Electronic Prior Authorization Bill for Medicare Part D Passes in Senate

 |  Kim Diehl-Boyd

Legislative updates

CoverMyMeds is excited to report that bipartisan leadership has come to an agreement on legislation that will help combat the opioid epidemic in America. We applaud the final passage of Congress’ opioid legislation agreement, known as the SUPPORT for Patients and Communities Act (HR6), on October 4, 2018.

Contained within this legislation, in Section 6062, is the provision for the utilization of electronic prior authorization (ePA) for covered Medicare Part D drugs. This law calls for Medicare Part D plans to accept medication prior authorizations via the NCPDP SCRIPT Standard when submitted by a prescriber.

For more than a year, CoverMyMeds has been at the forefront of this effort, advocating for the passage of this bill and engaging in discussions with members of Congress to secure sponsors and cosponsors who understand the importance and benefits of ePA. CoverMyMeds is grateful to lawmakers for their support.

The utilization of ePA for Medicare Part D, and as a part of efforts to combat the opioid crisis, will help ensure that the determination process for the prescribed medication is performed in real-time. This means that ePA enables expedited efficacy determinations, so those patients with a legitimate need for the prescribed medication will be given expedited access to their prescribed therapy. This is especially important for patients who experience pain, have complex conditions or are chronically ill. For medications that have been determined not appropriate for the patient through the clinical determination process of PA, the prescriber and patient can have an informed conversation and work toward a more appropriate therapy for the diagnosis.

Electronic prior authorization notoriously speeds up the process from prescription submission to medication in hand, with providers across the board agreeing that this solution is the least burdensome channel and increases speed to therapy.1

For detailed legislation information by state, visit the ePA National Adoption Scorecard.

If you have any questions on this bill or anything related to government affairs, please reach out to Kim Diehl-Boyd at kdiehlboyd@covermymeds.com.


  1. 2018 ePA National Adoption Scorecard
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