Electronic Prior Authorization Benefits Proven, Yet Provider Adoption Lags

March 21, 2019

Most EHRs (electronic health records), health systems, payers and pharmacies have committed to electronic prior authorization (ePA), but realizing patient benefits from these platforms will rely on broader provider utilization, according to a new report.

The research, from healthcare technology company CoverMyMeds, part of McKesson Prescription Technology Solutions, is part of the organization’s 2018 Real-Time Benefit Check National Adoption Scorecard and its ePA National Adoption Scorecard.

The ePA approach allows physicians and their staffs to request approval from pharmacy benefit managers (PBMs) and health plans inside their EHRs.

The reports illustrate that CoverMyMeds captures an average of 90 percent ePA volume across the industry, while noting that widespread provider adoption will deliver even more value to patients awaiting treatment. 

The new reports reveal that when ePA and real-time benefit check solutions are implemented well and adopted by providers, they can achieve the following:

  •     Faster turnaround times: 62 percent of prior authorization (PA) requests submitted electronically receive a determination in less than two hours, compared to 0 percent of PA requests completed via the traditional phone and fax method.
  •     Improved dispense rate: Electronic prior authorization solutions can lead to an 80 percent higher dispense rate and three percent greater likelihood that patients pick up their medications due to the faster turnaround times on PA determinations, compared to PA requests completed via the traditional phone and fax method.
  •     Increased adherence: Real-time benefit check solutions that deliver at least 97 percent accuracy for prescription cost information at the point of prescribing can lead to a nearly 20 percent increase in medication adherence.

That said, there are areas for improvement, according to the research. For one, the research points out that despite there being widespread availability of ePA solutions, provider adoption lags behind, with 47.5 percent of PA requests occurring through ePA. What’s more, there is a lack of trust in the data: among a survey of 1,300 providers, the average trust factor in the accuracy of real-time benefit check solutions that rely solely on existing formulary and benefit information is only 5.7 out of 10, according to the research.

And, only recently have real-time benefit check solutions emerged that deliver patient pay details at the point of prescribing. While EHR availability is currently at 73 percent and payer availability is at 81 percent, in order for provider adoption of real-time benefit check to increase, “solutions must deliver the elements providers say are most important: cash price, patient assistance programs, PA requirements and medication alternatives,” the researchers stated.

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