, access, cost containment, and choice are critical to improving health care services, and that physicians must retain responsibility for treatment decisions for patients regarding prescriptions and treatments, including appropriate step therapy. EHR systems including eRx should be provided through a neutral and open platform that does not advance commercial interests of any particular party, including the government, the insurance industry, or any manufacturer, to the potential detriment of the patient. An E-Rx platform should contain ePA as part of the mechanism to streamline and improve the care of all patients.
By: Arthur Chen, M.D.
Happy Father's Day! Dads, in honor of Men's Health month this June, please look over these important health facts. Family members and friends, please take note, also, and share these facts with the men in your lives to help keep them healthy.
Regular checkups and appropriate screenings can improve your health and reduce premature death and disability. You should also ask your health care provider if you should have earlier screenings, especially important for people with a family history of disease or who are members of high risk groups.
Every year during an annual exam, men of all ages should have their blood pressure checked, as hypertension can contribute to premature death, heart attack, renal insufficiency, and stroke. All men over the age of 35 and men aged 20-35 who are at increased risk for coronary heart disease should also have their cholesterol checked.
In addition to these annual checks, please read below to see what additional preventive services and screenings you should consider:
- Tobacco cessation interventions should be considered if you use tobacco products. Cigarette smoking is the leading preventable cause of death in the United States, and can result in death from cardiovascular disease, respiratory disease, and cancer. Lung cancer is a very serious health issue for Asian Americans. Southeast Asians have lung cancer rates that are 18% higher than among White Americans, and also have higher smoking rates than among other Asian groups. The Vietnamese have the highest rates of lung and and bronchial cancers among all Asian subgroups. And among all subgroups, smoking rates are higher in men than women.
- Abdominal aortic aneurysm (AAA) by ultrasonography (one time) for men aged 65 to 75 who have ever smoked.
- TB skin test if you have spent time with a person known or suspected to have active tuberculosis, have HIV infection or another condition that weakens your immune system, have symptoms of active TB disease, are from a country where TB disease is very common (including Asia), live in the United States where TB is more common, or inject illegal drugs. Asian Americans have a high prevalence and risk for tuberculosis.
- Sexually transmitted diseases including syphilis and HIV for sexually active adults who are at increased risk for STDs. Consult with your physician if you should be screened for syphilis or HIV, or if you believe that you may have symptoms for chlamydia or gonorrhea.
- Type 2 Diabetes screening for asymptomatic adults with sustained blood pressure greater than 135/80 mm Hg.
- Colorectal cancer screening for men over the age of 50. Screening is not recommended for men over the age of 75 with regular screening histories, or for men over the age of 85. Colorectal cancer is the second most common diagnosed cancer among Asian Americans, and it is the third highest cause of cancer-related mortality. Ask your doctor if and when you should be screened for colorectal cancer with high-sensitivity fecal occult blood testing (FOBT), sigmoidoscopy with interval FOBT, or colonoscopy. Among the Asian subgroups:
- Filipino men have the second poorest five-year survival rates for colon and rectal cancers among U.S. ethnic groups.
- Japanese men have the highest incidence and mortality rates for colorectal cancer.
- Koreans have the lowest rate of colorectal cancer screening.
Also remember that an active, healthy lifestyle and balanced diet is the first line of defense against disease and premature mortality. Take care of your health and communicate with your doctor if you have any questions.