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CVS Caremark will launch a pilot of a real-time, integrated electronic prior authorization capability, available to its pharmacy benefit management clients, to help speed access to prescription medications.
Obtaining prior authorization for prescription medications is a time-consuming process for prescribers, patients and pharmacists, and currently requires phone calls, faxes and hard-copy request forms. While some online solutions are available, they do not provide both a real-time solution and one that is integrated with available e-prescribing or electronic health record tools. Recognizing this gap in the marketplace, CVS Caremark has developed the ePA capability. A successful pilot would represent a significant first step toward the development of a technical standard the industry could use to achieve broad adoption of ePA.
The ePA pilot aims to enable prescribers that use a variety of available e-prescribing and EHR tools to coordinate a real-time ePA request when initiating a patient’s prescription. Prescribers also will have the option to access the process through a client portal. The prescriber will be able to send an ePA request detailing the related coverage criteria and receive a real-time status update regarding an approval for the medication. Requests that are denied will be communicated following manual review by clinical staff.
Surescripts is participating in the CVS Caremark ePA pilot to monitor and understand how what is learned can be applied to the industry. NaviNet, through its NaviNet Mobile Connect platform, will be participating in the ePA pilot. Also participating is Allscripts, whose client base includes all former users of CVS Caremark’s proprietary iScribe e-prescribing tool, which was transitioned to the Allscripts ePrescribe solution last year. CVS Caremark added that MedPlus has indicated its intent to deliver ePA functionality in a future release of their tool. Additional vendors have expressed their intent to deliver ePA functionality in future product releases upon the successful completion of this pilot.