DEPARTMENT OF HEALTH &. HUMAN SERVICES	 Office of Inspector General 

Washington, D.C. 20201 

OCT 16 2009 

TO:	 Charlene Frizzera 

Acting Administrator 

Centers for Medicare & Medicaid Services 

FROM: Stuart Wright 

Deputy Inspector General 

for Evaluation and Inspections 

SUBJECT:	 Memorandum Report: "Medicare Part D Plan Sponsor Electronic Prescribing 

Initiatives," 0 EI-05-08-00322 

This memorandum report describes Medicare Part D plan sponsors' voluntary electronic 

prescribing (e-prescribing) initiatives (hereinafter referred to as initiatives) and implementation 

strategies to promote e-prescribing adoption. Plan sponsors' initiatives include information 

technology and support services that may help defray prescribers' (e.g., physicians') costs 

associated with e-prescribing adoption.} While plan sponsors must implement the Centers for 

Medicare & Medicaid Services (CMS) defined e-prescribing standards, prescribers and 

dispensers are not required to adopt or support e-prescribing. To encourage prescribers to adopt 

e-prescribing, some plan sponsors voluntarily offer e-prescribing technology items and services. 

As such, we provide this memorandum to inform CMS of plan sponsors' efforts to promote 

e-prescribing. We do not make any assessments about the quality or success of these initiatives. 

We found that plan sponsors have launched voluntary e-prescribing initiatives to increase 

prescriber adoption of e-prescribing. At the time of our data collection in September 2008, 

approximately 20 percent of plan sponsors reported that they had an initiative and another 

18 percent reported that they were planning an initiative. Over half of plan sponsors with an 

initiative reported average or high prescriber participation levels for their initiatives. Finally, 

75 percent ofplan sponsors with an initiative did not report a quantifiable benefit because they 

did not measure outcomes for their initiative. The remaining 25 percent of plan sponsors with an 

initiative reported that they measured a quantifiable benefit. These plan sponsors most 

commonly reported that their initiative resulted in an increase in generic substitutions and an 

increase in formulary compliance. 

}As of2003, an entry level e-prescribing system may cost up to $4,500 plus approximately $],500 for annual 

support, maintenance, and licensing fees. The Center for Information Technology Leadership, "The Value of 

Computerized Provider Order Entry: Executive Preview," 2003. Available online at 

http://www.citl.org/research/ACPOE Executive Preview.pdf. Accessed on June 24,2009. 

OEI-05-08-00322 Medicare Part D Plan Sponsor Electronic Prescribing Initiatives 
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In October 2009, the Office of Inspector General (OIG) released a companion report to this 

memorandum, “Medicare Part D E-Prescribing Standards: Early Assessment Shows Partial 

Connectivity” (OEI-05-08-00320). That study assessed plan sponsors’ implementation of 

CMS-required e-prescribing standards to support connectivity with prescribers and dispensers 

(e.g., pharmacies). We found that nearly 80 percent of plan sponsors reported at least partial 

e-prescribing connectivity but few reported complete connectivity. 

BACKGROUND 

E-prescribing occurs when a prescriber uses a computer or an electronic hand-held device, such 

as a personal digital assistant, to write and send a prescription directly to a dispenser. Before a 

prescriber sends a prescription to a dispenser, he or she can request electronic data regarding 

patient eligibility, formulary and benefits, and medication history from the patient’s health 

insurance plan. 

