07 ― Payer Availabilty
Payer integration of ePA functionality helps to ensure all PA requests may be reviewed and determined electronically. Currently, 96% of payers are committed to an ePA solution.
For payers, ePA eliminates manual entry of faxed or phoned PA requests, enables payers to receive complete information on initial submission and can facilitate real-time determinations based on payer-specific criteria. Auto-determination functionality helps payers auto-review requests and provide real-time determinations based on preset criteria. In many cases, providers receive the outcome within moments of submission.
Indicating a payer is live with ePA does not mean all medications or plans—in the case of a PBM—use ePA functionality. The majority of payers initially activate ePA for a select number of medications or plans that they service while they work toward electronic incorporation of all criteria, which differs by plan and medication.
|Argus Health Systems|
|Envolve Pharmacy Solutions|
|Mayo Clinic Health Solutions|
|Moda Health Plan|
ePA Streamlines the Process for Payers
"We’ve had great feedback from our physicians that it [ePA] drives efficiency."
― Dr. Lynne Nowak, Express Scripts