Prior authorization is the process of exchanging patient health and medication information required to help the patient’s prescription health plan verify clinical decisions and make clinically-appropriate coverage determinations.
Many PA requests are still completed through a manual process that involves phone calls and faxes between the pharmacy, provider and health plan. This is an inefficient, time-consuming process that leads to the patient abandoning the prescription 37 percent of the time.1
Electronic prior authorization automates this process by allowing the provider to initiate the PA electronically at the point of prescribing within their E-Prescribing workflow. The most successful ePA solutions also allow the pharmacy to initiate an ePA after it has been prescribed, and allow the provider to complete a pharmacy-initiated PA electronically in their EHR or a designated ePA web portal.
The ePA process involves a four-part transaction established in the National Council for Prescription Drug Programs (NCPDP) SCRIPT Standard that enables patient and drug-specific prior authorization criteria and real-time approval process.