Preparing for the New Year with Electronic Prior Authorization

Dec 8, 2015
In preparation for January, Express Scripts continues to improve Electronic Prior Authorization (ePA), connecting with physicians to improve patient care.
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  • Commercial

Earlier this year, Express Scripts launched multiple electronic prior authorization (ePA) tools to improve the patient, physician and client experience. These tools aim to streamline the Prior Authorization (PA) process by replacing existing fax and phone exchanges with an electronic method, which is the preference for 75% of physicians. ePA can reduce the time it takes to complete a PA request from days to minutes, and eliminates any back and forth between the prescriber and Express Scripts for additional information or questions.

Since May 2015, the number of prescribers using ePA has increased an average of 11% every month, to 23,000 in October. Express Scripts is now processing over 10% of our total PA volume through the electronic channel.

The new ePA system helps physicians prepare for January, when the number of PA requests increases dramatically. Annual plan design changes usually take effect in the New Year, triggering prior authorization renewals and an increased administrative burden on offices. ePA can make this transition more efficient and less time consuming for both the prescriber and the patient.

By utilizing ePA tools, physicians can receive approvals in real-time if the criteria is met. The prescriber can also check the status online at any time. This improved efficiency minimizes gaps in patient care and decreases patient frustration while waiting on a prescription to be filled.

Benefits

  • More efficient than phone/fax process in place today
  • Real-time approval in many cases
  • Faster approval minimizes gaps in patient care
  • Decrease administrative work for prescriber office
  • Decreased patient frustration while waiting on a prescription to be filled
  • Prescriber can check status online anytime
  • Improves turnaround time for clients, patients and physicians

ePA Tools

Working collaboratively with a variety of vendors, Express Scripts streamlines the process of prior authorization by seamlessly integrating within a physician’s electronic health record (EHR) vendor’s ePrescribing tool or through web-based portals:

  • ExpressPAth®: This proprietary online provider solution portal offers real-time information about coverage and clinical rules to encourage optimal prescribing decisions. ExpressPAth ensures that every dollar spent is appropriate for the patient’s treatment, and it can seamlessly manage claims under both the pharmacy and medical benefit.
  • Surescripts®: Integrated within EHRs, as well as connected to PBMs and pharmacies, Surescripts works to ensure that healthcare providers have the most efficient process and the most complete picture of a patient’s health.
  • CoverMyMeds®: Advancing the coverage review process, CoverMyMeds’ electronic prior authorization technology integrates with pharmacy systems, EHRs and PBMs to accelerate patient access to their medication.
  • AllscriptsTM: Leveraging point-of-care prior authorization for prescriptions, Allscripts works to improve efficiencies, foster adherence and reduce costs.

As the industry changes, Express Scripts continues to evolve and innovate with ways to connect with physicians to improve patient care. And, the time they save with ePA can translate into more time seeing patients in the New Year.

To learn more, physician offices should visit www.express-scripts.com/PA.

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