Key Elements in the 2018 ePA National Adoption Scorecard

February 19, 2018  |  Jessica Behrendsen

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Each year, CoverMyMeds and an advisory board of industry experts publish the ePA National Adoption Scorecard, which quantifies the state of electronic prior authorization (ePA) in the industry.

This year, in addition to new data elements and ePA updates, the scorecard includes educational sections around real-time prescription benefit (RTPB) and electronic solutions for specialty medications as the industry moves toward finding and improving ways to help patients get the medications they need more quickly. We encourage you to check the scorecard throughout the year for relevant updates to these elements, as we will post them as information becomes available.

Additionally, the scorecard continues to be the best place to get accurate and up-to-date information on individual state mandates around prior authorization (PA) and any federal movement.

We pulled out a few key elements to help understand what the report contains, and narrow down what would be relevant by stakeholder (all data is cited within the scorecard):

ePA

Approximately 10 percent of prescription claims are rejected at the pharmacy, and 66 percent of those prescriptions require PA. Of those, 36 percent are abandoned each year.

Providers

Electronic health record systems (EHRs) representing 79 percent of market share are committed to implementing an electronic prior authorization (ePA) solution. Seventy percent currently have ePA available.

Only 31 percent of physicians reported knowing if a PA was required while prescribing a medication.

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 of reportedly using more than one channel to complete PA requests.

Payers

Nearly the entire payer industry (96 percent) is committed to implementing an ePA solution, and 90 percent currently have ePA available.

Pharmacies

Based on market share, one hundred percent of pharmacy chains are committed to an ePA solution.

Legislation

In January 2018, 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 move the needle on ePA usage in the Medicare Part D Program, improving prescription access for Medicare beneficiaries.

A recent study indicated specialty drugs account for nearly 33 percent of the total Medicaid drug spend, despite only 0.9 percent of the nearly 75 million Medicaid patients utilizing specialty medications.

Specialty medications account for 33 percent of total Medicaid drug spend. Non-adherence to specialty medications can create an even costlier burden, further proving the importance of ePA adoption for Medicaid.

If you have any questions regarding the latest edition of the scorecard, please reach out to VP of Industry Relations, Perry Lewis at plewis@covermymeds.com.

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