Electronic prior authorization piloted for e-prescription

CVS Caremark, which includes a leading pharmacy benefit manager (PBM), is piloting a method of electronic prior authorization (ePA) that can be used in the workflow of electronic prescribing. The company is making the specifications available to e-prescribing software vendors and hopes it will become an industry standard.

Today, most practices use fax and phone for the time-consuming prior authorization of many prescription drugs. While some PBMs and health plans have websites for prior authorization, they create double work because physicians can't apply for authorization on their e-prescribing devices. That's the problem that CVS Caremark aims to solve.

Surescripts, which connects physician offices with most pharmacies online, is participating in the CVS Caremark pilot to see whether the tool can be applied industrywide. NaviNet--through its Mobile Connect platform--and Allscripts also are participating. The latter last year absorbed the iScribe e-prescribing solution, which formerly was owned by CVS Caremark. MedPlus, a Quest Diagnostics subsidiary, has indicated it will use ePA functionality in a future release, and additional vendors also have reportedly shown interest in the tool.

"The prior authorization process is currently evolving to keep pace as prescribers transition towards electronic prescribing and electronic patient records to better manage their patients' pharmacy care," Troyen A. Brennan, MD, M.P.H., chief medical officer of CVS Caremark said in a statement. "This pilot is an important step toward demonstrating how the industry can integrate ePA with e-prescribing to streamline and speed up processing of prior authorizations to ensure that members have quick access to care that is medically appropriate and cost-effective." 

To learn more:
- read the press release
- check out this iHealthBeat piece
- here's a blog post from ONC's Doug Fridsma on ePA

Related Content:
Prescription Solutions Offers New Online Prior Authorization Service for Physicians and Health Care Professionals
Pharmacies sue CVS Caremark over privacy issues