01 ― About ePA
The industry continues to take note of the importance of an electronic prior authorization (ePA) solution and how it benefits all stakeholders. More states are adopting ePA language, more legislation is being proposed and electronic health record (EHR) systems are moving the needle forward on enabling PA.
While the market continues to grow and evolve, a natural focus is beginning to shift to more strategic and granular approaches to ePA to meet market need; for example, how can ePA be of use for specialty medications?
What other technology solutions are there to solve problems such as real-time prescription benefit check during the E-Prescribing process? It is important for the patient and health care IT, as an industry, to tactically execute on solutions to solve existing problems, and to be deliberate in advancing future solutions.
Electronic prior authorization is the automated process of exchanging patient health and medication information required to help the patient’s prescription coverage plan make a coverage determination.
Today, many prior authorization requests are 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 36% of the time.1
Electronic prior authorization automates this process by allowing the provider to initiate the ePA prospectively within their E-Prescribing workflow. The most successful ePA strategies also connect the pharmacy to initiate an ePA that was missed at the point of prescribing, 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 (PA) criteria and a real-time approval process.