Prescriber access to prescription information, such as medication history and formulary 

information, has several potential benefits. With access to medication history, prescribers can 

potentially avoid adverse drug events, such as drug-to-drug allergies or interactions. In addition, 

prescribers can use e-prescribing systems to look up and prescribe lower cost alternative drugs 

listed on a patient’s formulary. A 2008 study indicated that, with access to formulary 

information, doctors prescribed less costly medications, leading to an estimated savings of 

$845,000 per 100,000 patients.2

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) 

established the Medicare prescription drug program, known as Medicare Part D, which provides 

optional drug benefits to Medicare beneficiaries.3 CMS contracts with private health insurance 

companies, or plan sponsors, to provide prescription drug coverage for beneficiaries who choose 

to enroll in the program. Plan sponsors may offer prescription coverage as a stand-alone 

prescription drug plan or as part of a managed care plan.4 As of February 2009, approximately 

26.6 million beneficiaries were enrolled in Medicare Part D.5 

The Medicare Part D E-Prescribing Program 

The MMA established the Medicare Part D e-prescribing program.6 For this program, CMS 

requires plan sponsors to implement four e-prescribing standards to provide the technical 

infrastructure that supports interoperable e-prescribing systems. A standardized technical 

infrastructure enables plan sponsors, prescribers, and dispensers to exchange prescription 

information with each other. Complete implementation of all four standards is necessary for 

2 M. Fischer, et al., “Effect of Electronic Prescribing With Formulary Decision Support on Medication Use and 

Cost.” Archives of Internal Medicine, 168 (22), pp. 2433–2439, 2008. 

3 Title I of the MMA, P.L. No. 108-173; Part D of Title XVIII of the Social Security Act; 42 U.S.C. § 1395w-101 

et seq. 

4 MMA, P.L. No. 108-173 § 101(a); Social Security Act, § 1860D-1(a)(1); 42 U.S.C. § 1395w-101(a)(1). 

5 CMS, “Total Medicare Beneficiaries With Prescription Drug Coverage,” 2009. Available online at 

http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/. Accessed on February 23, 2009. 

6 MMA, P.L. No. 108-173 § 101(a); Social Security Act, § 1860D-4(e); 42 U.S.C. § 1395w-104(e). 

OEI-05-08-00322 Medicare Part D Plan Sponsor Electronic Prescribing Initiatives 
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complete e-prescribing connectivity between plan sponsors, prescribers, and dispensers. CMS 

required plan sponsors to completely implement two standards by January 2006 and the other 

two standards by April 2009. 

Beginning in 2010, plan sponsors will also be required to obtain prescription origin information 

on new prescriptions to monitor the rate of adoption of e-prescribing in Medicare Part D.7 The 

Prescription Origin Code (POC) is a data field that will be populated by the pharmacist to 

describe the method in which a prescription was received by the dispenser (i.e., paper, fax, or 

electronic). Plan sponsors will obtain the POC data from dispensers and then submit them to 

CMS for inclusion in Medicare Part D prescription drug event (PDE) data. 

Plan Sponsor E-Prescribing Initiatives

While plan sponsors must implement CMS-defined e-prescribing standards, prescribers and 

dispensers are not required to adopt or support e-prescribing. To encourage prescribers to adopt 

e-prescribing, some plan sponsors offer e-prescribing initiatives, which include a combination of 

technology items and services. 

To address plan sponsor donations of e-prescribing items and services, the MMA required that 

OIG establish an e-prescribing safe harbor rule to the antikickback statute, which prohibits 

payment in return for patient referrals.8 The safe harbor rule protects certain low-risk 

arrangements that encourage prescriber adoption of e-prescribing. It allows plan sponsors, 

among other health care entities, to provide prescribers with nonmonetary remuneration 

including hardware, software, or information technology and training services necessary and 

used solely to receive and transmit electronic prescription information.9 For example, plan 

sponsors can provide hardware, such as a personal digital assistant or computer. Plan sponsors 

can also provide software that has e-prescribing functionality either as a stand-alone program or 

as part of an electronic medical record. 

