Implementation of electronic prior authorization (ePA) solutions is increasing, as more states are adopting ePA language, more legislation is being proposed and electronic health record (EHR) systems are moving the needle forward on enabling solutions, according to CoverMyMeds' 2018 ePA National Adoption Scorecard.
Electronic prior authorization is the automated process of exchanging patient health and medication information required to help the patient's prescription coverage plan make a coverage determination, according to the report.
"The most successful ePA strategies also connect the pharmacy to initiate an ePA that was missed at the point of prescribing, and allow the provider to complete a pharmacy-initiated PA electronically in their EHR or a designated ePA web portal," the authors write.
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Key metrics and takeaways from the report include:
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Sixty-six percent of prescriptions rejected at the pharmacy require PA (this equals approximately 300 million PA requests). Of those, 36 percent are abandoned each year.
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Only 31 percent of physicians reported knowing if a PA was required while prescribing a medication.
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Forty percent of providers cite PA around specialty medications as the main pain point when prescribing medication.
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On average, providers who exclusively use an electronic method for PA requests report spending 2.5 fewer hours on PA each week. However, few providers reported exclusively using an ePA solution, with 76 percent reportedly using more than one channel to complete PA requests.
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In January, H.R. 4841, the Standardizing Electronic Prior Authorization for Safe Prescribing Act, was introduced in the U.S. Congress. This bipartisan bill is designed to drive ePA usage in the Medicare Part D Program, improving prescription access for Medicare beneficiaries.
"While the market continues to grow and evolve, a natural focus is beginning to shift to more strategic and granular approaches to ePA to meet market need," the authors write. "For example, how can ePA be of use for specialty medications? What other technology solutions are there to solve problems such as real-time prescription benefit (RTPB) check during the E-Prescribing process?"
"It is important for the patient and health care IT, as an industry, to tactically execute on solutions to solve existing problems, and to be deliberate in advancing future solutions," they write.
The National Council for Prescription Drug Programs is in the process of developing RTPB standards, which can be utilized using either the Telecom or SCRIPT model, according to the report. There are several solutions currently available to the market, and similar to ePA, the success of RTPB solutions will be based on provider adoption.
"Ease of access to the provider is key; however, more critical will be delivering information in the RTPB transaction that reflects the data providers and their patients need to make informed clinical decisions," the authors write.
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Katie Kuehner-Hebert
Katie Kuehner-Hebert is a freelance writer based in Running Springs, Calif. She has more than three decades of journalism experience, with particular expertise in employee benefits and other human resource topics.
