Health Plans and Pharmacy Benefit Managers Leverage Technology to Streamline Medication Prior Authorization for Virtually All U.S. Patients

Nationwide, Regional and Local PBMs and Health Plans Remove the
Administrative Burden, Costs and Treatment Delays Related to Manual
Prior Authorization

ARLINGTON, Va.–(BUSINESS WIRE)–#EHR–In an effort to reduce administrative costs and increase medication
adherence, more health plans and pharmacy benefit managers (PBMs) are
replacing the manual prior authorization process with Surescripts
Electronic Prior Authorization, embedded in prescribers’ electronic
health record (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%.

“Together with our health plan and PBM partners, the Surescripts Network
Alliance™ is having a significant impact
on patient-provider satisfaction and medication adherence,” said Tom
Skelton, Chief Executive Officer of Surescripts. “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 administrative burden on providers
and promote patient access to medications, the Centers for Medicare &
Medicaid Services (CMS) 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 (NCPDP) 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.

A large Wisconsin-based health
system 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.

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, 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.

Visit Surescripts
for more information on electronic prior authorization, and join
Surescripts June 19–21 at AHIP
Institute and Expo 2019 at Booth 625. On Thursday, June 20, at 2
p.m. CT, Josh Sturm, Surescripts Vice President of Key Accounts for
Health Plans, will present “Reducing Friction at the Point of Care: How
to Engage with Providers for the Best Prescription Decision.”

About Surescripts

Our purpose is to serve the nation with the single most trusted and
capable health information network, built to increase patient safety,
lower costs and ensure quality care. Since 2001, Surescripts has led the
movement to turn data into actionable intelligence and convened the
Surescripts Network Alliance™ to enhance prescribing, inform care
decisions and advance the healthcare industry. Visit us at surescripts.com
and follow us at twitter.com/surescripts.

Contacts

Media Contact:
Kelly Jeffers
Surescripts
(571)
384-4776
kelly.jeffers@surescripts.com