FAQs - Physician Practices
How can I prescribe electronically over the Surescripts
Network?
How will a connection to the Surescripts network benefit my
practice?
What are the minimum requirements for introducing true
electronic prescribing in my practice?
How much does
e-prescribing cost?
Are
there transaction fees for e-prescribing?
Are there subsidy programs available to help with
e-prescribing costs?
Does
e-prescribing cost patients more money?
How do electronic prescribing applications that are
certified to connect to the Surescripts network differ from
other electronic prescribing applications?
Which pharmacies can accept e-prescriptions via the
Surescripts network?
Why do some pharmacies send me faxes even though I use
electronic prescribing software?
How can I be certain that the pharmacy will receive my new
prescription or renewal authorization when I send it
electronically?
What should I do if I receive an error message that my
electronic prescription didn't go to the pharmacy?
How are the prescribing messages that I send handled at the
pharmacy?
Does electronic prescribing offer the patient advantages?
Is the information sent to the pharmacy sold or shared with
any third party?
When I prescribe electronically, will the system try to
influence my decisions?
If certain local pharmacies do not accept electronic
prescriptions today, how can I get them to start?
Can electronic prescribing be used for Medicaid
prescriptions? What restrictions apply?
How will I know if pharmacies are properly loaded in my
e-prescribing system?
How are
controlled substances handled?
What if the patient's pharmacy only receives faxes?
Can I reply to a faxed prescription renewal request with a
new e-prescription?
How is electronic prescribing viewed by the Medicare
requirement to submit prescriptions using
serialized/tamper-proof prescription forms?
How secure is the information that the pharmacy and I
exchange via the Surescripts network?
Do pharmacies wait until they hear from me to start sending
me prescription renewal requests electronically?
What should I do when I get both electronic and faxed
prescription requests from a pharmacy?
How can I prepare for my e-prescribing training?
Can I work offline using my e-prescribing system?
How do I introduce e-prescribing to my patients?
If an e-prescribing physician leaves the practice should he
or she notify you of their change in employment?
How can I prescribe electronically over the Surescripts
network
Physicians interested in e-prescribing must use
e-prescribing software or an Electronic Medical Record (EMR)
that has been certified to connect to the Surescripts
network. Surescripts certifies software used by prescribers
for access to the three core services: Prescription Benefit,
Prescription History, and Prescription Routing. Each service
is supported by individual message types. These message
types include:
Prescription Benefit
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Eligibility/Formulary – the ability to request
and receive eligibility and formulary
information from payers and PBMs. |
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Reporting – the ability to provide utilization summaries for the prescription benefit service. |
Prescription History
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Rx History
(pharmacy) – the ability to request and receive
prescription history from community pharmacies. |
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Rx History (payer) – the ability to request and receive prescription history from payers and PBMs. |
Prescription Routing
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New Rx (pharmacy) –
the ability to route new prescriptions to
community pharmacies. |
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Rx Renewal
(pharmacy) - the ability to electronically route
prescription renewal requests and responses with
community pharmacies. |
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New Rx (mail) – the
ability to route new prescriptions to mail order
pharmacies. |
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Rx Renewal (mail) – the ability to electronically route prescription renewal requests and responses with mail order pharmacies. |
Surescripts works with existing medical software
companies to certify their prescribing software for these
services. This way you get to choose the software that best
suits the needs of your practice – from simple prescribing
software to more robust electronic medical record (EMR)
systems.
Surescripts does not sell, develop or endorse software, but
we can provide interested prescribers with a list of
technologies certified for Surescripts services and message
types along with other helpful resources.
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How will a connection to the Surescripts network benefit my
practice?
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A Safer and
More Accurate Prescribing Process. |
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Prescription
Benefit services allow easy selection of
medications that are preferred by the patient's
health plan, that meet therapeutic guidelines
and are cost effective for the patient. |
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Prescription
History services allow prescribers to access
critically important information on their
patient's current and past medications from
pharmacy benefit managers and community
pharmacies. This helps inform prescribers about
potential medication issues with their patients
and can improve safety and quality. |
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Prescription
Routing services allow legible new prescriptions
to be sent directly to the computer at the
pharmacy of the patient's choice. Renewal
authorization requests can be sent directly to
the practice computer. Prescribers can then
review and respond to pending requests with a
few keystrokes. |
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Enhanced Productivity. The reduction in pharmacy faxes and phone calls associated with refill requests, legibility issues, and drug incompatibility or ineligibility problems provides physicians and their staffs with more time to devote to patient care or other reimbursable activities. |
What are the minimum requirements for introducing true
electronic prescribing in my practice?
