Insurers aim to get physicians to incorporate electronic processes for prior authorization

Insurers launched a new initiative aimed at expanding the use of electronic prior authorization, hoping to address an issue most providers say is the most burdensome they face.

The Fast Prior Authorization Technology Highway (PATH) Initiative aims to use technology from Availity and Surescripts in physician offices to speed up requests and responses for prior authorization, where a provider must get permission from an insurer before prescribing a pricey drug or performing a certain surgical procedure.

The initiative, launched Monday by insurance industry group America’s Health Insurance Plans and several member insurers including Anthem, Cigna and WellCare, will have physician offices volunteer to work with insurers to incorporate the new processes into existing technology.

“The goal is to offer a voluntary approach that is scalable and can be highly integrated with existing electronic health records systems,” AHIP said in a release.

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AHIP said there is no cost to physicians participating in the initiative, but it is possible that practices could incur a cost from vendors or EHR companies to access the functionality of prior authorization.

The first part of the initiative will use technology from electronic prescribing company Surescripts to give doctors key information on a new drug.

When a doctor prescribes a drug through their EHR, they can immediately access their patient’s pharmacy benefit to see if prior authorization is needed and “have the information to choose an alternative treatment that is clinically equivalent but more cost-effective and does not require prior authorization,” AHIP said.

A doctor could also immediately submit their prior authorization request via the patient’s EHR.

The initiative also aims to create a multi-payer portal via the data-sharing company Availity that doctors and surgeons can access to simplify prior authorization requests for surgery or other procedures.

“The portal allows for easier communication and faster approvals, thus speeding the delivery of quality care for patients,” AHIP said.

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The nonprofit research organization RIT International will also evaluate the results of deploying the technologies. The goal is to uncover the impact of electronic prior authorization and share best practices and lessons for how to deploy this technology.

The group added that most providers still use fax and telephone to submit prior authorization requests. A 2019 study from the American Medical Association found that 60% of 1,000 doctors surveyed use a phone and 46% use a fax machine.

The reliance on manual processes comes as the rate of prior authorization requirements has increased.

A large majority of 88% of those surveyed by AMA said that the number of prior authorization requests for drugs and services has increased over the past five years. Insurers have increasingly turned to prior authorization to curb the use of high-cost drugs. 

The same survey found that 28% of respondents said that a prior authorization request has led to a serious or life-threatening adverse event for patients.

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Providers say that insurers have made prior authorization requests to be extremely burdensome.

A survey released last year by the Medical Group Management Association found that 83% of respondents listed prior authorization as “very” or “extremely” burdensome. Provider leaders also say there has been “no progress” in resolving the issue.