PBM Perspective: Potential Benefits of Electronic Prior Authorization

Author(s):

Laurie Toich, Associate Editor

Electronic prior authorization can reduce time to fill for specialty drugs.

Electronic prior authorization (ePA) may be able to provide physicians with a faster, more streamlined method to ensure patients are treated with the most cost-effective and appropriate therapy, according to a press release from Express Scripts.

For most pharmacies and providers, the fax machine is still a crucial component of day-to-day business. Managing paperwork for prescription drug approval can be time-consuming and leave less time to interact with patients.

The emergence of digital technology holds numerous possibilities to improve health care and lower the administrative burden of prescription drugs.

Submitting ePAs is faster and more efficient compared with traditional faxes or phone calls, according to Express Scripts. The turn-around time for payer acceptance can also be done within minutes, whereas faxed PAs can take days, which could impact patient care and adherence to therapy.

A quick turn-around time is especially crucial for patients treated with specialty drugs who often have complex and life-threatening conditions.

Express Scripts, along with the National Council for Prescription Drug Programs and industry stakeholders, worked to develop ePA standards to ensure the submissions are secure while allowing payers to collect data needed to make a decision, according to the release.

Recently, the American Medical Association found that 75% of physicians say PAs impose a high or extremely high burden and 90% report that the process can impede access to necessary therapies.

With ePAs, a decision can be made quickly and potentially reduce the prevalence of gaps in care, according to the release.

There are a few states that already require ePAs to be used, including Minnesota, Maryland, and Ohio, Express Scripts reported.

Nearly half of PAs submitted to the PBM in November 2017 were electronic, highlighting its growing prevalence. The emergence of ePAs into the specialty market will likely be of significant benefit to pharmacists and patients.