COLUMBUS, OH — According to the newly-released ePA National Adoption Scorecard and the Real-Time Benefit Check National Adoption Scorecard, most EHRs, health systems, payers and pharmacies have committed to electronic prior authorization (ePA) and real-time benefit check solutions; however, attaining patient-benefit from these platforms relies on broader provider utilization.
While CoverMyMeds captures an average of 90 percent of ePA volume across the industry1 and its RxBenefit Clarity™ solution has achieved the highest provider utilization rate of real-time benefit check, the reports illustrate that widespread provider adoption will deliver even more value to patients awaiting treatment.
The new reports reveal that when ePA and real-time benefit check solutions are implemented well and adopted by providers, they can achieve the following:
- Faster turnaround times: 62 percent of prior authorization (PA) requests submitted electronically receive a determination in less than two hours, compared to 0 percent of PA requests completed via the traditional phone and fax method.2
- Improved dispense rate: Electronic prior authorization solutions can lead to an 80 percent higher dispense rate and three percent greater likelihood that patients pick up their medications due to the faster turnaround times on PA determinations, compared to PA requests completed via the traditional phone and fax method.2
- Increased adherence: Real-time benefit check solutions that deliver at least 97 percent accuracy for prescription cost information at the point of prescribing can lead to a nearly 20 percent increase in medication adherence.3
The reports also reveal areas for improvement:
- Complete provider adoption: Despite widespread availability of ePA solutions, provider adoption lags behind, with 47.5 percent of PA requests occurring through ePA.2 Of those that submit PA requests electronically, the majority use CoverMyMeds.1
- Provider trust in data: Among a survey of 1,300 providers, the average trust factor in the accuracy of real-time benefit check solutions that rely solely on existing formulary and benefit information is only 5.7 out of 10.4
- Implementation of provider-centric functionality: Only recently have real-time benefit check solutions emerged that deliver patient pay details at the point of prescribing. While EHR availability is currently at 73 percent and payer availability is at 81 percent, in order for provider adoption of real-time benefit check to increase, solutions must deliver the elements providers say are most important: cash price, patient assistance programs, PA requirements and medication alternatives.4
“As both of these industry reports highlight, having accurate visibility into prescription cost and prior authorization requirements within workflow helps combat common medication access barriers and helps patients get on therapy faster,” said Melissa Paige, Patient Access Principal Coordinator at University of Virginia Health System. “This is especially important for some of the most vulnerable patients who lack reliable transportation and cannot make multiple trips to the pharmacy if their medication is denied or too expensive to afford during their initial visit. If we miss our window on the patient’s first trip to the pharmacy, they may not come back to fill their prescription.”
The reports are published by CoverMyMeds, part of McKesson Prescription Technology Solutions, with an advisory board of leaders from The American Medical Association, athenahealth, BestRx, Blue Cross Blue Shield of North Carolina, Cardinal Health, Cerner, eMDs, Express Scripts, Horizon Government Affairs, Humana, National Alliance of State Pharmacy Associations, National Council of Prescription Drug Programs, OptumRx, RelayHealth Pharmacy Solutions, United States Public Health Service and University of Virginia Health System.
1. CoverMyMeds Data on File, 2018
2. 2019 ePA National Adoption Scorecard
3. CoverMyMeds Case Study: Improving Prescription Decision Support with RxBenefit Clarity™, 2019
4. 2018 Real-Time Benefit Check National Adoption Scorecard