Electronic Prior Authorization Program To Help Patients Get Faster Access To Prescription Medication

Main Category: Pharmacy / Pharmacist
Also Included In: IT / Internet / E-mail
Article Date: 02 May 2009 - 1:00 PDT

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Gaining prior authorization for prescription medication requires phones calls, faxes and request forms, which often can be time-consuming. Fortunately for both providers and patients, help is on the way to streamline and accelerate this process.

CVS Caremark, Blue Cross Blue Shield of Tennessee and Horizon Blue Cross Blue Shield of New Jersey announced today that physicians and other providers who prescribe medicines throughout Tennessee and New Jersey will have access to instant prior authorization status for their patients' medications through an electronic Prior Authorization (ePA) pilot program.

Prior authorization requires physicians to show the medical necessity for a patient to receive a particular medication. The process can be inefficient. A study published last August suggests clinicians and their office staff spend an average of 4.6 hours a week fulfilling requirements of the prior authorization process.(1)

In this new collaboration, physicians and other providers who prescribe medicines will use the CVS Caremark iScribe Web portal to answer coverage criteria related to a prior authorization requests and receive an immediate status update regarding the approval or denial for the medication.

"Today's prior authorization processes are dependent upon completing paper request forms, faxing and phone calls between the practice, the pharmacy and the prior authorization department. By taking this online, we reduce many of the hassles and headaches associated with the process and ensure that patients are getting access to the appropriate medications faster," said Dr. Terence Shea, Director of Pharmacy Services, Blue Cross BlueShield of Tennessee.

"We continue to seek ways to be more efficient in order that our members get the care they need quickly while we ensure that it is medically appropriate and electronic prior authorizations meet both of those important goals," said Richard Popiel, Vice President & Chief Medical Officer, Horizon BCBSNJ.

This pilot builds on what was learned from a 2006 Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ) pilot in which iScribe, Caremark and Horizon BCBSNJ participated to test electronic prescribing standards, including ePA standards. This new program is among the first in the nation to target widespread use of an ePA product in order to understand the true impact on the prescribing process.

Utilizing the iScribe portal, a clinician will send an ePA request detailing the coverage criteria to a patient's health insurer. The physician will receive an instant response on iScribe, which makes prior authorization a quick, easy and integrated process. On the backend, the pilot uses functionality built by Surescripts as part of the 2006 ePA program to transmit ePA requests between the provider and the CVS Caremark prior authorization team.

"We are excited to offer electronic prior authorizations to physicians who already prescribe electronically, but also to any physician who has access to the Internet and wants to be more efficient for their patients," said Peggy Johnson, Vice President and Chief Pharmacy Officer, Horizon BCBSNJ.

"CVS Caremark understands the opportunities that innovations such as electronic prior authorization provide to prescribers and patients looking to embrace a more efficient and effective manner of sharing critical prescribing information," said Dr. Troyen Brennan, CVS Caremark's Chief Medical Officer and Executive Vice President. "We are building best practices for consumer care through our eHealth programs and products and in partnership with clients such as BlueCross BlueShield of Tennessee and Horizon BCBS of New Jersey."

Prescriber recruitment for the ePA pilot began in April in Tennessee, and will be followed shortly by outreach efforts in New Jersey. The pilot is anticipated to run for six months.

About iScribe e-Prescribing

iScribe e-prescribing allows prescribers to send prescriptions securely and directly to the patient's pharmacy of choice from either a handheld PDA or desktop computer. iScribe meets the qualifications set by the Centers for Medicare & Medicaid Services (CMS) for the 2009 incentives provided through the Medicare Improvements for Patients and Providers Act, and is compliant with the CMS Part-D standards for e-prescribing.

iScribe provides the prescriber with generic and formulary coverage and alternative information, assisting the physician in selecting the most cost-effective medication for their patients. Physicians can use the electronic prescribing tools to write prescriptions for all of their patients, regardless of the patient's prescription benefit coverage. Physicians can check for potentially harmful drug interactions at the point of prescribing, or follow-up with patients when iScribe alerts them to unfilled prescriptions. The convenience of a mobile device ensures patient prescriber history is with them at all times -- either in the office or when the prescriber is on-call. iScribe electronic prescribing helps to reduce phone calls and faxes between the practice and the pharmacy, improve patient safety and drive better medication compliance.

About CVS Caremark

CVS Caremark (NYSE: CVS) is the largest provider of prescriptions in the nation. The Company fills or manages more than 1 billion prescriptions annually. Through its unmatched breadth of service offerings, CVS Caremark is transforming the delivery of health care services in the U.S. The Company is uniquely positioned to effectively manage costs and improve health care outcomes through its more than 6,900 CVS/pharmacy and Longs Drugs stores; its Caremark Pharmacy Services division (pharmacy benefit management, mail order and specialty pharmacy); its retail-based health clinic subsidiary, MinuteClinic.

About BlueCross BlueShield of Tennessee

BlueCross BlueShield of Tennessee is the state's oldest and largest not-for-profit health plan, serving nearly 3 million Tennesseans. Founded in 1945, the Chattanooga-based company is focused on financing affordable health care coverage and providing peace of mind for all Tennesseans. BlueCross serves its members by delivering quality health care products, services and information. BlueCross BlueShield of Tennessee Inc. is an independent licensee of BlueCross BlueShield Association.

About Horizon Blue Cross Blue Shield of New Jersey

Horizon Blue Cross Blue Shield of New Jersey is the oldest and largest health insurer in the state serving over 3.6 million members. Horizon BCBSNJ is New Jersey's only not-for-profit, health service corporation and is headquartered in Newark with offices in Wall, Mt. Laurel, and West Trenton.

Horizon BCBSNJ provides a broad array of health and dental insurance products and services for individuals and small and large companies, including national companies headquartered in New Jersey. Horizon BCBSNJ is committed to improving the health care experience for all the communities we serve as well as helping our members become and stay healthy.

(1) Drug Topics, August 11, 2008.

Source: CVS Caremark

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