Office configurations will vary depending on the
e-prescribing system chosen. However, regardless of the
e-prescribing system, practices must have a good Internet
connection (preferably high speed), as well as desktop,
laptop or tablet computers, or hand-held PDAs, or a
combination. If PDAs or tablets will be the primary
technology used by prescribers, setting up a wireless
network is recommended.
In choosing an electronic prescribing application (either
stand-alone or EMR-based, your system must be certified to
connect to the Surescripts network. A list of certified
solutions can be found here or requested by calling Surescripts at 1-866-RxReady (866-797-3239).
Surescripts does not sell or develop electronic prescribing
systems or applications, but instead acts as a neutral
resource that certifies existing technologies to connect to
its national electronic prescribing network, which more than
75% of pharmacies now actively use. This way, physicians
have an open choice of technology and can select the one
that is right for their practices.
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How much does
e-prescribing cost?
Costs vary depending on which kind of hardware and software
(electronic medical record (EMR) systems vs. a stand-alone
e-prescribing system) a practice chooses. Stand-alone
e-prescribing applications range from free to approximately
$2,500 per year per prescriber. Be sure to look for local,
state or national initiatives that subsidize the cost of
e-prescribing systems. There may be additional fees to
integrate patient demographic information from your practice
management system into the e-prescribing application;
however, the alternative means that you will need to enter
each patient into the system as you prescribe, which can be
time consuming and may be a barrier to using the system.
EMR systems offer more comprehensive functionalities, but
are more costly, complex and time consuming to implement.
According to the Congressional Budget Office, office-based
EMR systems cost about $25,000 to $45,000 per prescriber.
Estimated annual costs to operate and maintain an EMR system
(e.g., software licensing fees, technical support, and
updating and replacing used equipment), range from $3,000 to
$9,000 per physician per year.
Be sure to ask vendors specific questions about any
incremental fees related to e-prescribing functionality as
well as training. The figures above do not include the
initial costs of the hardware required to support either an
e-prescribing or an EMR system, or the costs of temporary
decreases in productivity resulting from training or
workflow redesign, practice management interfaces,
customization, maintenance, upgrades, or data conversion.
Whether you choose a stand-alone e-prescribing application
or an EMR system with integrated e-prescribing, cost is only
one part of the equation. You should compare the costs –
both direct and indirect, start-up and ongoing – with
expected benefits such as improved efficiency and
productivity, decreased administrative expenses and staff
utilization to fully understand the value of e-prescribing
to your practice.
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Are
there transaction fees for e-prescribing?
There are no transaction fees for prescribers to access or
use the networking services provided by Surescripts.
However, prescribers must use an electronic prescribing
system that is certified to connect to the Surescripts
network before they can send and receive prescription
information. A practice may be using a certified application
already or it may need to acquire a new certified
application. Costs for these systems are set by the
companies that provide them.
Systems that are certified to connect to the Surescripts
network range from simple electronic prescribing software to
full-featured EMR systems.
The only time your practice would incur transaction fees for
e-prescribing would be if the vendor you select charged your
practice a transaction fee. Most vendors do not charge
practices a transaction fee, but be sure to ask your
potential vendors about this during system selection.
Prescribers can check to see if their electronic prescribing
system is certified by clicking here.
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Are there subsidy programs available to help with
e-prescribing costs?
There are a number of e-prescribing and EMR initiatives
available at the national, state and regional levels
designed to assist prescribers with the adoption of
e-prescribing technology. To review a partial list of these
programs, please click here.
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Does e-prescribing cost patients more money?
Patients pay the same amount and can use the same payment
methods for electronic prescriptions as they do for
traditional paper ones. With e-prescribing, however,
prescribers will likely have information about the patient's
formulary at the time of prescribing, which may allow
prescribers to prescribe a medication with a lower co-pay or
cost to the patient if paying out of pocket.
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How do electronic prescribing applications that are
certified to connect to the Surescripts network differ from
other electronic prescribing applications?
Some electronic prescribing applications are connected to
pharmacies by fax, and these systems provide no ability for
pharmacies to send renewal authorization requests directly
to physician practice computers. Faxed prescriptions cannot
help to ease the burden of time-consuming telephone and fax
transmissions currently associated with these requests.
These fax-based systems also lack a connection to payers,
which means you are not able to access patient prescription
benefit or prescription history information.