Plan sponsors may choose to promote e-prescribing by providing prescribers and dispensers with 

financial incentives.10 According to the MMA, payment of financial incentives may take into 

consideration the cost to implement an e-prescribing program and may also be given to 

prescribers that have increased their formulary compliance, lowered drug costs, or reduced 

potential drug interactions.11 

Plan sponsors’ financial incentives may include pay-to-participate, pay-for-performance, and 

pay-per-transaction incentives. Pay-to-participate incentives are one-time grants given to 

prescribers to assist with startup costs. Pay-for-performance incentives are bonuses paid to 

prescribers for meeting specified e-prescribing metrics or outcomes. Pay-per-transaction 

incentives are bonuses given to prescribers every time they e-prescribe. 

7 CMS, “Issuance of the 2010 Call Letter,” 2009. Available online at 

http://www.cms.hhs.gov/PrescriptionDrugCovContra/Downloads/2010CallLetter.pdf. Accessed on July 9, 2009. 

8 MMA, P.L. No. 108-173 § 101(a); Social Security Act, § 1860D-4(e)(6); 42 CFR § 1001.952(x). 

9 42 CFR § 1001.952(x). 

10 MMA, P.L. No. 108-173 § 102(b); Social Security Act, § 1852(j)(7); 42 U.S.C. 1395w-22(j)(7). 

11 Ibid. 

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The Medicare Improvements for Patients and Providers Act of 2008 

In other efforts to promote e-prescribing, the Medicare Improvements for Patients and Providers 

Act of 2008 (MIPPA) stipulates that CMS offer financial incentives directly to prescribers. To 

receive these incentive payments, CMS requires prescribers to meet specified e-prescribing 

quality measures.12 Financial incentives are available beginning in 2009 and will continue 

through 2013.13 

METHODOLOGY 

Scope 

This memorandum report describes plan sponsors’ e-prescribing initiatives and implementation 

strategies to promote e-prescribing adoption. It does not include information or results from the 

Medicare e-prescribing incentive program. 

Data Collection and Analysis 

Between August and September 2008, we conducted an electronic survey of all plan year 2008 

plan sponsors. We surveyed a total of 278 plan sponsors and received responses from 206 plan 

sponsors for a 74-percent response rate. We identified plan sponsors using July 2008 Part D plan 

sponsor data from CMS’s Health Plan Management System. 

The surveys gathered descriptive information about plan sponsors’ initiatives. We asked plan 

sponsors if they had or were planning an initiative to promote prescriber adoption of 

e-prescribing and to describe their initiatives. We defined an initiative as a plan sponsor program 

designed to promote e-prescribing that includes any combination of e-prescribing technology 

items or services. We also asked plan sponsors to describe anything else they offered as part of 

their initiatives. We refer to the combination of these elements as an initiative package in this 

memorandum report. 

We also asked plan sponsors about any quantifiable benefits that resulted from their initiatives. 

We requested evidence of the claimed benefits when plan sponsors reported quantifiable benefits 

resulting from their initiatives. If the plan sponsor could not provide evidence or we could not 

verify the benefits, we excluded those claimed benefits from our analysis. 

To determine prescriber participation in initiatives, we asked plan sponsors to report whether 

they had low, average, or high participation in their initiatives. The categorization of low, 

average, or high participation is based on the plan sponsor’s perception. We also asked them to 

provide the specific number of prescribers participating in their initiatives. 

To analyze participation in plan sponsor initiatives, we categorized plan sponsors into three 

categories based on the number of beneficiaries they covered. We did this because participation 

levels for initiatives are relative to a plan sponsor’s size. Table 1 shows the beneficiary ranges 

we used to categorize plan sponsors. 

12 MIPPA § 132, P.L. 110-275; Social Security Act, § 1848(m)(3); 42 U.S.C. § 1395w-4(m)(3); 73 Fed. Reg. 69726, 

69847 (Nov. 19, 2008). 

13 Ibid. 

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Table 1: Plan Sponsor Size Categories 

Plan Sponsor Size Category Number of Beneficiaries Covered by Plan Sponsor 

Small 1–10,000 

Medium 10,001–500,000 

Large 500,000 + 

Source: OIG analysis of Part D plan sponsor enrollment data, 2009.

