Electronic Health Reporter

Surescripts, the nation’s largest health information network, is expanding its electronic prior authorization (ePA) service for e-prescribing with four nationwide pharmacy benefit managers (PBMs), including CVS/caremark and Express Scripts, as well as six health technology vendors, Aprima Medical Software, DAW SYSTEMS – SCRIPTSURE, digiChart, First Databank, Inc.’s FDB MedsTracker, OA Systems, and Stratus EMR.  Through these connections and others already in place, prescribers nationwide will be able to submit ePA requests for 70 percent of patients, representing 210 million lives covered by the nation’s largest PBMs, and realize significant time and cost savings during the electronic prescribing process.

“There is so much opportunity for clinicians to leverage data to improve healthcare, but more often than not, critical information exists on paper and in silos,” said Tom Skelton, Chief Executive Officer of Surescripts.  “By connecting our healthcare system with solutions like ePA, we can make healthcare more efficient and easier to manage and ensure that care providers have a more complete picture of a patient’s health.”

According to a recent report in Health Affairs, physicians claim prior authorization takes up more time than any other interaction with health plans at an average of eight hours per physician per week.  Ninety percent of all prior authorization requests require a phone call or fax, and time spent completing these requests can add up to a cost of $2,000 to $14,000 per physician each year.  Manual prior authorization typically takes one to two days to complete and is frustrating for all parties involved.

“Electronic prior authorization is yet another enhancement that helps physicians and healthcare payors improve the quality and affordability of patient care,” said Glen Stettin, M.D., Senior Vice President, Clinical, Research and New Solutions at Express Scripts.

Electronic prior authorization (ePA) replaces an inefficient process that relies on forms, faxes and phone calls to collect information, process prescriber requests, and review prescription coverage.  Surescripts CompletEPA™ is the leading end-to-end ePA solution integrated into a physician’s EHR workflow that enables real-time information exchange between providers and PBMs.  CompletEPA utilizes recently established industry standards for ePA from the National Council for Prescription Drug Programs (NCPDP) and leverages Surescripts eligibility and formulary data to proactively notify providers of prior authorization requirements within the e-prescribing workflow.

“Prior authorization has long been an inefficient and cumbersome process for physicians,” said Dewey Howell, MD, PhD, Vice President of Clinical Applications at FDB.  “Electronic prior authorization that is designed to be streamlined within the prescriber’s normal workflow offers undeniable advantages to patients and the industry as a whole.  It is an important standard for realizing the full benefits of electronic prescribing.”

CompletEPA aligns with the needs of the medical community and can save EHR users and PBMs valuable time and resources by allowing them to obtain PA approvals prior to sending prescriptions to the pharmacy along with the flexibility to support retrospective processing.  For EHR vendors, connecting to Surescripts CompletEPA is a differentiating capability, adding value for physicians by simplifying the administrative burden of prior authorizations.  According to NCPDP, ePA is the most desired e-prescribing capability among providers.

“We hear every day how prior authorizations are a point of frustration for our users,” said Neil Simon, Chief Operating Officer of Aprima.  “Because CompletEPA is integrated directly into their Aprima EHR system, the authorization process is dramatically simplified, turning it from a dreaded, time-consuming task, to one that can be completed with a few clicks of a mouse or taps on the screen.”

Integrated within the EHR workflow, CompletEPA proactively informs prescribers of medications requiring PA, asks only the needed questions, and the approval status may be known before the patient leaves the office.  Direct access to PBM data allows CompletEPA to pre-populate patient information based on pharmacy plans, improving accuracy and drastically speeding up the communication process to provide quick, cost effective access to care and increase customer satisfaction.

During a two-year pilot, providers were able to process prior authorizations with CVS/caremark within the e-prescribing workflow in less than five minutes, making it much easier and faster than manual prior authorization.

“Providing patients timely access to the right medication is a priority in driving better patient medication adherence,” said Troyen A. Brennan M.D., M.P.H., Chief Medical Officer of CVS Health.  “Transitioning to an electronic PA process enables us to communicate more efficiently with prescribers through their EHRs in order to get patients quickly started on medically appropriate and cost-effective therapy.”