What's Next for Electronic Prior Authorization?

Express Scripts is already working on future enhancements as ePA becomes more widespread.

Express Scripts will keep investing in Electronic Prior Authorization (ePA) and all areas of digital healthcare connectivity, because it alleviates administrative burden, reduces cost, and puts medicine within reach of patients more quickly. We are building a smarter prior authorization (PA) system that reaches deep into our claims data to answer some PA questions before sending the rest to the doctor.

Express Scripts has also begun providing physicians with Real-Time Prescription Benefit (RTPB) functionality within the Electronic Health Record. During the ePrescribing event, prescribers see the following components:

  • The patient’s cost at each channel (retail, mail, specialty pharmacy)
  • Coverage information (prior authorization, step therapy requirements and quantity limits)
  • Alternative drugs and details (generic vs. brand pricing)

According to AIS Health, only 31% of physicians reported knowing if a PA was required while prescribing a medication. With RTPB and ePA, that information is much more evident and streamlined.

Prescribing effective therapies that better align with patient benefits makes it easier for patients to do the right thing when it comes to taking medication. Less disruption, getting their medicine quickly, and cost savings all increase the likelihood of adherence and better health. Both the patient and the physician finish the visit with increased satisfaction.

According to CoverMyMeds 2018 ePA Scorecard publication, healthcare providers overwhelmingly see the benefits of electronic prior authorization in speed to therapy, positive impacts to healthcare, easing the burden of the PA process, and ensuring patients get their medications. View the entire 2018 Scorecard here. Express Scripts partners with a variety of ePA providers so all physicians can find a solution that fits their workflow. 

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