We also used survey data from a companion study, “Medicare Part D E-Prescribing Standards: 

Early Assessment Shows Partial Connectivity” (OEI-05-08-00320), that we collected 

simultaneously with data for this memorandum report. We have data from the previous study for 

194 of the 206 respondents for this memorandum report. For these 194 plan sponsors we 

assessed whether plan sponsors with an initiative also reported implementation of the CMS 

e-prescribing standards. 

Finally, we conducted structured in-person interviews with four plan sponsors that had 

well-developed initiatives. We selected these plan sponsors based on their survey responses. 

We defined well-developed initiatives based on the duration of the initiative and the number of 

participating prescribers. In the interviews, plan sponsors described their initiatives and the 

benefits and challenges they experienced. 

Limitations 

This report relies on self-reported data. Other than plan sponsors’ reported quantifiable benefits, 

we did not verify plan sponsors’ responses. 

Standards 

This study was conducted in accordance with the “Quality Standards for Inspections” approved 

by the Council of the Inspectors General on Integrity and Efficiency. 

RESULTS 

 

Approximately 20 percent of plan sponsors have voluntary e-prescribing initiatives, which 

most commonly include the provision of training and software 

Twenty-one percent of plan sponsors (44 plan sponsors) reported that they have an initiative to 

promote prescriber adoption of e-prescribing. Another 18 percent of plan sponsors (36 plan 

sponsors) reported that they were planning to offer an initiative. Initiatives consist of any 

combination of free or discounted software, hardware, Internet connectivity, financial incentives, 

and educational materials (e.g., newsletters). 

Although plan sponsors most commonly provide training and software, there is no prevailing 

model for an initiative. Among the 44 plan sponsors with an initiative, there were 20 different 

initiative packages. Initiative packages most commonly included one to three different elements, 

but some had up to six different elements, such as hardware, software, training, and financial 

incentives. 

OEI-05-08-00322 Medicare Part D Plan Sponsor Electronic Prescribing Initiatives 
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Despite the variety of initiative packages, two-thirds of plan sponsor initiative packages (29 plan 

sponsors) included a basic package of free or discounted training and software. Over half of 

planned initiatives (21 plan sponsors) will also include a basic package of training and software. 

Chart 1 shows the number and type of elements plan sponsors currently offer or plan to offer in 

their initiatives. 

 

Chart 1. 

Elements 

of Plan 

Sponsor 

Initiatives 

0

10

20

30

40

50

60

70

Software Hardware Internet

Connectivity

Training Financial

Incentives

Educational

Materials

Initiative Elements

Number of Plan Sponsors

Plan to

provide

Currently

provide

Source: OIG analysis of survey data, 2009.

Additional patterns emerged among plan sponsors’ initiative packages. The most frequent 

initiative package, offered by eight plan sponsors, includes training, software, and hardware. 

These are some of the most basic elements required to e-prescribe. If a prescriber already had 

Internet connectivity, these items and services would be sufficient for a prescriber to start 

e-prescribing. 

Sixteen plan sponsors with an initiative reported that they currently offer prescribers a financial 

incentive for e-prescribing. Thirteen of these plan sponsors reported offering 

pay-for-performance financial incentives to prescribers. Seven plan sponsors reported offering 

prescribers a combination of financial incentives. For example, some plan sponsors provided 

prescribers both pay-to-participate and pay-for performance incentives. 

Almost all plan sponsors with an initiative reported implementing some of the technical 

infrastructure to support e-prescribing but only one reported complete implementation. Almost 

all plan sponsors with an initiative (36 plan sponsors) reported implementing at least some of the 

standards that support the technical infrastructure to deliver e-prescribing information, such as 

medication history, eligibility, and formulary information to prescribers. Of the remaining eight 

plan sponsors with an initiative, four reported that they had not implemented any of the standards 

that support the technical infrastructure for e-prescribing and four did not provide information 

about their implementation. 

