Prior authorizations are one of the biggest frustrations for doctors and their staff. In order to get certain medications approved by patients’ insurance companies, the standard method of paper prior authorizations involves filling out long forms, spending time on the phone, and faxing back and forth potentially multiple times over several days. However, there is now a new alternative. Introducing: Electronic Prior Authorization or e-PA.

What is e-PA?

Electronic Prior Authorization also known as, e-PA, is a streamlined method of completing prior authorizations electronically. A message with the patient’s information and prescription information is securely sent online to the Pharmacy Benefit Managers (PBMs) for review. A lot of the time e-PAs are completed directly in the Electronic Health Record system making it that much easier for the provider and staff to complete in their workflow.

How does e-PA work?

There are several different kinds of electronic prior authorization on the market today.  Many early versions turn the paper forms into PDF documents and give providers a way to fill out those forms online or electronically. Many times they are the same forms as the paper versions but allow online entry and submitting to the insurance company which saves time over manually filling and faxing. Newer e-PA implementations (like MDToolbox offers) take it to the next level by pre-filling all of the patient and medication pertinent information. They also have simple question sets that are filled out and submitted to get the prior approval instead of needing to complete the long forms.

What are the benefits?

• Saves Time for Physicians

In a 2010 AMA survey it was found that physicians alone, not including other staff, spend on average 20 hours a week dealing with prior authorizations¹.  The time saved by using e-PA means that physicians can devote more time to caring for their patients.

•  Saves Time for Patients

The same survey showed 69% of physicians typically wait several days to receive prior authorization from an insurer for drugs, while 10% wait more than one week. By using e-PA, physicians can sometimes get a response immediately, therefore patients would not be stuck waiting several days or making failed attempts to pick up their prescription at the pharmacy.

• Improves Patient Care and Outcomes

20-30% of patients waiting on PAs ultimately give up without getting their prescription² while up to 70% of patients don’t receive the original prescription prescribed by their provider if a prior authorization is required³. Not only will physicians have more time to devote to patient care by reducing the time spent on prior authorizations with e-PA, patients will also be more likely to follow through with their originally prescribed treatment.

• Saves Money

A study presented in Health Affairs put the monetary cost of physicians interacting with insurance plans at $83,000 annually⁴. By utilizing e-PA and reducing administrative efforts put into manual prior authorizations, these costs can be drastically reduced as well.

It is clear to see that there are many obvious reasons providers should be happy to switch to completing prior authorizations electronically and it’s expected that this technology will be a welcome change in offices across the nation.

1. American Medical Association, “New AMA Survey Finds Insurer Preauthorization Policies Impact Patient Care,” November 22, 2010
2. Journal of Managed Care Pharmacy, K.A. Hanson, et.al An analysis of Antihypertensive Use Following Initially Rejected Pharmacy Claims for Aliskiren, Sept. 2009, Vol. 15, No. 7, pg 573-57
3. FrostSullivan Study, The Impact of the Prior Authorization Process on Branded Medications
4. Health Affairs: “What Does It Cost Physician Practices To Interact With Health Insurance Plans?”; May 2009