Electronic prescribing software from Surescripts Solution
Providers allow physicians, pharmacies and payers to clearly
and securely communicate and share information. The
resulting benefits to prescribers include:
Ability to display economic
alternatives for patients
Eliminate errors from poor
handwriting or faxing
Reduce pharmacy callbacks
More convenient for patients
Less time spent on prescription
renewals
Opportunity to improve patient
adherence
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Which pharmacies can accept e-prescriptions via the
Surescripts network?
More than 75% of community pharmacies, including nearly all
chain pharmacies, in the United States are accepting
e-prescriptions, and more are connecting every day.
E-prescribing pharmacies operate in all 50 states. In
addition, the following mail order pharmacies can accept
e-prescriptions via the Surescripts network:
CVS Caremark
Express Scripts
Medco Health Solutions.
Prescription Solutions
Prime Therapeutics
Wellpoint Pharmacy
Click here to
search for e-prescribing pharmacies in your area.
If you know of any pharmacies in your area that are not
currently accepting e-prescriptions,
resources are
available to help you encourage them to get started.
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How will I know if pharmacies are properly loaded in my
e-prescribing system?
It is best to provide your e-prescribing vendor with a
comprehensive list of pharmacies that your patients
frequently use. The vendor can then match this list with the
pharmacy records information in your application. This will
help ensure that your frequently used pharmacies are
appropriately matched to the master pharmacy file from the
beginning, and thus are enabled for electronic
prescriptions. If your practice application allows you to
create customized pharmacy records (customized name,
address, or phone and fax number), then it is also important
to ensure that the application system matches such records
in the master pharmacy lists provided by the Surescripts
network.
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How are
controlled substances handled?
Prescriptions for Schedule II drugs can never be sent
electronically or by fax. Hand-signed hard copies of
prescriptions for Schedule III through V drugs can be sent
using manual fax technologies. Neither computer-generated
faxes containing electronic signatures nor totally
electronic prescriptions for controlled substances can be
sent to pharmacies at this time. Some pharmacies will
continue to send refill requests for controlled substances
by fax.
If a user attempts to send a prescription for a controlled
substance electronically, a system message should inform the
user that this medication cannot be filled this way and then
offer alternatives to generate and submit the prescription.
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What if the patient's pharmacy only receives faxes?
If the pharmacy selected to receive the prescription does
not have electronic prescription capabilities, the
electronic prescribing application you use may present
options to fax or print. Or, as you write new prescriptions,
your application may have the capability to determine if the
pharmacy can receive the prescription electronically or via
fax.
Please check with your vendor for specifics on this process
for your system. Pharmacies receiving fax-based
communications will not be able to send you refill requests
electronically until they establish their own connection to
Surescripts.
If you would like to encourage non-connected pharmacies to
e-prescribe, communication resources are available by
clicking here. More than 95% of the nation's pharmacies use
systems that can be enabled for e-prescribing. More than 75%
currently process prescriptions electronically.
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Can I reply to a faxed prescription renewal request with a
new e-prescription?
Yes – although this process can make it difficult for
pharmacies to match the new prescription order to the
original request. As a result the pharmacy may send a
duplicate renewal request or follow-up with a phone call to
your office to ensure that the request is responded to. To
prevent this from happening, please place a note on your new
e-prescription that states that the prescription is a
response to a separate renewal request and include the
original prescription number. E.g.) “Relates to Rx#123456”
or “Relates to faxed Rx#123456“
Remember, any request for a controlled substance must be
responded to in accordance with DEA requirements – which
currently do not permit these prescriptions to be managed
electronically. And, if you feel that you are getting a
significant number of faxed requests from pharmacies that
should be sending them to your practice electronically,
please report them to your vendor.
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How is electronic prescribing viewed by the Medicare
requirement to submit prescriptions using
serialized/tamper-proof prescription forms?
On October 1, 2008, the Centers for Medicare and Medicaid
Services (CMS) enacted a regulatory change requiring that
all written Medicaid prescriptions be on a tamper-resistant
blank. Electronic prescriptions are exempt from this
requirement.
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How secure is the information that the pharmacy and I
exchange via the Surescripts network?
Surescripts and the prescribing applications certified to
connect to the Surescripts network use
dedicated leased line, VPN and/or SSL network technologies
that are compliant with HIPAA security requirements.
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Why do some pharmacies send me faxes even though I use
electronic prescribing software?
Although in most circumstances, electronic prescribing can
replace voice and paper-based communications with a totally
electronic process, there are exceptions.
• First, some pharmacies in your area may
still be upgrading their systems and may not yet be ready to
send and receive prescription information electronically.