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Among the 36 plan sponsors that reported some implementation, one plan sponsor reported 

completely implementing all of the standards that support e-prescribing. The other 35 plan 

sponsors with initiatives have not completely implemented all of the standards that support 

e-prescribing. 

Plan sponsors that have not completely implemented the four CMS-defined e-prescribing 

standards do not completely support the technical infrastructure required for interoperable 

e-prescribing systems. Plan sponsors’ e-prescribing systems must be interoperable to maximize 

e-prescribing benefits. Plan sponsor systems that are not fully compliant with all e-prescribing 

standards limit the types of e-prescribing information available to prescribers. 

For more detail about plan sponsors’ implementation of e-prescribing standards, see OIG’s 

companion report, “Medicare Part D E-Prescribing Standards: Early Assessment Shows Partial 

Connectivity” (OEI-05-08-00320). 

Over half of plan sponsors with an initiative reported average or high prescriber 

participation in their initiatives 

Twenty-seven plan sponsors with an initiative reported average or high levels of prescriber 

participation in their initiatives. Small plan sponsors reported high prescriber participation more 

often than medium or large plan sponsors. This may be because small plan sponsors interact 

with fewer prescribers. Small plan sponsors can more easily reach their entire network of 

prescribers compared to medium and large plan sponsors. Plan sponsors reported participation 

ranging from 4 to 13,000 prescribers. 

Some plan sponsors attributed their high levels of prescriber participation to implementation

strategies that they used to promote their initiatives. Some plan sponsors reported using 

implementation strategies to reach more prescribers, including creating mandates for staff 

physicians to use e-prescribing technology, tying other quality bonuses to e-prescribing, 

extending a financial incentive to pharmacies, and partnering with other health care 

organizations. In structured interviews, three plan sponsors with high prescriber participation 

described their strategic approaches. 

Sierra Health Services

Sierra Health Services (Sierra) offered all Nevada prescribers free, stand-alone 

e-prescribing software as part of its initiative to promote the adoption of e-prescribing. 

Only prescribers that were part of a large medical group owned by Sierra, Southwest 

Medical Associates (SMA), took advantage of the initiative. However, even with free 

software, SMA prescribers were slow to adopt e-prescribing. 

SMA increased e-prescribing in its practice by making two changes. First, SMA 

integrated e-prescribing into its electronic health record system. Second, SMA changed 

its prescriber bonus structure so that only prescribers who were 100-percent compliant 

with SMA’s e-prescribing program were eligible for bonuses. Within 1 month of this 

change, the number of e-prescriptions went from 0 to 80,000. As of September 2008, 

almost all prescriptions generated by SMA were electronic. 

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Blue Cross Blue Shield of Massachusetts 

Blue Cross Blue Shield of Massachusetts (BCBS-MA) is a founding member of the 

eRx Collaborative (Collaborative), a collaboration of three local health plans in 

Massachusetts.14 The Collaborative’s initiative to promote the adoption of e-prescribing 

includes free stand-alone software, hardware, Internet connectivity, and staff training. 

BCBS-MA also offers its prescribers financial incentives based on e-prescribing use. 

The Collaborative rolled out its e-prescribing initiative in two phases. First, the 

Collaborative targeted high-volume and specialty prescribers (e.g., an allergist). The 

Collaborative found that more high-volume prescribers adopted e-prescribing than 

specialty prescribers. Specialty prescribers were less likely to adopt e-prescribing 

because they did not see patients regularly. Second, the Collaborative offered its 

initiative to any interested prescriber in Massachusetts. 

The Collaborative also invited two e-prescribing software vendors to help recruit 

prescribers to adopt e-prescribing. Because e-prescribing was a relatively new 

technology, software vendors gave in-office demonstrations and explained the features 

and benefits of e-prescribing. The Collaborative found this approach successful in 

recruiting prescribers to adopt e-prescribing. 

