Prescription Electronic Signatures – Regulatory Requirements and Technology Solutions

Right now electronic signatures might seem like a distant memory for pharmacists, from a time, back in the pre-COVID-19 era, when things were “normal.”  For so long, the relatively simple practice of capturing a patient’s signature to validate a pickup was just a routine, expected part of the point-of-sale process.

That all changed though, in late March, when the Centers for Medicare & Medicaid Services (CMS), followed by pharmacy benefit managers (PBMs) issued guidance urging all states, including boards of pharmacies and Medicaid agencies, to temporarily waive proof-of-receipt and signature delivery requirements.  As the CMS noted in its guidance, “requiring a patient signature for receipt of medication could undermine current public health efforts to combat the spread of coronavirus.”

Since then, home deliveries, curbside pickups and contactless transactions have become the preferred methods of prescription transactions, with most signature pads safely tucked away for another day.

When that day will come seems far away, as the pandemic shows no sign of abating and pharmacies focus their efforts on finding increasingly creative ways to prioritize patient and staff safety.

But when pharmacies return to the day when prescription pickups require signatures, pharmacists will be reminded that electronic signatures require compliance with multiple legislative and regulatory requirements, and that when it comes to the law, not all signatures are the same.

As confusing as this may seem, pharmacy managers can be assured that technology providers have kept pace with signature requirements, and that certain systems, including PrimeRx™ from Micro Merchant Systems, offer solutions that are easy to use, ensure seamless storage, facilitate regulatory compliance, and can be portable, for use with handheld devices.

First though, a quick overview of the legislative requirements affecting electronic signatures.

E-Signatures – Legislative History

E-prescribing for non-controlled substances became legal in all 50 states in 2007.  But the 2008 development of what today is known as the “Surescripts  Network Alliance,” a national network that ensures seamless and secure transmission of prescription data, facilitated the process and helped drive its growth.  Today, roughly 80 percent of all prescriptions are transmitted electronically.

But the stage had been set for health-related electronic signature capture years before, with the enactment of three specific pieces of legislation:

Following is a brief overview of each:

 Electronic Signatures in Global and National Commerce Act (E-SIGN)

E-SIGN was signed into law in 2000 by President William Clinton.  According to the National Telecommunications and Information Administration (NTIA), E-SIGN essentially established the validity of an electronically signed document, and invalidated prior legislation requiring written documents.

An important tenet of E-SIGN, was the establishment of an official definition of an electronic signature.  According to the law, “the term ‘electronic signature’ means an electronic sound, symbol, or process, attached to or logically associated with a contract or other record and executed or adopted by a person with the intent to sign the record.”

According to analysis by FindLaw, the law does not mandate use of a particular technology, but instead “allows the parties to select the method of authentication that best suits their needs and security concerns.”

UETA actually preceded E-SIGN, and was adopted by the National Conference of Commissioners on Uniform State Laws (NCCUSL) in 1999.  NCCUSL recommended UETA to the states as model legislation for regulation of electronic transactions and to date, UETA has been adopted by 47 states.  Only New York, Illinois and Washington have not adopted UETA but, according to Thomson Reuters, each has enacted similar laws.

Analysis by DocuSign notes “both UETA and the E-SIGN Act have four major requirements for an electronic signature to be recognized as valid under U.S. law.”  Those requirements include:

  1. Intent to sign – Electronic signatures, similar to traditional “wet” signatures, are only valid if each party intended to sign.
  2. Consent to do business electronically – Each party to the transaction must consent to do business electronically. As the analysis explains, establishing a consumer’s intent is only possible when the consumer has:
    1. Received a consumer consent disclosure
    2. Affirmatively agreed to use electronic records, and
    3. Not withdrawn such consent.
  3. Association of signature with the record – In order to qualify as an electronic signature under ESIGN and UETA, the system used to capture the transaction must keep an associated record that reflects the process by which the signature was created, or generate a textual or graphic statement (which is added to the signed record) proving it was executed with an electronic signature.
  4. Record retention – U.S. laws on electronic signatures and electronic transactions require that electronic signature records be capable of retention and accurate reproduction for reference by all parties or persons entitled to retain the contract or record.

While both UETA and E-SIGN apply to contracts and transactions executed across a broad scope of industries, the need for requirements specific to the healthcare industry was addressed through provisions included in the Health Insurance Portability and Accountability Act (HIPAA).

HIPAA was signed into law  in 1996 by President William Clinton, and according to the HIPAA Journal, a key aim of the original legislation was to improve the portability of health insurance coverage – ensuring employees retained health insurance coverage while between jobs.  The law was subsequently modified to address patient privacy, most notably through enactment of the HIPAA Privacy Rule which became effective in 2003, and the HIPAA Security Rule which took effect in 2005.

A key pillar of HIPAA is the determination of  acceptable uses and allowable disclosures of protected health information (PHI).  With regard to pharmacies, the HIPAA Journal notes that the statute “sets standards for the secure storage and transmission of PHI, and gives patients the right to obtain copies of their PHI.  “HIPAA compliance for pharmacies is not an option,” the Journal advises.  “The penalties for failing to comply with HIPAA can be severe.”