• Second, pharmacies may need time to update
their prescriber directories from the time that they
recognize that you are using your system to send new
prescriptions electronically to when they start to send
refill requests to your practice computer.
• Finally, there is the chance that your
individual prescriber record did not get updated correctly
in the pharmacies' systems. This should be reported through
your normal support desk process as soon as possible so that
the pharmacies can be contacted and the problem can be
investigated. Your prescriber record should match the
information found on your prescription forms. This way the
pharmacies will have a one-to-one match between your
e-prescribing record and your existing record on their
databases.
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How can I be certain that the pharmacy will receive my new
prescription or renewal authorization when I send it
electronically?
Surescripts manages a central directory of pharmacies and
physicians that have signed up for electronic prescribing,
and the technology vendors they use work closely with
Surescripts and their customers to stay in sync. The chances
of the pharmacy not receiving a prescription sent
electronically are very small. However, if a pharmacy you
are sending to is not enabled to accept a prescription
electronically, the request will be sent by fax. If you send
an electronic prescribing message that cannot be delivered
to the destination within a certain time period (a specified
number of minutes) because of other issues, Surescripts will
send an error message notifying you that the message could
not be delivered. Please make sure that you are familiar
with how to find these messages in your system.
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What should I do if I receive an error message that my
electronic prescription didn't go to the pharmacy?
If the electronic prescription did not go to the pharmacy
because the pharmacy is not enabled to accept electronic
prescriptions, it will automatically be sent by fax. For all
others, depending upon the urgency of the prescription, you
may want to call the pharmacy and arrange for an alternate
way of sending the prescription. You should also contact
your physician technology vendor to report the error so it
can work to limit the chance of a reoccurrence.
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How are the prescribing messages that I send handled at the
pharmacy?
Pharmacies generally have a centralized area to which all
pending prescriptions are routed. From there, the pharmacy
personnel can see the incoming prescriptions and refills and
prioritize them accordingly. Pharmacies usually handle
prescriptions and renewal authorizations in the order in
which they arrive, but because electronic prescriptions are
sent electronically, they can get into the dispensing area
quicker than if patients were to drop them off. Still,
patients should leave sufficient time for the pharmacy to
receive, process and dispense their prescription orders. Two
or three hours is normally sufficient.
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Does electronic prescribing offer the patient advantages?
For patients, an important advantage of a prescription being
sent electronically is that the message is already formatted
in such a way that the pharmacy computer can assimilate the
information for rapid dispensing. You also have the comfort
of knowing that an accurate, legible prescription will
arrive at the pharmacy and that it won't get lost,
misplaced, destroyed or forgotten by the patient. Plus,
patients can avoid making one trip to the pharmacy to drop
off a prescription and another to pick it up.
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Is the information sent to the pharmacy sold or shared with
any third party?
No. Information sent over the Surescripts network is private
and confidential. It is not shared with any third party.
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When I prescribe electronically, will the system try to
influence my decisions?
No. One of Surescripts' founding principles is to ensure
that there is no commercial messaging allowed on its
electronic prescribing network. Electronic prescribing
applications that are connected to this network signify that
your vendor completed a certification process to ensure that
there is no commercial messaging at the point of care.
Surescripts also protects your choice of therapy and your
patients' choice of pharmacy. All prescribing applications
certified to connect to the Surescripts network are required
to abide by these rules, and only physician technology
companies that agree with this philosophy are allowed to
connect.
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If certain local pharmacies do not accept electronic
prescriptions today, how can I get them to start?
Contact your local pharmacies and let them know that you are
using an electronic prescribing application that is
connected to the Surescripts network. More than 95% of the
nation's pharmacies have software that is enabled to
connect, although not all have activated their connections
yet. Urge pharmacies that have not yet activated their
connections to contact their vendors to activate them or
tell them when their software will be enabled.
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Can electronic prescribing be used for Medicaid
prescriptions? What restrictions apply?
Doctors can prescribe electronically for most Medicaid
prescriptions. However, if a physician wants to prohibit
generic substitution by specifying 'DAW' (dispense as
written) or 'brand medically necessary,' the federal
government requires the physician to hand-sign a hard copy
of the prescription as a pharmacy audit copy. This
requirement prevents e-prescribing from being an acceptable
transmission option for the small percentage of Medicaid
prescriptions that are DAW. Surescripts is working closely
with regulatory and other agencies to attempt to change this
restriction.
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Do pharmacies wait until they hear from me to start sending
me prescription renewal requests electronically?
