The Secret to Fixing ePA (Electronic Prior Authorization)


The Secret to Fixing ePA (Electronic Prior Authorization)

Learn what needs to be done to improve the prescription prior authorization approval process

As one provider stated in a national survey with us, “PAs are the pits!”, a sentiment that many providers and patients share. On average the American Medical Association says providers spend 14 hours a week (more than 700 hours a year!) processing prior authorizations (PAs). And it’s more likely than not that each of us reading this has personally experienced, or knows someone who has had, a delay in accessing medications or care due to PA approvals.   

Prior authorizations in and of themselves are not to blame. At its core, PA is meant to enhance safety and support quality care while also managing inappropriate use and healthcare costs. The reason for frustration is that the process used to manage PAs is complex and broken – and providers and patients are paying the price. 

ePA on Its Own Isn’t Enough

The introduction of electronic prior authorization (ePA) was met with much excitement, and providers expected the approval process to change when it was launched. But even though ePA improved today’s processes, clearing scripts requiring PA still takes too much administrative time, leaving providers, pharmacists, and patients responsible for a mountain of administrative tasks to complete. 

This happens because the ePA solutions used today begin after a script has been written and rejected at the pharmacy. Waiting for the rejection to start the PA approval process creates a waterfall of downstream activity:

  • Pharmacies send faxes and call the provider’s office to get the PA approval started
  • Patients show up at the pharmacy only to find they can’t pick up their medication yet
  • Patients call their doctor to figure out what’s going on
  • Doctors and care teams have to manage all the faxes/phone calls while also working the PA

The secret to fixing ePA and reducing this burden is integrating ePA with real-time prescription benefit (RTPB) so scripts are clean before they get to the pharmacy.  

Clearing Scripts Faster Starts with RTPB

The best PA is an avoided PA, and RTPB is the tool to avoid as many unnecessary PAs as possible. With access to high-quality RTPB data in the prescribing window, providers can not only see what medications cost, but also which medications require PA, how complex the PA is, and what covered alternatives exist at the point of prescribing. They can confidently use this information to make clinical decisions, selecting affordable options and often switching medications to one without restrictions, avoiding upwards of 30% of PAs as we observed for one national PBM. 

When PA cannot be avoided, the second step is leveraging RTPB to automatically start the PA approval process, saving hours of administrative time and delivering a better patient and provider experience by:

  • Eliminating hundreds, even thousands, of unnecessary faxes and phone calls triggered by scripts rejected at the pharmacy by sending scripts to the pharmacy after the PA decision. 
  • Saving providers time by showing details about the question set and typical approval rates (so they can switch medications if highly unlikely to be approved), as well as automatically starting the PA process, so the first step is answering the required questions. 
  • Driving the right conversation between the patient and provider at the point-of-care to set expectations about the cost of the medication and the time it will take to resolve the PA. 
  • Keeping patients proactively informed along the way with patient status updates telling them when the PA has been submitted, received, and approved so they know when to go pick up their medication.

You Don’t Have to Settle for the Status Quo

The PA approval process is complex, but that doesn’t mean providers and patients have to settle for the status quo. Arrive Health has implemented integrated RTPB and ePA with leading health systems, and they are seeing significant value: from reduced provider burden to faster patient access to medication (<4 hours compared to the typical 3-to-4 day wait). 

Ready to learn more? Read this ePA Q&A with our COO Christie Callahan, or contact us to speak directly with our team.

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