Among the law’s pharmacy-related provisions, is the requirement that all patients be provided with a copy of the pharmacy’s “notice of privacy practices,” and for patients to acknowledge receipt of that notice via a signature.  More specifically, the pharmacy must make a “good faith effort” to obtain the patient’s signature, and to document instances in which the patient either refused to sign, or due to extenuating circumstances, was unable to provide a signature.

HIPAA does not explicitly authorize the use of electronic signatures but, according to the HIPAA Journal, the practice is generally allowed, “provided that mechanisms are put in place  to ensure the legality and security of the contract, document, agreement or authorization, and there is no risk to the integrity of PHI.”

More specifically, the Department of Health and Human Services (HHS) website offers the following guidance:  “Currently no standards exist under HIPAA for electronic signatures.  In the absence of specific standards, covered entities must ensure any electronic signature used will result in a legally binding contract under applicable state or other law.”

Despite the absence of statutory language, HIPAA offers guidance for “conditions necessary for e-signatures,” which builds on provisions outlined in E-SIGN and UETA.  Those conditions include:

  • Legal compliance: The document, agreement or authorization must not only comply with all provisions of E-SIGN, but must also clearly demonstrate the terms, intent of the signatory, and provide the option for the signatory to receive a printed or emailed copy of the document.
  • User authentication. A system must be in place to validate the identity of all transacting parties.  This may include mechanisms such as two-step verification, specialized e-signature software, and answers to “secret” questions.
  • Message integrity. A system must be in place to prevent digitally tampering with documents after signing.
  • Non-Repudiation. In order to ensure that the signatory cannot deny having signed the agreement, e-signatures used under HPAA rules should have a timestamped audit trail indicated dates, times, location and the chain of custody.
  • Ownership and control. In order to ensure the integrity of PHI, all evidence supporting the e-signature should be on the same document under the ownership and control of the covered entity.  All other copies – except those provided for the signatory – should be shredded.

Not surprisingly, the complexity of these three statutes caused a degree of confusion among pharmacy managers and other stakeholders.  Which is why a recommendation offered by FindLaw attorneys seems to make sense:  “There is one safe rule to follow when determining which laws or regulations govern a particular healthcare transaction involving the use of electronic records or signatures:  Closely consider all of them.  Assuming each is consistent with E-SIGN, it is highly likely each will apply.”

Signature “Differentiations”

As pharmacy managers consider implementing a compliant signature collection process, it is necessary to understand the different types of “signatures” that may need to be incorporated.  These  different categories, as defined by the National Council for Prescription Drug Programs (NCPDP), include:

  • Wet signature. A wet signature refers to an original signature handwritten in ink on a piece of paper.
  • Electronic signature. As the above discussion indicated, the E-SIGN legislation defines an electronic signature as an “electronic sound, symbol, or process, attached to or logically associated with a contract or other record and executed or adopted by a person with the intent to sign the record.”
  • Digital signature. A digital signature is defined as the capture of a wet signature, which is reproduced electronically to create a computer-generated signature.  A digitized signature resembles a wet signature, but rather than being handwritten in ink on paper, is computer-generated.

The NCPDP makes a few distinctions with regard to these different signature categories:

  • A digital signature is a type of electronic signature, but not all electronic signatures are digital signatures.
  • For electronic prescribing of non-controlled substances, an electronic signature as defined by E-SIGN and/or state boards of pharmacy rules is required.
  • For electronic prescribing of controlled substances, more specific digital signature requirements are defined by DEA regulations.
  • Wet signatures are not an acceptable authentication method for electronic prescribing. This is because wet signatures can easily be produced by unauthorized individuals, which therefore presents a security risk.
  • Digitized signatures are not acceptable authentication methods for electronic prescribing and according to NCPDP, are expressly prohibited by many state boards of pharmacy. As NCPDP notes, “Digitized signatures are typically captured ‘one-time’ and pre-programmed to appear on every printed document where a signature is required – a process similar to a ‘rubber signature stamp.'”

Technology Considerations in Selecting a Pharmacy Electronic Signature Solution

The typical pharmacy manager would not be alone in wondering how to implement an electronic signature program that satisfies these complex requirements.  In fact, there are many pharmacy management systems that offer electronic signature functionality.

But not all have the same functionality, which means a pharmacy manager must take the time to carefully consider the capabilities and attributes of each system.

PrimeRx™ is a good example of a technology solution that is highly responsive to changing pharmacy needs, and continually offers innovative approaches for better, more efficient workflow management.   PrimeRx™ serves as the core processing center, through which key pharmacy management systems and processes are accessed.  But a suite of services, which seamlessly integrate with PrimeRx™, provide access to a wide range of processes and services.

