Policy and Regulation News

Pros and Cons of Electronic Prior Authorizations, Prescribing

New data, insights point to pros and cons in electronic prior authorizations and prescribing adoption.

Electronic prior authorizations, e-prescribing

Source: Thinkstock

By Kelsey Waddill

- A new rule from CMS calls for electronic prior authorization (ePA) updates, aiming to improve prescribers’ decision-making processes, ease administrative burden, and decrease the wait time for patients to receive prior authorization for a drug.

The proposed rule would require that all Medicare Part D plans be equipped with the National Council for Prescription Drug Plans (NCPDP) SCRIPT standard.

Under the proposed rule, prescriptions would be requested through an electronic prescribing (eRx) system or an eRx-enabled EHR. The system would notify prescribers of prior authorization (PA) requirements and direct the provider to fill out the necessary information for an electronic PA (ePA). The provider would then receive real-time feedback as to whether the request was approved.

Evidence shows that healthcare professionals are ready to use e-prescribing tools and find them useful.

A study by the Office of the National Coordinator for Health Information Technology showed that between 2008 and 2014, the amount of physicians in the US who used e-prescribing tools jumped from seven percent to 70 percent.

Ninety-six percent of community pharmacies in 2014 were able to accept e-prescriptions. In some states, 99 percent of pharmacies were e-prescription-enabled. By 2013, 57 percent of all new and renewal prescriptions were fulfilled electronically.

New Surescripts data about their e-prescribing platform also bodes well for the nation’s transition.

After implementing the ePA system a large Wisconsin-based healthcare system, Surescripts reported that it saw wait times drop by approximately two-thirds, with the overall time frame—from initiating the ePA request to order fulfillment—declining ten minutes from 22 to 12 active minutes.

The ePA process saved healthcare facilities more money by causing clinicians’ overtime costs to decrease by 20 percent.

The electronic system also proved to have both short-term and long-term effects as physicians saw improvements in first-fill medication adherence over time. When the health system introduced an ePA process, patients were eight percent more likely to refill their medication when it depleted.

“By removing the administrative burden from prior authorizations in real time at the point of care, we’re helping ensure that patients take home the right medication the first time, and adhere to their treatment,” Tom Skelton, Chief Executive Officer of Surescripts said.

However, despite these advances, Florida’s House of Representatives described a couple of issues that transitioning from manual to electronic systems can pose in their recent bill on e-prescription.

Although electronic systems would reduce eligibility errors and can help prevent dosage errors and misinformation, they cannot eliminate human error altogether. E-prescribing would not solve provider burnout, which is cited as the primary reason for adverse drug events (ADEs). Fatigued or overloaded physicians and nurses are more prone to writing down an incorrect dosage, drug name, or other detail. Even an electronic system cannot entirely prevent a physician from entering the wrong information.

Design and interface may become an impediment in some scenarios. For some e-prescription systems, for example, the alerts are not noticeable enough. Others send so many alerts that the prescriber becomes overwhelmed and less sensitive to them. When a physician faces issues such as these, faulty dropdown boxes and automatic entries, or presets such as bundled payments or automatic submission times, it can lead to the prescriber expending more time to edit the document manually.

Despite these potential issues, Florida passed the bill and will require a fully electronic prescription system by 2020, joining fifteen states to mandate e-prescribing since Congress ruled that certain drugs under Medicare Part D must be e-prescribed. These laws apply to all transactions, not solely prior authorizations. Florida will be a state to watch as the effectiveness of transitioning entirely from manual to electronic systems becomes clear.