In many ways, e-prescriptions have been one of the most popular and efficient tools available in the e-health toolkit. After a physician visit (live or virtual), a patient's prescriptions can be electronically transmitted to the patient's pharmacy of choice. There is only one problem with this type of e-transaction as was highlighted in an article five years ago. Surescripts, the provider of most of such e-prescription services, holds a monopoly in this market (see: The Medical Monopoly You’ve Never Heard of). Here's a quote from March, 2014, claiming that fact:
...Surescripts, a consortium consisting of national pharmacy chains, independent pharmacies, and the big “pharmacy benefit managers” (groups like Express Scripts or Caremark) [dominates the e-prescription market]. Last year, the Surescripts network surpassed the 50% mark: half of all prescriptions are now generated electronically. It’s a big number: Surescripts reports handling 6 billion electronic transactions a year. Imagine Coke and Pepsi uniting with artisanal/local cola makers to create a single distribution and delivery system nationwide, in which they’d share proportionally in the costs and the utilization. Seems inconceivable. Yet it’s exactly what’s happened in the retail drug industry.
Five years later, there may be a day of reckoning in the future for Surescripts. The FTC has filed an antitrust suit against the company, accusing it of using illegal means to maintain monopolies over two portions of the electronic prescribing market (see: Surescripts faces U.S. antitrust lawsuit over electronic prescription monopoly). Below is an excerpt from the article:
Surescripts said in a statement that it was "disappointed" by the lawsuit and had been cooperating with the agency. The FTC accused Surescripts, which provides a range of electronic records and prescribing services to doctors, pharmacists and patients, of requiring long-term exclusivity from customers and punishing them with high prices if they bought some prescriptions from another company....,It also contacts patients' insurance companies to determine benefit eligibility. Surescripts’ illegal contracts denied customers and, ultimately, patients, the benefits of competition - including lower prices, increased output, thriving innovation, higher quality, and more customer choice....The FTC also accused Surescripts of illegally pressuring a corporate customer, Allscripts Healthcare Solutions Inc, to prevent them from taking their business to a competitor. Surescripts Chief Executive Tom Skelton said in an email statement that the company has reduced the cost of electronic prescribing by 70 percent since 2009.
So it turns out that one of the reasons that e-prescribing has been dominated by Surescripts for the past five years was that the company appears to have held a monopoly and that we, as medical consumers, may have been paying dearly for our e-prescriptions as a result. I wonder if there are any other monopolies in healthcare such as Epic or Cerner in the EHR market? I discussed this possibility in April, 2011 (see: Does Epic Exercise a Near-Monoply for EMRs in Larger U.S. Hospitals?). I suspect that, even today, the case for an EHR monopoly is less obvious than perhaps that for e-prescribing. Moreover, I think that there are going to be major upheavals in the EHR market over the next few years with Big Tech entering it (see: What Are the Consequences of Big Tech Entering the Healthcare Market?; Healthcare Will Contribute a Sizable Portion of Future Earnings for Apple).