With regard to electronic signature capture, PrimeRx™ capabilities include:

  • Seamless integration with Surescripts. Surescripts is the dominate provider of electronic health record management systems, and a vital partner in linking doctors, payers, and pharmacies.  PrimeRx™ interfaces with the Surescripts Network Alliance to ensure seamless transmission of electronic prescriptions and timely, accurate processing of patient information.
  • Certification for NCPDP SCRIPT Standard 2017071. E-prescribing took a big step forward in early 2020, when SCRIPT Standard 2017071 became mandatory.  The new standard includes several enhancements to the prior SCRIPT Standard 10.6 including improved digital signature capabilities, to facilitate electronic prescribing of controlled substances.  Micro Merchant Systems was among the first pharmacy systems certified for the new standard, and as a result, PrimeRx™ system users were among the first to benefit from the improved functionality.
  • Tablet/iPad capability. No longer  must pharmacy staff be tethered to a point-of-sale electronic signature pad.  Instead, PrimeRx™ allows electronic signature functionality via a tablet or iPad.  This feature is especially helpful for home deliveries, and in managing pharmacy drive-thru windows.
  • Records management. PrimeRx™ automatically captures all signatures, and adds them to each patient’s record.  The system allows pharmacy managers to easily retrieve signature logs, which allows for easy compliance with PBM audit requests and internal reporting needs.  In addition, pharmacy staff can have immediate access to patient signature records, and provide requested information upon request, per HIPAA requirements.
  • Signature Validation. Consistent with HIPAA requirements, signatures are automatically date/time stamped at point of collection.  Signatures can easily be collected for a wide range of pharmacy purposes including:
    • HIPAA requirements
    • Easy-off cap requests
    • Counseling
    • Third party release authorizations.
  • Data encryption/Security. PrimeRx™ offers the highest levels of security, which include encryption of all data, and strict log-in protocols for all system users.
  • Ease of use. Perhaps as important as the signature capabilities offered in PrimeRx™, are the user-friendly interfaces that allow pharmacy staff to quickly and easily take advantage of this functionality.  Electronic prescriptions seamlessly arrive in the pharmacy’s workflow, with “flags” raised for those prescriptions requiring a patient signature.  The system automatically tracks those prescriptions, and once a signature is recorded, it is seamlessly added to a patient record, and to the pharmacy’s overall signature log.
  • Remote signature capability. The system’s PrimeDELIVERY™ in-house/wireless delivery module includes a new remote signature capability.  Through this feature, a prescription can be delivered to a patient’s residence, even if the patient is not available to sign for the package.  Instead, an advance electronic signature request is sent to the individual, through the PrimeDELIVERY™ module.  The patient then provides an electronic signature that is automatically transmitted back to the pharmacy and uploaded to the patient record.

Patient signatures serve an important purpose, and electronic signature capability facilitates the efficiency of the collection process.  Once pharmacies return to regular protocols, and are again required to capture patient signatures, pharmacy managers will find technology has kept pace, with solutions to ensure fast, accurate and non-intrusive signature collection processes.


LTC Pharmacies Find a Lifeline in Technology Management Systems, including PrimeRx™

In a 2020 benchmark report targeted at pharmacy start-ups, the National Community Pharmacists Association (NCPA) suggests pharmacies can “diversify their revenue while focusing on the health care needs of their local communities,” by offering long-term care (LTC) services.  Specifically, the report was referring to the growing need for pharmacy services among the millions of patients – including an estimated 12 million senior citizens – living in long-term care residential facilities including nursing homes, assisted living facilities, rehabilitation centers, and group homes.

The survey noted that currently 15 percent of new pharmacies provide some degree of LTC services.  Roughly 82 percent offer those services from the same pharmacy from which they dispense to non-LTC patients, with 18 percent exclusively serving LTC populations.  Among “combination” pharmacies, the average number of beds serviced is 53, a number that jumps to 107 among closed-door pharmacies.

It’s easy to see then, how offering LTC services can significantly expand a pharmacy’s revenue potential.  “Once you reach 100 residents, that’s worth about $500,000 in additional business,” Bill Popomaronis of the NCPA said in a 2019 interview with Elements Magazine.  “That number is based on the number of prescriptions that a particular patient might use and other factors, but I believe it to be a conservative number,” he added.

Research by McKesson seems to support the revenue possibilities for LTC pharmacies, with findings that include:

  • The average independent LTC pharmacy dispenses 12,460 prescriptions per month.
  • Nursing home and other long-term care facility patients receive, on average, 12 prescriptions per month (3 branded and 9 generic).
  • The average LTC pharmacy services 10 to 13 facilities, with 80 to 100 residents per facility.
  • 82 percent of LTC pharmacies experience eight or more inventory turns per year. 60 percent have more than 12 turns per year, and 38 percent have more than 15 turns per year.  Based on these numbers, the average costs of goods sold is between 61 percent and 70 percent, meaning that gross margins are in the 30-40 percent range.

But with this potential, come additional challenges and responsibilities, and lots of them.

These challenges and responsibilities come in many forms and include packaging/labeling requirements, dispensing needs, records management, reporting needs, regulatory and licensing mandates, and the list goes on.

Technology is playing an integral role in helping LTC pharmacies manage these complicated and diverse issues.  Certain pharmacy management systems, including the comprehensive PrimeRx™ solution offered by Micro Merchant Systems, include capabilities developed specifically for today’s LTC pharmacies.

Consider, for example, the need for LTC pharmacies to accommodate electronic medication records (eMARs).  Federal law mandates the creation of a medication administration record (MAR) for every patient admitted to a long-term care facility as a way to track and manage medication histories.  Those forms are increasingly in the form of technology-based eMARs, driven largely by federal mandates requiring electronic health records.

