CoverMyMeds: Prior authorization scripts get filled faster when submitted electronically

Some 62% of prior authorization requests submitted electronically receive a determination in less than two hours, compared to 0% of prior authorization requests completed via the traditional phone and fax method, according to research from the published Electronic Prior Authorization National Adoption Scorecard and the Real-Time Benefit Check National Adoption Scorecard by CoverMyMeds, which is part of McKesson Prescription Technology Solutions.

According to the research, most electronic health records, health systems, payers and pharmacies have committed to electronic prior authorizations and real-time benefit check solutions; however, attaining patient benefit from these platforms relies on broader provider utilization.

CoverMyMeds captures an average of 90% of electronic prior authorization volume across the industry and its RxBenefit Clarity solution has achieved the highest provider utilization rate of real-time benefit check, yet the reports illustrate that widespread provider adoption will deliver even more value to patients awaiting treatment, according to the company.

The new reports reveal that when  electronic prior authorization and real-time benefit check solutions are implemented well and adopted by providers, they also can achieve:

  • Improved dispense rate: ¬†electronic prior authorization solutions can lead to an 80% higher dispense rate and 3% greater likelihood that patients pick up their medications due to the faster turnaround times on prior authorization determinations, compared to prior authorization requests completed via the traditional phone and fax method.

  • Increased adherence: Real-time benefit check solutions that deliver at least 97% accuracy for prescription cost information at the point of prescribing can lead to a nearly 20% increase in medication adherence.

The reports also reveal areas for improvement:

  • Complete provider adoption: Despite widespread availability of electronic prior authorization solutions, provider adoption lags behind, with 47.5% of prior authorization requests occurring through electronic prior authorization. Of those that submit PA requests electronically, the majority use CoverMyMeds.

  • 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 electronic health records availability is currently at 73% and payer availability is at 81%, 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, prior authorization requirements and medication alternatives.

"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,"University of Virginia Health System patient access principal coordinator Melissa Paige said. "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."