As soon as you send five new prescriptions electronically
via the Surescripts network, pharmacies will be alerted and,
within a few days to a few weeks, will begin to send you
prescription renewal requests electronically as opposed to
fax or phone requests.
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What should I do when I get both electronic and faxed
prescription requests from a pharmacy?
If you are receiving faxed renewal requests from pharmacies
that you believe should have been sent electronically, you
may report them by using the form found
here.
Before you do though, it is helpful to consider the
following questions:
| 1 |
Are you responding
to your e-refill requests within 24 (business)
hours? If not, a pharmacy may send a duplicate
request by fax to try and get your attention.
Please ensure that you are checking your
e-prescribing system regularly for these
requests and always respond within 24 hours. |
| 2 |
Is the pharmacy
enabled for e-prescribing? Non-enabled
pharmacies will continue to send prescription
refill requests to you by fax or phone. A list
of e-prescribing pharmacies in your area can be
found by
clicking here. |
| 3 |
Is your
registration information accurate? Sometimes the
name and location your vendor uses to set up
your e-prescribing account can differ from the
information typically present on your
prescription forms. This can cause pharmacies to
mismatch your records and not recognize you as
an e-prescriber. Please ensure that your
registration information is up to date by
contacting your vendor. If you have responded to a fax- or phone-based request but the electronic request is still pending in your system, the best way to manage this is to deny the electronic request and add a note saying 'already responded to' or similar. |
How can I prepare for my e-prescribing training?
Personalized one-on-one training using a variety of common
scenarios seems to work best for most prescribers. It is
important to ask detailed questions during your training
sessions, including:
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What happens if the
patient is not matched in the system when a
pharmacy sends renewal requests? |
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Can I cover for my
colleagues when they are on leave, and under
whose name will the prescriptions be sent to the
pharmacy? |
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How does the system
handle controlled substance prescriptions and
pharmacy renewal requests for controlled
substances (which currently cannot be managed
electronically)? |
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How do I write
prescriptions to the pharmacy when a patient
calls in a request via phone? |
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How do I know
whether the prescription was successfully sent
to the pharmacy? |
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How do I handle
mail-order prescription writing? |
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How do I create my
favorite medication list? |
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How do I search pharmacies within the practice database? |
Can I work offline using my e-prescribing system?
Some e-prescribing programs allow access offline, which
would enable prescribers to prepare multiple scripts and
then transmit them when they have Internet access again.
However, queuing or 'batching' prescriptions before sending
them to pharmacies electronically is not recommended.
Sending prescriptions to pharmacies as soon as possible
after they are prepared ensures that the pharmacy has
adequate time to receive the prescriptions before patients
arrive to pick them up.
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How do I introduce e-prescribing to my patients?
Introducing e-prescribing to patients is important, as well
as communicating its benefits and implications. Some
patients may express initial reluctance in response to a new
system, but prescribers can make patients more comfortable
by explaining how e-prescribing works and its benefits to
patients, providers and pharmacies.
In the initial phases, it's important for you and your
practice staff to educate and reinforce the benefits of
e-prescribing with your patients. Talking points include:
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Fast -
E-prescribing allows you to electronically send
prescriptions directly to the patient's choice
of pharmacy. The prescription travels from your
computer to the pharmacy's computer before the
patient leaves the exam room, giving that
prescription a head start. However, this does
not necessarily mean that the prescription will
be at the pharmacy when the patient arrives.
Patients should leave a few hours between their
visit and the trip to the pharmacy to pick up
their prescriptions. |
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Convenient – The
patient no longer has to make an additional trip
to the pharmacy to drop off his or her
prescriptions. |
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Safe and Secure –
Prescription information is not sent over the
open Internet and is not sent via e-mail.
E-prescriptions are sent electronically through
a private, secure and closed network – the
Surescripts network. |
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Legible – The staff
in the pharmacy no longer has to spend time
interpreting handwriting or dealing with blurry
faxes. |
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Informed – The availability of formulary information from health plans allows for a choice of medications that are more affordable, and e-prescribing allows drug-to-drug interaction checking and allergy-drug interaction checking for safer choices. |
If an e-prescribing physician leaves the practice should he
or she notify you of their change in employment?
The physician should communicate this change to his/her
software vendor. The vendor will disable the prescriber's
record in the Surescripts Directory so that no additional
prescription renewals will be sent to the prescriber from
pharmacies. Any additional new prescriptions sent by this
prescriber would be returned in error by Surescripts.
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