However, with multiple eMAR technology solutions currently available, LTC pharmacies must be equipped to accommodate the intricacies and nuances of a wide number of systems.  An inability to accommodate a specific technology system would essentially prohibit a pharmacy from servicing a particular facility.

The PrimeRx™ solution allows this capability.  PrimeRx™ was designed with an understanding that, within the pharmacy industry, different functions would be built using different coding and different platforms.  To address this, PrimeRx™ includes the capacity to accommodate different providers, and seamlessly integrate eMARs into PrimeRx™.

PrimeRx™ also allows pharmacies the option of creating customized eMARs, based on unique needs.

Because the use of eMARs is growing at a rapid rate, it follows that the corresponding technology is also evolving.  Micro Merchant Systems is at the forefront of these efforts, and a leader in promoting innovative solutions developed by solutions-minded technology companies.  With regard to eMAR technology, Micro Merchant Systems has partnered with several companies offering eMAR capabilities including:

PrimeRx™ seamlessly solves the eMAR integration problem, as it does multiple other challenges unique to LTC pharmacies.

A new white paper, “Using the PrimeRx™ Management System to Improve Long-Term Care Pharmacy Efficiency” highlights several of these challenges, and details the seamless ways in which technology is solving those problems.

“There are really two customers,” Randy McDonough, co-owner and director of clinical services at Iowa-based Towncrest Pharmacy told Elements. “The residents are our customers, but we’ve also got the facilities.  Ultimately we want to make sure the residents are optimizing their medications, but we’ve also got to protect the facilities.”

Helping LTC pharmacies service those two customers is all in a day’s work for high-functioning technology solutions such as PrimeRx™.  Learn more by downloading a complimentary copy of the new white paper.


A message about COVID-19

The global community is trying their best to cope with the rapidly evolving situation surrounding the spread of COVID-19. Governments are trying to quell panic while being appropriately cautious to contain the spread. Individuals are preserving their own and their families’ health by minimizing exposure. And businesses, particularly those that have logistics at the core, are struggling to find ways to mitigate damage to their bottom line and productivity. These are no doubt challenging times, and signs point to things getting worse before they get better.

As a profession, we need to observe and think deeply about what actions to take as this virus continues to spread around the globe, and how to be as helpful as we possibly can be. Here is what I came up with, as a direct result of the personal experience that I had with my own physician.

Dr. Michael Goodman, MD in Bellmore is a board certified internist who has been my physician for over 30 years. He has always been there for me and my wife, helping both of us try to achieve optimal health. Over the years, I was fortunate enough to establish a personal and professional relationship, as we both always looked for innovative ways to advance healthcare through collaboration. As two health care providers, we believed that having a Pharmacist, right in the office as a clinical partner of  the Physician, would help address the challenges in medication management that patients struggle with everyday. Delivering better adherence solutions, by utilizing cost saving and life saving resources as a medication expert in the office, can help create a new standard of patient engagement.

Today Dr. Goodman is sitting in his home, unable to deliver care, compassion and empathy to patients in his office, that always went hand in hand with his medical expertise. He is on a two week quarantine as a result of a positive COVID-19 test that he personally administered to one of his patients earlier this week.

I needed to see him yesterday when my wife experienced some flu-like symptoms that concerned me. As an asthmatic patient, over 60 years old (sorry honey, had to say that) her shortness of breath and cough was disturbing for obvious reasons. When I called Dr. Goodman, always available to his patients on his cell, I asked if I could bring her in to see him. It was at that moment , the world of healthcare as I knew it changed when he said that he was closing the office for two weeks.  This was not a time for him and his lovely wife to go on vacation or to visit with their grandchildren up in Boston, always with a covering doctor on call to handle any emergencies. This was THE OFFICE IS CLOSED.

After I hung up, I realized that the people putting their lives on the line to help patients during this coronavirus pandemic, are in fact putting themselves and their families at risk. As a patient, and as a caring Pharmacist and as a human being trying to deal with this health care crisis, I had to do something….immediately !

I called my partner Peter Bechtel, and said…”Remember that TeleHealth conversation we had a few months back to add that to our PharmD Concierge services ?…WE NEED IT TODAY !

I am not going to bore you with the dynamics or gymnastics over the past 12 hours that Peter did to accomplish, but today at 4PM we installed the first RXVIP Concierge TeleHealth platform for  Dr. Goodman so he can ‘meet’ with patients tomorrow. He now has the only telemedicine solution in the country that comes with a Pharmacist (me) in the box, making this a turnkey solution so that his practice can continue to serve his patients in what we both agree will be the “new normal” that will save lives.

I am personally reaching out to the next generation of licensed PharmDs who have entered our profession recently, plus those at the door to our great profession. We need YOUR leadership  to set the bar for social distancing and safe practices. As the youth of America, not just as future health care providers, you have the opportunity to save lives today by refraining from what comes naturally in your normal activities. There is no normal now so the responsibilities to set the ‘New Normal’ sits squarely on your shoulders.  As clinical experts, you must be following the trends that indicate much larger positive test results of testing for people not originally identified as high risk. No one knows who is carrying this deadly virus as numerous cases show that it is now showing up in patients before they show any symptoms. Please think of the impact that you can have by following the guidelines set for flattening the curve, even if it seems challenging. The end result of your ‘adherence’, a powerful word for Pharmacists, is that YOU will deliver the right drug at the right dose which will help the next generation of PharmDs reach Provider Status.

