Virginia HIMSS March 19, 2009

1. National Progress Report onElectronic Prescribing Virginia HIMSS March 19, 2009

2. With a patient’s consent, electronically access information regarding a patient’s drug benefit coverage and medication history. Electronically transmit the prescription to the patient’s choice of pharmacy. When the patient runs out of refills, their pharmacist can also electronically send a renewal request to the physician’s office for approval. Support entire medication management process – prescribe, transmit, dispense, administer, monitor What is E-Prescribing? Prescribing without paper. When a prescriber uses a computer or hand held device with software that allows them to:

3. Why is E-Prescribing Important? • It is safer • It saves time and money • Pharmacies • Plans • Physician practices • Patients • It improves the quality of healthcare

4. Automating Prescribing with Clinical Decision Support and Pharmacy Interoperability Has Most Safety Benefit Pen Print6% Fax37% Advanced ACPOE Results in 2 million Fewer ADEs, 130k Of Which are Life Threatening EDI + Decision Support 61% Source: Center for Information Technology Leadershipbv

5. What Can Payers Achieve Through E-Prescribing? • Formulary alerts • Patient safety alerts • Medication adherence alerts • Gaps in care alerts Provider • Condition & therapy education • Medication adherence education • Mail order instructions • Care reminders Member Communication at the point of care

6. Lowers health plan drug costs • Increases prescribing of generic medications • Increases prescribing of lower cost alternative medications • Decreases amount of inappropriate medication therapy • Prior authorizations • Step therapies • Increases use of mail order for chronic medications Return On Investment +1% generic utilization = $4 - $12 PMPY* *Industry estimates by payer e-health consulting firm.

7. Importance of E-Prescribing:Saving Time/Money • MGMA • E-prescribing with pharmacy interoperability can significantly reduce the $10,000 spent annually per physician on phone calls with pharmacies related to prescription refills1 • SureScripts • Practices spend on average 4.78 to 4.92 hours/day2 managing refills • Prescribers spend on avg.1.84 – 1.88 hrs/day • Staff spend on avg. 2.94 to 3.04 hrs/day • MMA E-Prescribing Pilots • Average time spent per day on renewals was cut in half 3 • 2004 MGMA – Analyzing cost of administrative complexity in group practice. • 2006 SureScripts Get Connected Campaign Report • Brown University: 2006 MMA E-Prescribing Pilots

8. Lowers health plan medical costs • Reduced ADEs • More accurate drug dosing • Increased legibility • Drug interaction checking • Patient adherence • Increased first fill percentage • Increased persistence through availability of medication history • Prescribing of affordable, on formulary medications Return On Investment +$1 drug spend = $4 - $7 lower medical costs* *Medco, 2005 (study on increased adherence for diabetes, hypertension and other conditions).

9. Walgreens – IMS Study With E-Prescribing More Prescriptions Get to the Pharmacy

10. Increases provider and member satisfaction • Provider satisfaction • Practice efficiencies including less phone/fax through automated renewals • Availability of medication history information across providers • Availability of electronic prescription records outside the practice • Improved quality of care • Member satisfaction • Less wait in the pharmacy • Perception of more modern care Return On Investment Reduces staff time by hours per day in smaller practices

11. Status of E-Prescribing Adoption

12. 74,500 Active E-Prescribers at End of 2008

13. Use of EMR vs. Stand- aloneE-Prescribing – 60% using EMR 30,900 16,100 43,600 19,500

14. Activated Pharmacies -- 95% of Chains and 45% of Independents

15. Prescription Benefit Transaction Volume108 Million in 2008

16. Prescription History Transaction Volume35 Million in 2008

17. E-Prescription Routing Volume68 Million in 2008

18. Drivers of E-Prescribing in 2008 • Significant attention at federal and state policy levels • CCHIT certification of stand alone e-prescribing • Medicare e-prescribing incentive program • DEA proposed rule to allow e-prescribing of controlled substances • E-prescribing exemption from Medicaid required use of tamper proof prescription pads • National programs driving awareness of e-prescribing and offering practical tools • Get Connected Program • SafeRx Awards • Pharmacy campaign to raise awareness with consumers • Health plans, health systems, Governors offices, state departments of health and multi-stakeholder statewide e-prescribing initiatives • Physician technology vendor momentum in deploying e-prescribing • Continued adoption among payers/PBMs, independent pharmacies

19. Action Needed for E-Prescribing to Reach Mainstream Adoption • Continued work with DEA and Congress to pass regulations that allow controlled substances to be e-prescribed • Ensure that HIT funding from Stimulus is spent wisely and builds on proven technology including e-prescribing • Continue to fill remaining connectivity gaps among payers/PBMs, independent pharmacies • Raise industry awareness of fully informed e-prescribing encompassing prescription benefit, prescription history, prescription routing • Build on existing progress of Medicare incentives and stakeholder driven e-prescribing initiatives • Provide ongoing education, incentives, and implementation assistance

20. Questions? Thank You… Kate Berry kate.berry@surescripts.com 20