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RxHub, SureScript Move Forward, Downplay Rivalry

Kate Traynor

Potential rivals RxHub L.L.C. and SureScript Systems Inc., developers of health care information conduits to promote the widespread use of electronic prescribing technology, may be moving toward a peaceful coexistence as the companies target different steps in the prescribing process.

"There is virtually no overlap between the kinds of things that [SureScript] is working on and...the issues that we're working on," said James P. Bradley, chief executive officer (CEO) of RxHub. Bradley made the remark during a presentation at the Peter Lamy Conference on Drug Therapy and Aging, held Oct. 17 in Bethesda, Md.

RxHub was created in February 2001 by three large pharmacy benefit-management companies (PBMs)—AdvancePCS, Express Scripts Inc., and Merck-Medco Managed Care L.L.C. Originally touted as a standardized conduit that would link physicians, pharmacies, PBMs, and health plans, RxHub is mostly focusing, at least for now, on the interactions that occur outside the pharmacy, Bradley said.

SureScript, formed in August 2001 by the National Association of Chain Drug Stores and the National Community Pharmacists Association, is concentrating on establishing a standardized electronic link between pharmacies and physicians.

"What I think all of us are trying to do is say, 'Here's a single [electronic communications] standard. If you interact through the standard, you can talk to anybody,' " Bradley said. Both RxHub and SureScript rely on communication standards developed in conjunction with the National Council for Prescription Drug Programs.

RxHub, through its Benefits Connect system, will allow physicians to electronically verify the specifics of a patient's drug benefit before generating a prescription—potentially avoiding calls between the physician's office and the patient's pharmacy to iron out eligibility and formulary problems. Also to be linked to the conduit are companies that provide electronic prescribing software capable of alerting the physician to potential drug interactions and other safety issues that should be resolved before generating the prescription.

The next step—transmission of the prescription to the patient's pharmacy—is what SureScript wants to manage by electronically linking the nation's approximately 50,000 community pharmacies to physicians' offices.

SureScript CEO Kevin Hutchinson said during the Oct. 17 conference that today's so-called electronic prescribing is not fully automated. Often, the physician's prescribing system will generate a paper prescription that must be faxed to the pharmacy, where a pharmacist or pharmacy technician manually enters the information into the computer system. Hutchinson said that the SureScript conduit will replace much of the manual work associated with processing such prescriptions.

"What we're talking about is application-to-application connectivity, where whatever is prescribed at the physician level actually shows up in a queue at the pharmacy application. There is no rekeying of information between the applications," he said.

Although neither SureScript nor RxHub is fully operational yet, the companies seem to be gaining momentum in the marketplace. SureScript announced last month that two thirds of the nation's pharmacy chains had agreed to use the company's prescription-processing conduit. Hutchinson said that about half of the major pharmacy chains in the country would be technologically ready to connect to the system by January 2003.

RxHub is undergoing pilot testing, and the company predicted that it will finish the second round of testing for Benefits Connect before the end of the year. According to company's press releases, the pilot projects have involved PBMs, electronic prescribing-system vendors, and clinics. At least one electronic-prescribing technology vendor, Cincinnati-based PocketScript Inc., has committed to using the RxHub conduit when it launches.

Both SureScript and RxHub profess to be neutral systems, open to all who want to participate. Bradley sought to dispel rumors that RxHub will intercept prescriptions and route them to the PBMs' mail-order pharmacies.

"There will be no gaming of the system," he said. "These prescriptions are encrypted from the [physician's] office into the PBM database. We wouldn't know how to open up the transactions. And as soon as we did, I would go to jail," he added.

Funding for SureScript will come from transaction fees paid by the pharmacies that participate in the program. The company also expects to collect fees from what SureScript describes as "other stakeholders" who directly benefit from the use of the information conduit.

RxHub received $20 million in initial funding commitments from the company's three founding PBMs. Transaction fees to support the system will be paid, at least in the beginning, by PBMs and insurers.