Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

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96% of Payers Are Committed to Electronic Prior Authorization

Nearly the entire payer industry is committed to implementing electronic prior authorization solutions to address common issues with the approvals process.

96 percent of payers committed to electronic prior authorization

Source: Thinkstock

By Thomas Beaton

- The vast majority of payers are committed to implementing electronic prior authorization solutions as a way to address administrative problems with prior authorization procedures, according to research published through the ePA National Adoption Scorecard.

The scorecard found that the nation’s largest payers, including Aetna, Anthem, Cigna, and Humana, have committed to the use of electronic prior authorization to streamline approval procedures for providers and patients.

“Nearly the entire payer industry with leading market share is committed to electronic prior authorization and are bringing additional lines of business onto their electronic solution,” the report said.

“By doing so, payers are creating greater access for providers and decreasing turnaround time; however, there is still work to be done for each payer to get every line of business on electronic prior authorization and increase usage of auto-determination functionality.”

Payers may be able to use electronic tools to address common provider challenges associated with prior authorization burdens.

About 66 percent of prescriptions rejected at the pharmacy require prior authorization.  This equals approximately 300 million prior authorization requests. CoverMyMeds research previously found that nearly 30 percent of these prescriptions are abandoned by patients.

Thirty-one percent of surveyed physicians said they were aware when a prior authorization was needed for a prescription. Forty percent of providers cited prior authorizations for specialty medications as a major burden when prescribing medication.

The use of electronic prior authorization tools has helped the few providers that strictly use digital processing.

Providers that exclusively used an electronic prior authorization for medication requests reduced their administrative workload by 2.5 hours each week. However, only 24 percent of providers exclusively used an electronic prior authorization solution and the remaining 76 percent used multiple, complex prior authorization channels.

Authors of the report suggest that the industry will move towards optimized electronic prior authorizations as payers, providers, and pharmacies continue to adopt related technologies.

"Encouraging data discoveries from this year's report demonstrate a robust adoption of ePA as more stakeholders exclusively utilize an ePA solution,” said Perry Lewis, VP of Industry Relations at CoverMyMeds.

“I'm confident we'll see a corresponding increase in patient medication adherence and a decrease in avoidable medical spending."

Payers are looking for electronic prior authorization solutions that can easily integrate with their current technology systems, the team found.

Payers are likely to need solutions that easily integrate to avoid administrative waste, confusion between pharmacies and providers, and patient barriers for accessing necessary medications. Health plans also require solutions that have automatic determination capabilities to eliminate the need for manual review.

The findings follow an industry pledge from AHIP, BSBCA, AHA, and other healthcare leaders to improve prior authorization efficiency and reduce provider burdens.

The organizations specifically stated that implementing electronic prior authorization tools and integrating them with other technologies is critical to improve prior authorizations and real-time prescribing decisions.

“Making prior authorization requirements and other formulary information electronically accessible to health care providers at the point-of-care in electronic health records (EHRs) and pharmacy systems will improve process efficiencies, reduce time to treatment, and potentially result in fewer prior authorization requests because health care providers will have the coverage information they need when making treatment decisions,” the organizations said in a consensus statement.

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