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CoverMyMeds recently released the Electronic Prior Authorization (ePA) National Adoption Scorecard, with the support of an advisory group comprised of leaders from the National Council for Prescription Drug Programs (NCPDP), the National Alliance of State Pharmacy Associations (NASPA) and Cardinal Health, to name a few. In this interview, CoverMyMeds’ VP of Industry Relations Perry Lewis talks with ComputerTalk’s Will Lockwood about what the report says about the state of ePA adoption, the benefits that can accrue when converting from a paper-based prior authorization process, and the impact on minimizing prescription abandonment and administrative waste.
ComputerTalk: Perry, give us some background on the scorecard. How did it come about?
Perry Lewis: The main motivation was the fact that there really wasn’t anything out there that pulls together into one document all the current information on the uptake of ePA by all the different participants in the process. There was an opportunity to explain the state of affairs both for prior authorization (PA) and for ePA. There have been some reports and some studies, but nothing that delivered the complete package. We wanted to provide a tool for all channels to reference to see where they are in the process of converting to ePA.
CT: The scorecard breaks down these channels into three groups: EHR vendors, payers, and pharmacy. Where are each of these groups in the process of adopting ePA?
Lewis: I’ll start with the pharmacy segment channel first, because pharmacy, by far, is leading the adoption process and is the strongest component of adoption with ePA. Over 70 percent are committed to ePA, and almost 70 percent are live. We give a lot of credit to the system vendors out there that have worked hard to implement the ePA standards that are available. The scorecard has a list of some of the pharmacies that are live today. It’s worth noting that there are often different versions of pharmacy management system products out there, and some of these — the more recent versions — will be live and older versions will not be. This is true with EHR vendors, too. There are so many different versions of software systems out there.
CT: OK. What about the other two channels?
Lewis: Among EHR vendors, 54 percent are committed, and 22 percent are live. They’re lagging behind, and I think a lot of this has to do with the fact that they have so many other requirements out there right now, especially because of meaningful use. I think it’s a matter of priorities for them. But, over the next year or so I believe we’ll see this channel bringing that implementation level up quite a bit.
Then there are the payers, which the scorecard shows as 67 percent committed and 60 percent live. We’re working diligently with the health plans and the prescription benefit managers (PBMs) on this. It really depends on who’s in control of implementing. This is a segment that we think will also show some great improvement within the next year or so. As a recap, pharmacies and their system vendors are leading the pack when it comes to implementing standards for ePA, but we anticipate EHR vendor and payer adoption rates to steadily increase.
CT: You have the engagement level for each of the groups broken down into three levels: committed, available, and live. Certainly, if you look at committed and available, it seems like you’re really getting to that tipping point. How important is it to have all three of these segments push up that live metric?
Lewis: It’s very important. Right now, physicians mostly don’t know when they’re writing a prescription whether it needs a prior authorization or not. The patient finds that out when they go to the pharmacy. At that point, the pharmacies, because they’ve done so well implementing the standards, can often simply hit a button in their systems to prepopulate the prior authorization form for that drug. But to really see the benefit of ePA we will need to see true connectivity in all three segments. And that will mean that the physician and the health plan can send back what we call a four-part transaction.
CT: Break down that transaction for us.
Lewis: At the time of prescribing, doctors will be alerted that the prescription needs a PA and will report this to the payer. The plan will reply with a set of questions for the prescriber to answer. The physician’s answers then go back to the plan, which responds with an approval or denial. That’s all done electronically and is what we call a prospective ePA. This is compared to the retrospective PA, which may be electronic or not and does not happen until after a pharmacy submits a request and once the prescription has already been rejected by the payer. We’ll see, over the next year or so, the level of these retrospective PAs leveling off and a move toward more prospective ePAs.
CT: So the PA process will become something that happens at the time of prescribing, rather than at the pharmacy, and what’s written will be an authorized medication?
Lewis: Exactly. We see that paradigm really shifting once all these channels are implemented, especially once the number of live EHRs really ramps up.
CT: What’s on the to-do list to over the next year or so to get ePA really rolling?
Lewis: I think there are a couple of things that we’re seeing move the needle here. One is state legislative initiative. We’re seeing that there has been some proposed language that would implement a universal prior authorization form. We’re not opposed to that, but there’s the risk that a universal form won’t address all the questions you need to ask when there’s additional information needed on the patient. For example, lab work and drug specific information that may be required. We would prefer to see language that supports sending ePAs using national standards. We want to ensure that what’s going on throughout the states will protect the opportunity for ePAs.
We are also working with our channel partners — the EHR vendors and the payers specifically — on implementing the standards and the API quickly. We believe that abandonment of prescriptions is still rather high, and we’re hoping that with implementation we’ll see the tide turn here. We’re hoping that over the next year or so, our scorecard will be stating that ePAs can have an impact on decreasing prescription abandonment.
CT: Can you expand on how ePAs will reduce abandonment?
Lewis: Sure. One major reason is that they streamline the process and result in a prescription that pharmacists can dispense immediately, without having to take extra time. In the past, when a pharmacist had a prescription rejected because of a PA, they’ve either had to call the plan or the physician. That process can take 15 to 20 minutes and then possibly three to five days to get the approval or denial back. Retrospective ePA streamlines that considerably. If a prescription’s denied at the time of dispensing, ePA from the pharmacy cuts that 15 to 20 minutes down to three to five minutes for the authorization request to be submitted. It also reduces the time to get a response to two to four days. The patient gets on their medication a lot faster, and that’s ultimately the goal that we believe that the physicians, the health plans, and the pharmacies all want.
CT: What’s really critical then is making prior authorization occur within the workflow as smoothly as possible, right?
Lewis: We believe so. It really is important that this process doesn’t take pharmacists out of their workflow. Typically, they’ve had to make a call and then also do the follow-up by phone. ePA streamlines that process so that it happens while they’re working. Even if there is a delay that causes the response to be five days instead of two days, it’s still part of their workflow. That’s what we’re hearing has been a major plus for those pharmacies that are participating. CT