PHARMACY

Surescripts: More health plans, PBMs are using technology for prior authorizations

BY Sandra Levy

Surescripts is seeing an uptick in the use of technology to reduce administrative costs and increase medication adherence. Specifically, the company said that more health plans and pharmacy benefit managers are replacing the manual prior authorization process with Surescripts Electronic Prior Authorization, embedded in prescribers’ electronic health record, or EHR software or through its prior authorization portal.

Over the past 18 months, several national, regional and local PBMs and health plans representing virtually all U.S. patients have signed on, increasing the number of insured lives covered by Surescripts Electronic Prior Authorization by nearly 20%, the company noted.

“Together with our health plan and PBM partners, the Surescripts Network Alliance is having a significant impact on patient-provider satisfaction and medication adherence,” Surescripts CEO Tom Skelton said. “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.”

On June 17, in an effort to reduce the administrative burden on providers and promote patient access to medications, the Centers for Medicare and Medicaid Services issued a proposed rule to require all Medicare Part D plans to support electronic prior authorization transaction standards based on the National Council for Prescription Drug Programs SCRIPT standard version 2017071.

The prior authorization process is intended to provide medication safety and cost benefits to patients and health plans, but the manual process can be administratively burdensome. Surescripts Electronic Prior Authorization reduces that burden by streamlining the process and improving communication, which helps patients get needed medications faster and with less hassle, the company said.

Surescripts cited a large Wisconsin-based health system that used Surescripts Electronic Prior Authorization to reduce administrative work for healthcare providers and speed time to therapy for patients. After implementing the solution, the wait time from prescription to fulfillment decreased by nearly two-thirds. The time to complete the process overall decreased from 22 to 12 active minutes, improving physician, nurse and organizational buy-in and cutting overtime costs by 20%. After a few months, the health system saw an 8% increase in first-fill medication adherence, the company said.

Electronic prior authorization can be especially beneficial for the prescribing of specialty medications for complex and chronic illnesses like rheumatoid arthritis and multiple sclerosis. A recent Surescripts survey found that 80% of providers don’t have access to information about prior authorization requirements when they begin the prescribing process. With electronic prior authorization, prescribers will have that information at their fingertips, which can greatly expedite the prescribing and approval of these often costly medications.

In 2018, the adoption of Surescripts Electronic Prior Authorization increased by 128%. The top five specialties using Surescripts Electronic Prior Authorization are family practice, internal medicine, psychiatry, pediatrics and neurology.

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