CVS Caremark to Pilot Electronic Prior Authorization

By Kate H. Gamble, Senior Editor

CVS Caremark is launching a pilot of a real-time, integrated electronic prior authorization (ePA) capability that will be available to CVS Caremark Pharmacy Benefit Management (PBM) clients to help improve the patient experience and speed access to prescription medications. A successful pilot would represent the first step toward the development of a technical standard that the industry could use to achieve broad adoption of ePA.

The CVS Caremark ePA pilot aims to enable prescribers that use a variety of available e-prescribing and EHR tools to coordinate a real-time ePA request when initiating a prescription for a patient. Prescribers will also have the option to access the process through a client portal. The prescriber will be able to send an ePA request detailing the coverage criteria related to a prior authorization request and receive a real-time status update regarding an approval for the medication. Requests that are denied will be communicated following manual review by clinical staff.

“CVS Caremark understands the opportunities that innovations such as electronic prior authorization provide to prescribers and patients looking to embrace a more efficient and effective way to share critical prescribing information,” said Troyen A. Brennan, MD, MPH, chief medical officer of CVS Caremark, in a statement. “The prior authorization process is currently evolving to keep pace as prescribers transition towards electronic prescribing and electronic patient records to better manage their patients' pharmacy care. This pilot is an important step toward demonstrating how the industry can integrate ePA with e-prescribing to streamline and speed up processing of prior authorizations to ensure that members have quick access to care that is medically appropriate and cost-effective.”

Surescripts is participating in the CVS Caremark-led ePA pilot to monitor and understand how what is learned can be applied to the industry. NaviNet, through its NaviNet Mobile Connect platform, will be participating in the ePA pilot as well as Allscripts. MedPlus has indicated its intent to deliver ePA functionality in a future release of their tool. Additional vendors have expressed their intent to deliver ePA functionality in future product releases upon the successful completion of this pilot.

CVS Caremark believes the ePA pilot transactions will help lead to the development of standards that will be able to be used by any e-prescribing vendor. The company intends to share both the transactions and the results from the implementation with the market and the appropriate ANSI-accredited standards organizations to help drive the adoption of ePA standards by payor and provider systems, it stated. Technical guidelines for the pilot test have been published and are available through CVS Caremark.