Since 2003, the Collaborative’s initiative has assisted more than 6,000 prescribers to 

adopt e-prescribing. In 2008, Collaborative prescribers transmitted more than 4 million 

electronic prescriptions. Collaborative prescribers have transmitted 17.8 million 

electronic prescriptions between 2003 and 2008. 

Within the BCBS-MA provider network, approximately 13 percent of prescriptions in 

2008 were electronic prescriptions, up from 5 percent in 2005. To further promote 

e-prescribing adoption, BCBS-MA announced that beginning in 2011, prescribers must 

e-prescribe to participate in any BCBS-MA physician incentive program. 

Blue Cross Blue Shield of North Carolina 

To extend its initiative’s reach, Blue Cross Blue Shield of North Carolina (BCBS-NC) 

partnered with a large medical group and the Community Care Network of North 

Carolina (CCN). CCN is an affiliation of medical group practices that includes 

physicians and pharmacists. BCBS-NC’s initiative includes free Web-based 

e-prescribing software, discounted hardware, Internet connectivity, training, and financial 

incentives. 

BCBS-NC also extended a one-time financial incentive for pharmacies to update their 

computer systems. BCBS-NC found that some prescribers stopped e-prescribing because 

pharmacies were not equipped to accept electronic prescriptions. BCBS-NC found that 

pharmacies were receptive to the financial incentive, which led to an increase in the 

number of pharmacies connected for e-prescribing. BCBS-NC reported that its efforts 

encouraged approximately 2,500 prescribers to e-prescribe in 2008. 

 

14 The Collaborative was formed in 2003, before the creation of Medicare Part D plan sponsors. 

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Seventy-five percent of plan sponsors with an initiative could not report the quantifiable 

benefits of their initiatives because they did not measure outcomes 

Thirty-three plan sponsors could not report any quantifiable benefits from their initiatives 

because they did not measure the outcomes of their initiatives. Plan sponsors’ initiatives are 

voluntary and there are no requirements to report outcomes. However, measuring the outcomes 

of e-prescribing is the only way to determine whether e-prescribing leads to lower costs and 

improved quality. Possible outcome measures may include increased generic substitution, 

increased formulary compliance, or decreased medication errors. 

Some plan sponsors reported that they did not measure outcomes because e-prescribing data 

were not readily available, which hindered their ability to measure the impact of their initiatives. 

Specifically, some plan sponsors reported that they do not have adequate data because their 

metrics are under development or their prescription volume is too low to measure outcomes. In 

structured interviews, two plan sponsors described obstacles to obtaining e-prescribing data and 

measuring outcomes. 

BCBS-NC

BCBS-NC reported difficulty obtaining e-prescribing data because prescribers 

participating in its initiative used different e-prescribing software platforms. Initially, 

BCBS-NC partnered with three e-prescribing vendors to offer e-prescribing software to 

prescribers. Limiting the vendor options helped BCBS-NC track e-prescribing volume 

because it only had to collect data from three vendors. 

In 2008, BCBS-NC pursued a vendor-neutral strategy so prescribers would have a wider 

choice of e-prescribing software. With so many vendors, BCBS-NC tried to obtain 

e-prescribing data from a single source, RxHub,15 but the data were incomplete and 

inconsistent. Vendors have to undergo certification with RxHub to properly transmit 

e-prescribing data for reporting purposes, but BCBS-NC found that not all vendors had 

undergone certification. As a result, BCBS-NC had to coordinate data collection from 

multiple vendors and then manually aggregate the data. It had to contact several vendors 

for data and did not consistently receive data in a timely fashion. 

Inconsistent and incomplete e-prescribing data created two problems for BCBS-NC. 

First, BCBS-NC had trouble quantifying its e-prescribing benefits. BCBS-NC found that 

when data were collected from multiple vendors, the reporting of potentially avoided 

drug-drug allergy interactions was not consistent. The vendors often did not capture all 

of this information and many times were not able to report the number of prescription 

changes or cancellations that occurred as a result of the e-prescribing transaction. 