Finally, and with no political axe to grind, it just amazes me that with the leading experts in our nation coming together to deal with this horrific patient safety disaster, NO ONE has mentioned the word ‘Pharmacist’ in any guideline change or as a resource to leverage our profession for help. Now a new/old drug is coming into play plus tens of millions of Americans will struggle as a result of medication shortages on their life saving drugs, yet the value of Pharmacists to the healthcare continuum is based on the fact that CVS & Walgreens have big parking lots.
With TeleHeath guidelines being dramatically changed by CMS to allow physicians to stay engaged with their patients, and be compensated for their professional services, then there has never been or will never be a better time to allow Pharmacists to provide their medication expertise in the same fashion.

We have always advocated for provider status, and will continue to do so until our voices are heard. Now we are not advocating for the profession of pharmacy alone, but we are advocating for every person in America, who last year took over 4 BILLION prescriptions that physicians wrote. The need Pharmacists to help them manage their medication to stay alive during this pandemic wave that will crash on the healthcare system, but  also when it washes away.

My father was a community Pharmacist for over 60 years and I can assure you that he would have provided needed services in a crisis like this.  In his honor and memory, RXVIP Concierge will provide every Pharmacists with a TeleHealth solution that they can then implement and utilize with any physician practice who sees the value of what a Pharmacist delivers as a PROVIDER. There will be hundreds of telemedicine solutions hitting the market now, but you can offer the only one that comes with a Pharmacist In The Box !!

Just Call 1-844-MYRXVIP (1-844-697-9847) to get on the pathway to provider status with us.

Physicians are welcome to call as well because we can’t have doctors sitting at home (sorry Dr.G) not ‘seeing’ patients at this critical time for the health of our nation. RXVIP Concierge will make sure that those offices don’t stay closed forever.


COVID-19: An In-Depth Look at the Virus That’s Shaking the World

It’s on the news, on social media and just about everywhere. Coronavirus is striking fear and causing panic around the world as it continues to spread like wildfire killing thousands in its path and affecting thousands more.

The virus that started in Wuhan City is now a worldwide problem that everyone is scrambling to find a cure or at least prevent this deadly virus from spreading even more.

Cases and death tolls are rising at unprecedented rates and they keep growing every day. As the world continues to fight the coronavirus, let’s look back at how it all began, how it spread all over the world and what we can do to protect ourselves against it.

Wuhan: The city where it all began

 A lot of people didn’t know about Wuhan city before the coronavirus outbreak. The capital city of Hubei province with over 11 million residents, Wuhan used to be known as the “Chicago of China” for being an economic, political, cultural and financial hub. But in December 2019, the first case of pneumonia with an unknown origin was identified in the city and Wuhan has never been the same.

Chinese authorities reported a string of similar cases of pneumonia in the city and soon determined that it was caused by a novel coronavirus named SARS-CoV-2. Although coronaviruses are common in humans causing common illnesses like the cold, this novel coronavirus has not been previously identified and its origin remains unknown to this day.

Spreading at such a rapid rate, the outbreak was declared a Public Health Emergency of International Concern on January 30 and on February 11, the World Health Organization finally released an official name for the novel coronavirus: COVID-19.

WHO Director General Tedros Adhanom Ghebreyesus said of the name: “We had to find a name that did not refer to a geographical location, an animal, an individual or group of people, and which is also pronounceable and related to the disease. Having a name matters to prevent the use of other names that can be inaccurate or stigmatizing.”

The beginning of an outbreak: A timeline

After China alerted WHO of several pneumonia cases in Wuhan, the US Center for Disease Control and Prevention identified a seafood market in the city as the suspected source of the outbreak. Starting January 1, 2020, passengers from Wuhan airport were screened for flu-like symptoms and a few days after, WHO issued travel and trade restrictions in China. But that didn’t prevent the coronavirus from spreading outside the country:

