CVS Caremark develops Prior Authorization pilot program
WOONSOCKET, R.I. CVS Caremark has teamed up with BlueCross BlueShield of Tennessee and Horizon Blue Cross Blue Shield of New Jersey to afford physicians and other providers who prescribe medications throughout Tennessee and New Jersey access to instant prior authorization status for their patients’ medications through a new online pilot program.
Under the Prior Authorization pilot program, physicians and other providers who prescribe medications will use the CVS Caremark iScribe Web portal to answer coverage criteria related to prior authorization requests and to 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,” stated Dr. Terence Shea, director of pharmacy services for BlueCross BlueShield of Tennessee.
The pilot, which is expected to run for six months, builds on what was learned from a 2006 Centers for Medicare & Medicaid Services and the Agency for Healthcare Research and Quality pilot in which iScribe, Caremark and Horizon BCBSNJ participated to test e-prescribing standards, including ePA standards. According to CVS Caremark, this new program is among the first in the nation to test widespread use of an ePA product in order to understand the true impact on the prescribing process.
How it works: 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 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.
“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,” stated Dr. Troyen Brennan, CVS Caremark’s chief medical officer and EVP. “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.”