Ease and Efficiency with Electronic Prior Authorizations

Jan 3, 2018
Electronic prior authorization gives physicians a faster, easier and more efficient method to ensure patients are prescribed the most cost-effective and clinically appropriate medications.

New Pills

Fax machines have been disappearing from businesses and homes, but they’re still a fixture in many medical offices. Managing the resulting paperwork can be inefficient and time-consuming – a hurdle to good health rather than a facilitator.

With electronic prior authorizations (ePA), however, Express Scripts is making great strides to ensure proper prescription utilization while reducing administrative hassles for prescribers. Submitting PAs electronically is not only faster and more efficient than faxes or phone calls, but the turn-around time for a decision is usually seconds to minutes rather than the days it might take for a decision with a faxed PA. Electronic PAs can be done through two easy routes: a free and secure, online portal or through the physician’s existing Electronic Health Record (EHR).

Express Scripts has worked with the National Council for Prescription Drug Programs (NCPDP) and other industry stakeholders to develop Electronic Prior Authorization (ePA) standards that ensure secure transmission while allowing plan sponsors to collect the data they need to make a claim decision.

Physicians spoke

Prior Authorization is a process that ensures patients are prescribed the most cost-effective and clinically appropriate medications. While PAs are an important component of benefit designs, physicians’ offices may feel overwhelmed by the submission process.

Physicians Practice, a practice management company, and HIMSS Media, a media organization serving the healthcare industry, asked more than 300 health care professionals a simple question: “What is your biggest pain point associated with pharmacy Prior Authorizations?” More than half had an equally simple answer: time.

“Length of time staff spends on [the] phone, keeping them from patient care,” one respondent said. “The slowness, the redundancy …the lack of a clear, simple, transparent process,” said another.

The American Medical Association has reported that 75% of physicians say the burden associated with prior authorization is “high” or “extremely high,” and 90% say the PA process can delay access to necessary care. Physician offices spend an average of 16.4 hours each week completing PA requests for medications, medical services, or procedures.

Express Scripts delivers

We understand this pain point and have a solution that streamlines the physician’s experience. Electronic Prior Authorization can be completed in minutes and then submitted for a decision which often comes back in seconds. Patients get their medications more quickly, reducing gaps in care. In addition, plan sponsors can implement more complex PA requirements without increasing provider’s administrative workload.

While Express Scripts is the industry leader in driving change in PA submission, many state legislative bodies have also recognized the necessity and importance of driving health care in the direction of a more connected landscape. ePA is mandatory in Minnesota and Maryland. In Ohio, Governor John Kasich signed Senate Bill 129 into law, mandating ePA by January 1, 2018.

Growing trends

Over the past two and a half years Express Scripts has seen tremendous growth of PAs coming through the electronic channel, with over half coming in electronically in November 2017.

For those physicians who do use ePA, the benefits are apparent:

“It allows us to focus our time and energies to other areas of the practice that also require a great deal of time,” one physician said.

“It decreases miscommunications between staff, patients, insurance companies, and physicians,” added another.

This short video explains the benefits, ease and speed achieved when physicians use ePA. We encourage all plan sponsors to share the link and get the word out to drive more efficiency within their physician networks.

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