Approximately 11 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.6
Such prescription abandonment increases the risk of future health problems or hospitalization for the patient. The utilization of an electronic solution may increase patient medication adherence by helping to ensure patients leave the pharmacy with prescription in hand.
Not only can accelerated turnaround times on ePA determinations affect dispense rates at the pharmacy, the improved patient perception of access to medications can translate to a 3 percent greater likelihood that patients will pick up their prescriptions from the pharmacy9 — of the 4.5 billion prescriptions filled per year,10 this equates to nearly 30 million more patients getting their medication when a PA is required. As more providers begin to adopt ePA, more patients may adhere to their medications.
66% - Time consuming
48% - Takes away from patient care
38% - Lack of answers to form questions
31% - Lack of insurance information
27% – Cannot find the correct PA form
70% – Faster determinations
69% - Time savings
65% - Ease of use
54% - Organization of PA requests
* Percentages reflect those who selected these individual options.
Despite availability of ePA and its demonstrated efficacy to save time and money, research shows that providers use the burdensome phone and fax channel more than 50 percent of the time to complete PA requests.2
A recent direct-to-provider survey shines light on why providers are not using ePA more often.11
Among approximately 1500 surveyed providers currently using ePA, more than half reported occasionally using non-electronic methods (i.e. phone and fax) to complete PA requests for certain situations, including:
|Specialty Medications||Some providers are not aware of ePA as a solution for specialty medication PA requests.||Electronic prior authorization is already available and being utilized by providers for many specialty medications.|
|Urgent Requests||Even though phone calls with payers can take significant time, providers perceive they can get a determination more quickly (i.e. by the end of the call).||As an industry, we know this is not the case as most ePA request are made instantly with little or no wait time for an outcome.|
|Specific Insurance Plans||Some payers may not have all lines of business available for ePA functionality; ePA is not available for specific plans (e.g. Medicaid and Medicare Part D)||Leading ePA vendors have all payer capabilities such that providers can quickly find, complete and submit PA forms for any insurance plan electronically via a web portal.|
|Extenuating Circumstances||For difficult cases, providers feel limited by electronic forms and perceive a phone call as easier for explaining complicated patient scenarios.||Leading ePA vendors have functionalities that allow for document attachment (e.g. patient history, lab results, etc.) and dynamic fields that simplify the PA process as much as possible for any situation.|
Communicating the value of ePA to providers is critical for driving adoption and success. The ability of ePA to save time and administrative costs as well as contribute to positive patient outcomes through reduction in time to therapy must be continually expressed. Understanding factors that promote or limit providers from engaging with ePA solutions is important for overcoming limitations of the technology and crafting new outreach strategies to influence provider adoption.