2019 ePA National Adoption Scorecard

In this fifth installment of the Electronic Prior Authorization (ePA) National Adoption Scorecard for healthcare stakeholders, the focus of previous years shifts from ePA availability to understanding factors that positively and negatively impact provider adoption of ePA.

Education on time and cost savings available through optimal utilization of ePA will encourage provider adoption. Beyond provider outreach, healthcare stakeholders should continue to update current processes to limit the use of outdated prior authorization (PA) channels (i.e. phone and fax) and help achieve provider adoption across the board.

As health systems continue to grow at a rapid pace, ensuring an ePA solution is readily available will not only help reduce provider burden but could also benefit patient health. Data shows that adoption of ePA through EHR systems and health systems correlates with a decrease in time to therapy and an increase in patient medication adherence.1

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About ePA

Prior authorization is the process of exchanging patient health and medication information required to help the patient’s prescription health plan verify clinical decisions and make clinically-appropriate coverage determinations.

Many PA requests are still completed through a manual process that involves phone calls and faxes between the pharmacy, provider and health plan. This is an inefficient, time-consuming process that leads to the patient abandoning the prescription 37 percent of the time.1

Electronic prior authorization automates this process by allowing the provider to initiate the PA electronically at the point of prescribing within their E-Prescribing workflow. The most successful ePA solutions also allow the pharmacy to initiate an ePA after it has been prescribed, and allow the provider to complete a pharmacy-initiated PA electronically in their EHR or a designated ePA web portal.

The ePA process involves a four-part transaction established in the National Council for Prescription Drug Programs (NCPDP) SCRIPT Standard that enables patient and drug-specific prior authorization criteria and real-time approval process.

Infographic depicting the ePA process