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ARLINGTON, Va. — Surescripts is expanding its electronic prior authorization (ePA) service for e-prescribing with four national pharmacy benefit managers (PBMs), including CVS/caremark and Express Scripts, and six health technology vendors.
The health information network said Tuesday that through these connections and others already in place, prescribers nationwide will be able to submit ePA requests for 70% of patients, representing 210 million lives covered by the nation’s largest PBMs, and realize significant time and cost savings during the e-prescribing process.
The expanded ePA service includes health tech vendors Aprima Medical Software, DAW Systems-ScriptSure, digiChart, First Databank’s FDB MedsTracker, OA Systems and Stratus EMR.
"There is so much opportunity for clinicians to leverage data to improve health care, but more often than not, critical information exists on paper and in silos," commented Tom Skelton, chief executive officer of Surescripts. "By connecting our health care system with solutions like ePA, we can make health care 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, doctors claim that prior authorization takes up more time than any other interaction with health plans, at an average of eight hours per physician per week. Of all prior authorization requests, 90% require a phone call or a 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.
"Electronic prior authorization is yet another enhancement that helps physicians and health care payors improve the quality and affordability of patient care," stated Glen Stettin, senior vice president for clinical, research and new solutions at Express Scripts.
Surescripts noted that ePA replaces an inefficient process that relies on forms, faxes and phone calls to gather information, process prescriber requests and review prescription coverage.
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 easier and faster than manual prior authorization.
"Providing patients timely access to the right medication is a priority in driving better patient medication adherence," according to Troy Brennan, chief medical officer for 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."
Surescripts’ end-to-end ePA solution, CompletEPA, integrates with a physician’s EHR workflow to enable 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.
The company pointed out that CompletEPA aligns with the needs of the medical community and can save EHR users and PBMs time and resources by allowing them to obtain PA approvals before sending prescriptions to the pharmacy, along with the flexibility to support retrospective processing.
