Prior authorization provides us an important and effective tool to improve safety and reduce costs. But at the same time, prescribers and members alike find the paper process cumbersome. The forms, faxes and phone calls can create delays in approval that drive delivery delays for medicines.
- More than half of prescribers report that they, or their staff, spend over 20 hours a week on PAs.1
- Pharmacists say they spend an average of five hours each week on PAs.1
All that time spent dealing with paperwork equals money – in excess of 31 billion dollars each year1 — and takes valuable time away from patients. Despite this challenge, PA volume continues to grow at the rate of about 20 percent a year.1
Electronic prior authorizations streamline the process
Enter electronic PAs. ePAs aren’t a phase. They’re a vital part of safely and effectively managing any prior authorization program. They use real-time data to help doctors and insurers reach a decision on the best medicine quickly. ePA reduces PA turnaround time up to 90 percent.2
Everyone in the decision-making process can benefit:
- Doctors spend less time on administration and receive fewer callbacks.
- Pharmacy benefit managers and health plans can reduce administrative overhead reviewing PA requests. The system automatically finds recommendations based on plan-specific criteria
- Your employees get the medicine they need without delays or wasted trips to the pharmacy.
Connectivity – a critical step to adoption
Both industry and government are making progress on adoption of ePA. Fourteen states already have passed or proposed legislation mandating doctors and health plans support ePA.1
But for ePA to truly become viable, it has to be integrated with electronic medical records (EMR) as part of the entire clinical workflow – from prescriber to payer to pharmacy.
Right now, less than half of health insurers support ePA, and an even smaller percentage of prescribers do so.1 Pharmacies are ahead of the curve as they look for as many ways as possible to avoid claim rejections.
Prime is working to boost ePA adoption among prescribers. The technology integrates plan data with pharmacy systems and EMR data. This lets doctors see if a medicine requires PA before the patient leaves the office.
Targeted outreach to doctors focuses on education. ePA makes the doctors’ job easier and helps get their patients effective treatment, faster.
Prior authorizations are an important lever in keeping medicine safe and affordable. Improving the PA process is a key factor in reducing prescription abandonment, improving outcomes and saving money for everyone.
1. CoverMyMeds. (2015). ePA national adoption scorecard. Retrieved from author website: https://epascorecard.covermymeds.com