Section 01: Status of ePA
Understanding factors that positively or negatively influence provider adoption of ePA is critical for industry-wide success of solutions as more than half of all PA volume still occurs through the phone and fax channel.2
Learn the Full Value of ePA
The Value of ePA
Helping providers see the value of an ePA solution that is accessible through centralization of PA workflows and coupling ePA to real-time benefit check (RTBC) solutions during the E-Prescribing process may encourage providers to reject the phone and fax channel in favor of ePA.
Prior authorization requests can be started at the point of prescribing (prospective) or following claim rejection (retrospective), typically at the pharmacy.
A recent case study showed that patients get their medications an average of 13.2 days sooner when requests are submitted prospectively versus retrospectively. Nevertheless, retrospective ePA volume continues to outpace prospective ePA volume, suggesting providers may not be aware of the maximal time and cost savings available through prospective ePA.3
As providers have communicated that they don’t fully trust the formulary information supplied in their EHR systems,4 PA requests are more often initiated retrospectively at the pharmacy. Emerging RTBC can supply providers with high-accuracy patient information at the point of prescribing to give visibility into if a PA will be required for a medication. Already, RTBC and ePA are being utilized as a powerful combination to save providers time while increasing speed-to-therapy.4
* Percent of total ePA volume (sum 100%) occurring as retrospective or prospective for each year.
Looking to Specialty
As prescription of specialty medications is on the rise and a top concern for providers,5 ePA must be viewed as a means to propel provider adoption, simplify the complicated specialty process and benefit patient health. It is important for the patient and healthcare IT, as an industry, to tactically execute on solutions to solve existing problems and to be deliberate in advancing future solutions.
Key Takeaway
Vision is shifting toward driving provider adoption through identifying practical challenges in ePA utilization and innovating solutions to overcome these obstacles. Utilization of the prospective PA workflow extracts the most value from electronic solutions for providers. Centralization of PA workflows by dedicated PA experts at sites of care is seen as a powerful strategy for exploiting all ePA has to offer.