Second, inaccurate e-prescribing data complicated BCBS-NC’s ability to track 

prescribers who were eligible to receive financial incentives. BCBS-NC rewarded 

prescribers with a $1,000 bonus for viewing the medication history of 20 patients. 

Because of difficulty acquiring accurate data, BCBS-NC modified the financial incentive 

by rewarding prescribers that e-prescribed for 20 patients. 

 

15 E-prescribing software systems query RxHub for medication history and formulary and benefits information from 

plan sponsors. 

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Medco Health Solutions

Medco Health Solutions (Medco) also reported problems obtaining e-prescribing data and 

measuring initiative outcomes. Prescribers participating in Medco’s Southeast Michigan 

E-Prescribing Initiative (SEMI) can choose software from several e-prescribing software 

vendors. Similar to BCBS-NC, Medco had to pursue several vendors for e-prescribing 

data. Medco could not aggregate the e-prescribing data because the software vendors did 

not have a uniform way to report e-prescribing information. Without consistent and 

complete e-prescribing data, Medco reported difficulty quantifying benefits of SEMI. 

Medco reported that pharmacy use of the POC would greatly improve its ability to track 

e-prescribing volume and benefits. 

In the future, e-prescribing data may be more widely usable if pharmacies populate the POC 

field. With accurate POC data, CMS and plan sponsors could get e-prescribing volume data 

from PDE data. The accuracy of the POC data depends on accurate pharmacy entry, which may 

be complicated by some pharmacy operations. For example, if an electronic prescription is 

transferred from one pharmacy to another, the second pharmacy may not recognize it as an 

electronic prescription and enter the wrong code in the POC field. Any inaccuracies in the POC 

data may affect CMS’s ability to track e-prescribing. 

Twenty-five percent of plan sponsors with an initiative reported that they measured for and saw

a quantifiable benefit. These 11 plan sponsors reported that they were able to track e-prescribing 

volume and use the data to assess the impact of their initiative. Eight plan sponsors reported an 

increase in generic substitutions and an increase in formulary compliance. Five plan sponsors 

reported a decrease in medication errors as measured by the number of prescriptions changed 

because of medication alerts. Two plan sponsors also reported cost savings from their initiatives. 

CONCLUSION

Some plan sponsors have launched voluntary e-prescribing initiatives to increase prescriber 

adoption of e-prescribing. As of September 2008, approximately 20 percent of plan sponsors 

had an initiative and an additional 18 percent were planning an initiative. Although the 

composition of plan sponsors’ initiatives varied, most offered free or discounted software and 

training. Despite efforts to promote e-prescribing, not all plan sponsors with initiatives have 

completely implemented e-prescribing standards, which may limit e-prescribing benefits. 

Over half of plan sponsors with an initiative reported average or high prescriber participation 

levels for their initiatives. Some plan sponsors attributed their high levels of participation to 

implementation strategies they used to promote their initiatives. Some of these additional 

strategies include creating mandates for staff physicians to use e-prescribing technology, tying 

other quality bonuses to e-prescribing, extending a financial incentive to pharmacies, and 

partnering with other health care organizations to reach more prescribers. 

Most plan sponsors were unable to measure outcomes for their initiatives. Three-quarters of plan 

sponsors with an initiative could not report a quantifiable benefit because they did not measure 

outcomes for their initiatives. Plan sponsors that were able to measure outcomes from their 

initiatives reported an increase in generic substitution and formulary compliance. 

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OEI-05-08-00322 Medicare Part D Plan Sponsor Electronic Prescribing Initiatives 

This report is being issued directly in final form because it contains no recommendations. If you 

have comments or questions about this report, please provide them within 60 days. Please refer to 

report OEI-05-08-00322 in all correspondence.