  • January 7 – The first suspected coronavirus cases outside China were detected in Thailand.
  • January 9 – A 61-year old man from Wuhan who was admitted on December 27 for flu-like symptoms dies from coronavirus.
  • January 11 – A Chinese woman returning from a visit to Wuhan became the first confirmed coronavirus case in Thailand.
  • January 13 – Japan reported its first confirmed case of the virus.
  • January 15 – A 69-year old man from Wuhan became the coronavirus’ second fatality in China.
  • January 17 – China confirmed its third fatality with over 200 cases in less than a month. A Chinese passenger from Wuhan to South Korea was also detected with the virus as well as a British tourist in Thailand.
  • January 20 – The United States confirmed its first coronavirus case with a patient admitted in a hospital in Washington after his trip from China. Australia also reported its first case after a patient from Brisbane tested positive.
  • January 23 – Chinese authorities started the construction of a temporary 1000-bed capacity hospital in Wuhan’s Caidian district. There are now 830 confirmed cases in China, 85 of which are in critical condition.
  • January 24 – Canada reported its first suspected coronavirus case of a 50-year old man returning from Wuhan and a Nepali student who tested positive of the virus. There are now 1,320 confirmed cases around the world, 1297 of which are in China with a death toll of 41.
  • January 25 – Mexico reported its first confirmed case while France had three confirmed cases. China’s National Health Commission reported that there are now 15 fatalities in the country making the death toll at 56 and the reported cases at 1,975.
  • January 26 – Sri Lanka reports its first case and China confirmed 2,744 cases, half of which are from Hubei province with a death toll of 81.
  • January 27 – Germany and Cambodia reported their first coronavirus cases bringing the number to 4, 515 confirmed cases and a death toll of 107.
  • January 28 – Finland confirms its first coronavirus case while four members of a Chinese family in the UAE have been infected. There are now 5,974 cases and 132 fatalities.
  • January 29 – Russia, India and the Philippines have confirmed their first cases while Italy had two affected patients. The US CDC also reported the first person-to-person transmission in the country with the virus now affecting 7,783 people with a death toll of 170.
  • January 30 – NHS confirmed the first two cases of coronavirus in the UK while New Zealand announced its first suspected case. Infected patients now reached 9,776 with a death toll of 213, prompting the WHO to declare the outbreak as a Public Health Emergency of International Concern.
  • January 31 – Russia, Spain and Sweden reported their first cases. The virus has spread to 26 countries with 11,374 confirmed cases and a death toll of 259.
  • February 1 – The first coronavirus fatality outside China was reported in the Philippines while the number of cases soared to 14,413 with over 300 deaths.
  • February 3 – Malaysia and Belgium reported their first cases and death tolls are now at 427 with over 20,623 confirmed cases. 646 patients have fully recovered from the virus.
  • February 4 – A cruise ship named Diamond Princess that docked in Japan had ten confirmed cases including three Japanese, two Australians, three Chinese from Hong Kong, one American and a Filipino crew member. There are now 24,527 cases and 492 deaths.
  • February 6 – A Chinese doctor who tried to issue an early warning about the outbreak died from the virus while Japan reported 41 new cases from the cruise ship.
  • February 8 – There are now 813 deaths from coronavirus surpassing the 774 lives claimed by the SARS epidemic in 2002.
  • February 11 – WHO officially names the virus “COVID-19.” There are now 43,000 confirmed cases globally with 1,018 deaths.
  • February 14 – Egypt confirmed its first case with the number reaching to 67,000 and a death toll of 1,526.
  • February 18­ – There are now 75,000 infected patients around the world with the death toll reaching 2,000.
  • February 26 – There are now 82,000 confirmed coronavirus cases with 32,000 recoveries and 2,800 deaths.
  • March 1 – The total confirmed cases worldwide are now at 89,000 with 45,000 recoveries and a death toll of 3,000.


Understanding COVID-19: Everything you need to know

COVID-19 is unlike any other outbreak that we’ve seen over the last decade. Within just two months after the first case was detected in Wuhan, the coronavirus has already affected 103,950 people around the world with over 3,524 deaths as of March 7. But how exactly does COVID-19 spread and what are its signs and symptoms?

Mode of transmission

Although it came from an animal source, the virus is now capable of person-to-person transmission. The most common mode of transmission for the coronavirus is through respiratory droplets released when an infected patient coughs or sneezes and transferred to someone in close contact with that patient. Touching an infected object or surface and then touching the mouth, nose or eyes can also be a form of transmission for COVID-19.

Signs and symptoms

Patients who tested positive of the coronavirus showed three common symptoms related to severe respiratory illness—fever, cough and tiredness. In worse cases, patients reported shortness of breathing and eventually, organ failure.

Some patients were also asymptomatic even if they tested positive of COVID-19, maybe because they had stronger immune systems.

Although COVID-19 has already claimed thousands of lives around the world, a lot of those who were affected by it were also able to recover back to full health. According to studies conducted in Wuhan, more than 80% of those who died of the coronavirus were over 60 years old with 75% of these individuals having existing medical conditions like hypertension, heart disease, cancer and diabetes.

The younger population are believed to have a lower risk of contracting the disease, as evidenced by a report from the World Health Organization where only 2.4% of the 75,465 confirmed cases as of February 20 where under 18 years old.

Precautionary measures

With COVID-19 spreading across the world at an unprecedented rate, the WHO advises the public to follow these precautionary measures to prevent the virus from affecting more people:

  • Practice frequent and proper hand washing. Hand washing is still the single most important preventive measure that you can do against COVID-19. Wash your hands with soap and water as frequently as possible. If you don’t have access to water, use alcohol because it helps kill the virus that could be on your hands.
  • Keep your distance. Whenever you’re in public, be extra cautious of your surroundings and keep at least a 1 meter distance from a person who is coughing or sneezing since liquid droplet is the most common mode of transmission for the
  • Embrace proper respiratory hygiene. If you need to cough or sneeze, always cover your mouth and nose with your bent elbow or tissue and dispose the tissue immediately afterwards. Teach members of your family, friends and colleagues to do the same.
  • Avoid public places and traveling for now. Unless it’s absolutely necessary, try to avoid public places where there’s a potential risk for getting the virus. You should also delay any travel, especially to places where there’s an ongoing outbreak.

If you recently travelled to an area where there’s an ongoing COVID-19 outbreak, make sure that you stay at home and quarantine yourself if possible for the next two weeks.

