Friday, April 10, 2015

Insights from the Electronic Prior Authorization (ePA) National Adoption Scorecard

Today’s guest post comes from Perry Lewis, VP of Industry Relations at CoverMyMeds.

Perry discusses results from CoverMyMeds’ new Electronic Prior Authorization (ePA) National Adoption Scorecard. For those who don’t know, ePA connects all participants to provide real-time information for the PA decision-making process.

Perry explains which industry sectors are adopting ePA, discusses how ePA adoption affects different industry stakeholders, and describes how to pick the best ePA solution. He provides interesting insights on healthcare’s interconnected, technology-enabled future.

To learn more about CoverMyMeds or the Electronic Prior Authorization (ePA) National Adoption Scorecard, email Perry Lewis. You can also meet up with CoverMyMeds National Sales Director, Matthew Coyle, at the 2015 Armada Specialty Pharmacy Summit. Email Matthew to arrange a meeting.

Insights from the Electronic Prior Authorization (ePA) National Adoption Scorecard
By Perry Lewis, VP Industry Relations, CoverMyMeds

Recently, CoverMyMeds®–with the guidance of industry experts from NCPDP, NASPA, Express Scripts and Cardinal Health, among others – published the inaugural ePA National Adoption Scorecard. The report highlights the state of the industry, ePA adoption rates and implementation by the industry’s largest organizations.

During the past few weeks I’ve had the opportunity to present the report at conferences and speak with industry stakeholders about what the report means for their businesses.

The following questions surface most often. I’m pleased to provide perspective on them in this post.

Q: Which sectors of the industry are successfully adopting ePA? Which are lagging, and why?

A: Pharmacies and payers lead the industry in terms of commitment to ePA and implementation. Seventy percent of pharmacies representing the majority of the market are committed, and 67% have a live solution. Payers are a close second, with 67% of PBMs and health plans representing the majority of the market committed to ePA, while 60% have a live solution.

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Electronic health record (EHR) and E-Prescribing vendors have the longest road ahead when it comes to implementation. While 54% of vendors representing the majority of the market are committed to implementing an ePA solution, only 22% have a live solution in market.

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What’s holding EHRs back?

The lag on releasing live solutions in market is related to technical implementation challenges. Integrating ePA technology requires a development effort, testing, and deployment. Depending on the ePA vendor selected, this could be a 3-6 month effort - as it is for EHRs working with CoverMyMeds – or a 12-24 month effort.

What’s the difference? It’s likely related to API availability for ePA vendors. CoverMyMeds has an open API; however, that’s not true for all ePA vendors.

Q: How will industry wide ePA adoption change the industry?

A: We anticipate the largest change will be related to prescription abandonment. Currently 40% of PA requests are abandoned due to the complex PA process.

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As ePA adoption increases and prescribers use ePA as a decision-making tool during the E-Prescribing process, fewer medications will be declined at the pharmacy, and fewer prior authorization (PA) requests will be abandoned.

This will result in patients having faster access to medications and being less likely to abandon therapy.

The other impact will be related to less administrative waste and cost for all participants. As the PA process becomes more efficient through electronic methods, the completion process will require less time and fewer resources.

Q: How does pharmacy usage of ePA impact the industry?

A: Pharmacy adoption of ePA is crucial to driving adoption as EHRs ramp up implementations. Until physicians have the ability to initiate PA requests during the E-Prescribing workflow, and adjust their behavior to proactively initiate PAs, PA requests will continue to be largely initiated “retrospectively” at the pharmacy.

Pharmacy adoption enables pharmacists to electronically kick off the PA process. Prescribers can then complete the PA electronically and send it to the plan through their EHR system, when available, or a web application.

The implementation timeline of ePA in EHR systems is why retrospective functionality is a key success indicator for ePA vendors.

Q: How can industry stakeholders select the best ePA solution for their prescriber base?

A: This is one of the most critical questions facing organizations, because ePA functionality will either drive prescriber adoption, or it will frustrate physicians and their staff. The scorecard outlines key success indicators for ePA vendors. We’ve discussed several, including: prospective and retrospective PA functionality and open APIs.

The remaining success indicators are plan compatibility and financial model.

Plan compatibility indicates how/if the vendor connects to all payers. Currently, CoverMyMeds is the only ePA vendor with 100% plan compatibility. This is typically accomplished through a direct, electronic integration with payer partners. In instances where CoverMyMeds can’t directly connect to the payer, the same, electronic experience is replicated, but the PA request is delivered via fax to the payer. This enables the prescriber to leverage an electronic process regardless of the payer, and the tool becomes a “one-stop shop” for all PA requests.

Similar functionality will be required of all ePA vendors to facilitate adoption. Otherwise, prescribers will be stuck using an electronic method for some PA requests, while reverting to the inefficient, paper process for others.

The remaining success indicator is financial model. Tools that pass costs along to the EHR vendor – and, more importantly, the prescriber – will experience slower adoption.

We’d love to hear from you.

It’s our goal for the ePA National Adoption Scorecard to be a resource for all industry participants. If you have comments or questions, please email me at, or contact our research team at

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