Bill Overview
Title: EPCS 2.0 Act
Description: This bill generally requires health insurance plans to establish policies requiring in-network providers to transmit prescriptions for controlled substances to pharmacies electronically.
Sponsors: Rep. O'Halleran, Tom [D-AZ-1]
Target Audience
Population: People who use or prescribe controlled substances
Estimated Size: 130000000
- The primary impacted group includes healthcare providers, particularly those who prescribe controlled substances. These include doctors, nurse practitioners, and other licensed professionals.
- Pharmacists and pharmacy workers who will receive electronic prescriptions instead of paper prescriptions for controlled substances.
- Patients who use controlled substances for medical reasons, as their prescriptions will be delivered electronically to pharmacies.
- Health insurance companies who need to update policies to comply with the new requirements.
- The United States has millions of patients who may be using controlled substances for a variety of medical conditions, including chronic pain, anxiety, ADHD, and others.
Reasoning
- The EPCS 2.0 Act primarily affects healthcare providers, pharmacies, and patients receiving controlled substances. Providers will need to adopt electronic prescribing tools, which may require training and resources. This could impose a low to medium impact on their wellbeing depending upon resource availability and adaptability.
- Pharmacists may experience an immediate change in workflow, potentially increasing efficiency and reducing prescription errors, leading to a medium impact, generally positive.
- Patients receiving prescriptions electronically might see convenience improvements, though initially, there may be resistance or confusion among some, especially in older demographics, resulting in a low to medium impact.
- Health insurance companies will incur costs updating policies and systems but should benefit from reduced fraud and errors in the long run. The impact would vary by the size of the company and existing infrastructure.
- Considering the budget, implementing electronic systems for controlled substances will require coordinated effort across the healthcare sector, needing to prioritize high-prescription areas initially to balance costs.
Simulated Interviews
Family Physician (Texas, USA)
Age: 50 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 10/20
Statement of Opinion:
- I think electronic prescribing is a step in the right direction. It will streamline my work and reduce paperwork.
- I have concerns about the initial learning curve and potential technical issues.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 9 | 7 |
| Year 20 | 9 | 7 |
Pharmacist (California, USA)
Age: 34 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 15/20
Statement of Opinion:
- The shift to electronic prescriptions will reduce errors and save time.
- I'm optimistic but cautious about transition hiccups.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 9 | 6 |
| Year 20 | 9 | 6 |
Health Insurance Policy Analyst (New York, USA)
Age: 45 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 3.0 years
Commonness: 12/20
Statement of Opinion:
- Our company will have to overhaul some existing protocols, which is resource-intensive.
- Ultimately, it should benefit policyholders and reduce misuse.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 5 |
Retired, patient taking controlled substances (Florida, USA)
Age: 62 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 2.0 years
Commonness: 8/20
Statement of Opinion:
- I worry about not getting my medication if there are technical issues.
- It's nice that I won't have to visit the doctor as often for refills.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 7 | 6 |
Nurse Practitioner (Illinois, USA)
Age: 29 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 1.0 years
Commonness: 9/20
Statement of Opinion:
- I've been using electronic systems already; this will integrate well.
- My main concern is data security and patient privacy.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 8 | 7 |
| Year 20 | 8 | 7 |
Psychiatrist (Ohio, USA)
Age: 52 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 3.0 years
Commonness: 7/20
Statement of Opinion:
- I am concerned about the transition phase and ensuring no interruption in patient care.
- This could substantially reduce misuse and paper clutter in my practice.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 6 |
Patient taking anxiety medication (Georgia, USA)
Age: 40 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 2.0 years
Commonness: 11/20
Statement of Opinion:
- I'm used to paper prescriptions, so it'll take time to adjust.
- Less hassle to go to the pharmacy.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 5 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 7 | 5 |
Pharmacy Technician (North Carolina, USA)
Age: 55 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 3.0 years
Commonness: 13/20
Statement of Opinion:
- Electronic prescriptions make my job easier, reducing errors and confusion.
- Initial system integration could be challenging.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 9 | 6 |
| Year 20 | 9 | 6 |
IT Specialist in Healthcare (New Jersey, USA)
Age: 38 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 4.0 years
Commonness: 5/20
Statement of Opinion:
- This is a welcome challenge and a chance to enhance healthcare IT systems.
- It's stressful to ensure seamless transition and minimize disruption.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 5 |
Retired, patient on multiple medications (Arizona, USA)
Age: 67 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 3.0 years
Commonness: 6/20
Statement of Opinion:
- Not having to physically deliver prescriptions is a benefit.
- I'm concerned about pharmacies receiving everything correctly.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 6 | 4 |
| Year 10 | 7 | 4 |
| Year 20 | 7 | 4 |
Cost Estimates
Year 1: $750000000 (Low: $600000000, High: $850000000)
Year 2: $500000000 (Low: $400000000, High: $600000000)
Year 3: $300000000 (Low: $250000000, High: $350000000)
Year 5: $200000000 (Low: $150000000, High: $250000000)
Year 10: $100000000 (Low: $80000000, High: $120000000)
Year 100: $20000000 (Low: $15000000, High: $25000000)
Key Considerations
- Transitioning to electronic prescription systems requires significant upfront investment by healthcare providers and pharmacies.
- Widespread compliance will demand robust coordination and support from health insurance companies.
- Long-term savings and efficiency gains depend heavily on successful adoption and utilization of the electronic prescribing systems.