If you develop any symptoms during that time, seek medical care right away. Get in touch with your healthcare provider beforehand to let him know of your recent travel and symptoms so you could be given proper instructions on how to seek care without spreading the coronavirus to the people around you.

Since there have been reported cases of domestic transmission lately, it’s also very important to seek medical care early if you feel unwell, even if you haven’t travelled to affected areas. If you have a fever, cough, cold and breathing difficulty, get in touch with your healthcare provider right away.

If you tested negative for the virus but you’re still sick, stay at home and make sure to cover your mouth and nose when coughing or sneezing. You should also disinfect objects or surfaces that you constantly touch while sick.

Treatment and vaccination

As of today, there’s still no specific antiviral treatment for COVID-19 and experts are still looking to develop a vaccine for it. So the next best thing that we can all do is to take daily preventive measures like frequent hand washing, avoiding close contact with sick people and boosting the immune system.

Moreover, if you ever feel under the weather, have yourself checked right away to make sure that you don’t have the virus. If you do, getting early medical treatment increases your chance of recovery rather than waiting too long to get treated for your symptoms.

The future with an outbreak

COVID-19 definitely came without warning and it took the world by surprise with its aggressive nature. But like many other epidemics that we’ve been through, the best thing to do is to be aware of what’s happening around us and do our share in preventing the coronavirus from spreading further.

Experts from around the world are now in search for a cure to this deadly virus. But while we wait for that day when COVID-19 will finally be a thing of the past, we should also work together in making sure that we fight this virus and take it by the horn.








Prescription Deliveries – The New Normal in Customer Service?

When CVS Pharmacy announced in mid-2018 that it had launched a nationwide prescription delivery service capable of providing next-or-second-day delivery, the news garnered significant media coverage and quite a few headlines.  And so did news from Walgreens, that came a few months later, about a new partnership with Federal Express to offer next-day prescription deliveries.  Walgreen’s new service level was to complement  the “same day” service already offered in certain markets.

Less-well-noticed though, was a release issued by the National Community Pharmacists Association (NCPA), pointing out that locally-owned pharmacies had been in the business of home delivery for years.  “According to the NCPA’s 2017 Digest, sponsored by Cardinal Health,” the release stated, “72 percent of locally-owned community pharmacies offer same-day home delivery, and 76 percent of those offer home delivery as a free service.”  The release further noted that a 2017 “flash survey” of NCPA members found 68 percent of pharmacy managers said deliveries were made in less than six hours.

“What’s all the fuss?” noted an NCPA spokesman.  “Independent pharmacies have been offering same-day home delivery – most of them at no charge to the patient – for decades.”

Since then, availability of same-day prescription delivery services has only increased.  CVS now offers same day service at 6,000 pharmacy locations across the country, with patients charged a $7.99 delivery service charge.

“Consumers continue to demand faster delivery for online orders,” CNBC noted in reporting on CVS’s same-day service.  “This is especially true with groceries that need to stay fresh and prescription drugs that customers need to take right away.  If a person is diagnosed with strep throat and fills a prescription for an antibiotic, they’re not going to wait one or two days for it to arrive.”

All this is happening, of course, as online pharmacy PillPack, owned by Amazon, threatens to disrupt traditional patient/pharmacy relationships.  PillPack offers free, monthly deliveries of regularly-prescribed medications, along with 24/7 pharmacy support.   But, as CNBC’s analysis notes, pharmacies face threats that extend beyond PillPack:  “Other start-ups are also trying to woo consumers with the ease of filling their prescriptions without ever walking into a pharmacy or standing in line.”

Patient reliance on home delivery services became especially apparent, when a new federal regulation eliminated its availability for certain diabetes testing products.

A few years ago, the NCPA  surveyed pharmacy members about home delivery practices for homebound Medicare diabetes patients.  The survey was conducted in advance of a new mandate from the Centers for Medicare and Medicaid Services (CMS) requiring Medicare beneficiaries to obtain diabetic testing supplies through an approved mail-order supplier.  This mandate effectively removed the option of having those supplies delivered by a local pharmacy.  When asked what the effects would be on their patients, 65 percent of responding pharmacists said the impact would be significant.

“We have a large elderly population and are in a rural area in Minnesota,” one pharmacist noted.  “Especially in the winter during storms, many of our customers cannot leave their homes and rely on our home delivery service.”  Another pharmacist suggested patients would “be unable to follow up in maintaining their goals,” and cited the increased risk of patients developing complications and incurring added costs.

Whatever the reason, it’s clear that patients prefer the option of having their prescriptions delivered, and increasingly expect seamless, same-day service.  For pharmacy managers wanting to meet those expectations, the concept of home delivery raises a number of issues – regulatory, logistics, operational – that must be considered and addressed.

Foremost of course, is the need to ensure deliveries are made in accordance with all state and federal requirements.  HIPAA signature requirements must be met, and precautions must be taken to ensure that only eligible medications are delivered.  Prescriptions for controlled substances, for example, are subject to both federal and state regulations.  And some plans expressly prohibit home delivery of Schedule 2 controlled substances, which include oxycodone, codeine and hydrocodone, among other substances.  In addition, pharmacies certified to process electronic prescriptions for controlled substances (that demonstrate use of a technology system approved by the DEA), must meet strict recording keeping requirements.

