Technology to Help Patients and Providers: Key Findings of the ePA and RTBC National Adoption Scorecards

March 28, 2019  |  Austin Raper, Ph.D.

Article image

CoverMyMeds continues to work with an advisory board of industry experts to publish comprehensive reports on health care technology solutions, including electronic prior authorization (ePA) and real-time benefit check (RTBC). The intent of these open-access reports is to be sources of accurate and up-to-date information on their respective topics.

Recently, the 2019 ePA National Adoption Scorecard and updates to the 2018 RTBC National Adoption Scorecard were released. Stakeholders across the industry can utilize the reports to reference trends, key statistics and legislative progress (both federal and state).

Take a look at some key elements of the reports (all data is cited within the scorecards):

2019 ePA National Adoption Scorecard

As availability of ePA approaches 100 percent industry-wide, continued success of ePA depends on widespread adoption by providers. Concerted effort by all stakeholders to implement operational changes that promote awareness and utilization of ePA is critical.

Status of ePA

Eleven percent of prescription claims are rejected at the pharmacy, and, on average, 66 percent of those prescriptions require PA; furthermore, 37 percent of those prescriptions will be abandoned due to the complex paper-based process.

Impact & Adoption

Electronic prior authorization is used to complete 47.5 percent of PA requests on average. The remaining PA requests are completed by outdated phone and fax methods.

Compared to other completion channels, ePA achieves the shortest PA determination times: on average 43 percent of determinations occur immediately, 62 percent within two hours and 86 percent within one day.

Faster determination times can generally translate to higher medication dispense rates at the pharmacy. When PA requests are completed by ePA rather than fax, dispense rates at the pharmacy can be up to 80 percent higher in some cases.

A graph depicting the channel effect on determination time

EHR Availability

PROVIDERS

Electronic health record systems (EHRs) representing 89 percent of market share are committed to implementing an ePA solution. Seventy four percent currently have ePA available.

A direct-to-provider survey reveals major challenges of the PA process according to providers (e.g. time consuming, less time for patient care, etc.) as well as the major benefits of ePA to overcome these challenges (e.g. faster determination times, overall time savings, etc.).

Providers also report situations in which ePA seems limited (e.g. specialty medications, urgent PA requests, specific insurance plans, etc.) — certain ePA vendors have enabled capabilities to overcome such limitations.

Health systems represent a major opportunity for provider adoption of ePA. Centralized PA teams are effective at completing PA requests electronically at health systems with one new team improving same day ePA submissions from 31 percent to 92 percent in less than a year.

PAYERS

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

Certain payers have achieved provider adoption as high as 87 percent in some cases, relative to the 47.5 percent industry average. This was likely achieved by communicating the preferred completion channel to providers and implementing operational changes, like auto-determination.

96% - of payers are committed to implementing an ePA solution

PHARMACIES

Based on market share, 100 percent of pharmacy chains are committed to an ePA solution.

New ePA functionalities are making the PA process even easier for pharmacists by intelligently starting requests when a rejection occurs. Seventy six percent of pharmacists report that such automated ePA solutions make their job easier.

76% of pharmacists report that automated ePA solutions make their job easier.

LEGISLATION

H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, was signed into law this year and stipulates utilization of ePA for drugs covered under Medicare Part D by January 1, 2021.

2018 Real-Time Benefit Check National Adoption Scorecard Updates

On average, patients are struggling to get their medications. Lack of price transparency and rising out-of-pocket costs are leading to prescription abandonment and medication non-adherence. Real-time benefit check can help to solve these problems. In the latest scorecard updates, the value of RTBC from payer and pharmacy perspectives is evaluated, along with drivers for participation in RTBC solutions.

PAYERS

For payers, RTBC is seen as a valuable tool for positively influencing patient care and managing costs at the point of prescribing. Currently, 89 percent of payers by market share are committed to RTBC and 81 percent have RTBC solutions available.

Current percentage of the payer market, representing the majority of market share, committed to an RTBC solution.

89% Committed
81% Available

PHARMACIES

The value of RTBC to promote patient adherence and care is being recognized by pharmacies. Currently, at least 45 percent of pharmacies by market share are partnered with an RTBC solution.

If you have any questions regarding one of these reports, please email the team at epascorecard@covermymeds.com or rtbcscorecard@covermymeds.com.

Share this article on Facebook Share this article on Twitter Share this article on LinkedIn Share this article via email
Stay up to date on what's trending in health care