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Electronic Prior Authorization or ePA

Electronic Prior Authorization or ePA

Electronic Prior Authorization ePAPharmacy has historically embraced technology far faster than any other medical profession. The early use of technology by pharmacies has been documented in numerous instances and has labeled pharmacists and the entire profession as “early adapters”. Nowhere else has such swift adaptation to computerization and HIT (Health Information Technology) been seen when one looks at healthcare. Understanding all of the new technology and its uses though has created an environment that is constantly changing and therefore extremely challenging to keep up with.

The evolution and change seen in HIT has basically resulted in technological tools and systems that have revolutionized the way in which drugs are prescribed and dispensed. Paper prescription records, phone calls and fax transmissions are rapidly becoming things of the past, replaced by digital documentation and communication. Sharing patient information electronically and the computerization of medication management have become the standards in pharmacy and will continue to evolve at a rapid pace throughout the US and the rest of the world.

As noted by the Greek philosopher Heraclitus more than 2,500 years ago, “The only thing that is constant is change” and never before in history is change occurring at the rapid pace that is seen today. The real question is “what change is coming and should you embrace it”? Perhaps the best question of all is “what technology changes will result in your business operation becoming more profitable”? No one wants to change to a new technology that quickly becomes outdated and in the end costs more money than it was worth. However, with change also comes opportunities for both pharmacies and pharmacists to both improve a patient’s medication therapy, increase their operations’ efficiency and increase profits all at the same time.

Examples of New Pharmacy Technology

Although in no way intended as a complete in-depth look at every new technological advancement that is currently taking place in both the pharmacy and medical professions, in our next couple of posts we’ll discuss a few that are worth noting and discussing:
– Electronic Prior Authorization (ePA)
Prescription Drug Monitoring Programs (PDMP)
– Real Time Pharmacy Benefits (RTPB)
– Substance Abuse Monitoring and Prevention (EPCS – Electronic Prescribing for Controlled Substances)
– Specialty Rx Prescribing
Medication Therapy Management (MTM)

Electronic Prior Authorization or ePA

Let’s begin with a look at a technology that most pharmacists are currently using almost every day: ePA or Electronic Pre-authorization of prescriptions.

Basically there are two types of ePA: Prospective and Retrospective.
– In the Prospective ePA model, the electronic prior authorization is initiated by the physician. Software notifies the prescriber that PA (prior authorization) is a requirement, then a request is sent to the payer. In some instances the authorization is immediate, but in most instances it involves a “back and forth” question and answer interaction between the prescriber and the payer. The pharmacist may not ever even be aware that the ePA has even taken place.
– In the retrospective model, a pharmacy uses software to resubmit a rejected claim that required a prior authorization. In cases where the pharmacist did not realize that prior authorization was required and therefor the claim was subsequently rejected, the pharmacist can simply add a code and use their software to electronically forward a form to the provider in order to get the PA.

Already by the end of 2015 as reported by CoverMyMeds (in their National Adoption Scorecard highlighting industry technology progress), an estimated 67% of all pharmacies located in the US were utilizing ePA systems. Today this number is substantially higher. These systems adhere to all of the standards set in place by the NCPDP (the National Council for Prescription Drug Programs ) and  “leverage” the NCPDP Formulary and Benefit Flat File and SCRIPT Transaction Standards.

Developed to address the exponential increase in the volume of prescriptions that now require pre-authorization by insurance carriers, the benefits to the pharmacist are easy to see. The RPh will now have more time to perform their more important roles of being the overseer of a patient’s total medication therapy. This will allow the pharmacist the additional time for critical tasks such as patient consulting, medication management and regimen review, plus focus on increasing revenue (after all, all pharmacies are a business, right?). A recent report from Suresripts estimated that by using the ePA technology a pharmacy would save approximately four hours a week per pharmacist. This equates to a staggering average of over 200 hours a year for each pharmacist to perform more important patient focused duties.

ePA systems also will result in an increase in patient medication compliance by decreasing the incidence of “abandoned” prescriptions that has been on the rise over the past few decades. The National Center for Biotechnology Information (NCBI) reported in a study that 50% of patients do not take their medications or do not take them as prescribed (and that non-compliance by patients in medication therapies is the biggest problem faced today by healthcare providers in the US).

The increased efficiency that ePA’s provide are resulting in lowered costs, decreased delays and improved patient medication compliance. It is important to note that several states (such as New York, Ohio and Alaska) have already passed laws which legislate the use of an ePA system, while numerous other states are currently considering legislation to require ePA.

Pharmacy Technology Expertise

Many pharmacy owners are faced with the challenge of keeping up and understanding the new and rapidly changing pharmacy technologies. Healthcare Consultants has an in-house team that includes both consultant pharmacists and technology experts. Our staff keeps up with all the latest technological advancements that affect pharmacy as both a practice and a business. From major hospitals and healthcare systems to individual community pharmacies, HCC has been the nationally renowned pharmacy consultant firm of choice when it comes to questions regarding technology. From the selection of software to the actual implementation of systems, Healthcare Consultants has the experience required to do it right.

With over 28 years in the Pharmacy Consulting business, HCC can assist with expert advice in any area of your pharmacy business or practice. We urge you to contact us today to see how our Pharmacy Consulting services can help you and your business. With a full-time staff of in-house Pharmacy Consultant specialists, HCC can answer any questions that you may have in all Pharmacy settings. Contact us online or call us today at 800-642-1652 for a free consultation.




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