Then there are internal pharmacy processing requirements.  How to manage inventory levels, for example, keep track of payments, update signature logs, and maintain patient records.  A pharmacy must also ensure the efficiency of the delivery process itself, by making sure drivers’ routes are optimized, and enabling real-time communication between the driver and the pharmacy.

Which is where the choice of a pharmacy technology management system comes in.

Quite frankly, with many different technology systems to choose from, pharmacy managers will need devote a fair amount of time to identify the best system to meet their overall pharmacy needs.  In investigating current offerings, a pharmacy manager may find that certain systems may excel in workflow management, or pharmacy recordkeeping, but cannot accommodate patient-friendly services like home delivery, or online reorders.

Other technology providers, start-ups for example, tend to focus on developing solutions to address a specific category of pharmacy needs.  Solutions that target inventory management, electronic prescribing, immunization management – and home delivery – are good examples of this.

A better bet though, is to identify a comprehensive pharmacy management solution that offers a “one-stop solution” for all pharmacy needs.  The PrimeRx™ operating system, offered by Micro Merchant Systems, is one example of solution that fits this bill.

The PrimeRx™ core operating system serves as “command central” for the overall system,  and offers essential functions including prescription processing, workflow management, report generation, inventory management, automated refill management, patient record management, and patient communication capabilities.

Pharmacies can build upon these critical functions, by taking advantage of any number of software modules, designed to address specific pharmacy needs.  These software modules  seamlessly integrate with PrimeRx™ and include PrimePOS™, which ensures fast, seamless point-of-sale transactions; PrimeESC™ which allows for HIPAA-compliant electronic signature capture; PrimeRxSP™ which meets the unique needs of specialty pharmacies; PrimeDMS™ document management system; and the FillMyRefills™ automatic reordering capability.

The system enables remote deliveries through its innovative PrimeDELIVERY™ module, which allows the convenience of home delivery with all transactions wirelessly transmitted back to the core PrimeRx™ management system.  Through PrimeDELIVERY™, the pharmacy essentially goes “on the road,” by ensuring an electronic paper trail records all transactions, including critically-important HIPAA-compliant electronic signatures and privacy acknowledgements.

Pharmacies can install PrimeDELIVERY™ on any Android or IOS device, which allows a high degree of flexibility in selecting a preferred tablet or phone to accompany delivery personnel.  The delivery module is HIPAA-compliant, and interacts directly with PrimeRx™ and PrimePOS™ to manage prescription deliveries and collect and record all copays.

What differentiates PrimeDELIVERY™ from other pharmacy delivery services though, is the broad range of functionality it provides, along with its attention to detail.  For example, just as busy consumers have grown tired of waiting around to sign for product deliveries, so too have patients come to expect higher levels of convenience from their pharmacies.

PrimeDELIVERY™  addresses this need  through a new “remote signature capture” capability.  This feature allows the system to generate an advance electronic signature request, which is sent to the patient ahead of a scheduled delivery.  The patient provides a signature, which is transmitted back to the pharmacy via PrimeDELIVERY™, and integrated into the patient’s record.

By collecting the signature in advance, a delivery can be made, even if the patient is not present when the delivery person arrives.

PrimeDELIVERY™ includes other capabilities that facilitate deliveries to homes, workplaces and other preferred locations.  These capabilities include:

  • Seamless tracking of each prescription. All prescriptions set for delivery are marked as “out for delivery” in the pharmacy’s system.  Once the delivery is actually made, that notation is changed to “delivered.”  If a prescription needs to be returned to the pharmacy, the patient record will automatically be updated.
  • Inventory management. Any undelivered medications are returned to inventory, with stock levels automatically adjusted.
  • HIPAA Compliance. In addition to capturing prescription pickup signatures, PrimeDELIVERY™ captures a HIPAA acknowledgement signature, and stores that information in the patient’s record.
  • One signature for multiple prescriptions. A patient can sign once to accept multiple prescriptions.  The system also allows a patient to “uncheck” specific prescriptions they may not wish to take delivery of at that specific time.
  • Data and patient security are priorities. All data is encrypted and remains highly secure throughout the transaction.
  • Seamless integration with patient records. All remote transactions are automatically uploaded to a patient’s record.  This allows the pharmacist to accurately track patient adherence and/or medication therapy progress, while also ensuring full compliance with all record-keeping requirements.

Home delivery capability is a win-win for pharmacies and patients.  Pharmacies can meet patients expectations for convenient deliveries, while also ensuring meticulous record-keeping and full compliance with all applicable regulatory mandates.  And patients benefit from not having to schedule their day around an expected delivery.

As home delivery increasingly becomes an industry standard, pharmacy managers are looking to technology providers for solutions to facilitate the integration of this service into pharmacy operations.  And as the innovative features of PrimeDELIVERY™ demonstrate, certain technology providers are already prioritizing home delivery, and helping pharmacies stay a step ahead of patient expectations.



The American Pharmacy Purchasing Alliance is a community of pharmacy owners, pharmaceutical experts and professionals dedicated towards the recognition and advancement of the specialized industry  pharmacy, patient care & pharmaceutical purchasing. 

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