2018 ePA National Adoption Scorecard Offers Updated Industry Trends, Research, Data

Annual Report Reveals Impact, Adoption, Legislation of ePA and Examines Real-Time Prescription Benefit, Specialty Medication Landscape

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CoverMyMeds

Feb 20, 2018, 08:08 ET

COLUMBUS, Ohio, Feb. 20, 2018 /PRNewswire/ -- Electronic health record systems (EHRs) representing 79 percent of market share, 100 percent of pharmacies and nearly the entire payer industry are committed to implementing an electronic prior authorization (ePA) solution, according to new research released today by CoverMyMeds. The 2018 ePA National Adoption Scorecard summarizes the current state of ePA in the industry, quantifies the impact of prior authorization (PA) to patients and providers, and highlights current ePA adoption and implementation rates by market leaders. To access the report, visit epascorecard.covermymeds.com.

Approximately 10 percent of prescription claims are rejected at the pharmacy, and, on average, 66 percent of those prescriptions require PA; furthermore, 36 percent of those prescriptions will be abandoned due to the complex paper-based process.

The increase in legislation around prior authorization (PA) and electronic prior authorization (ePA) has become more prevalent at the state level. The mandates range from use of a standardized form for submission to mandating the use of the NCPDP SCRIPT Standard for ePA.

According to the 2018 National Adoption Scorecard, the industry as a whole recognizes the importance of an ePA solution and how it benefits all stakeholders. As progress is made, the report indicates the future focus of health care will likely shift to other areas of improvement in the industry, such as solutions for real-time prescription benefit (RTPB) transactions and specialty medication—two new sections added to this year's report.

"A real-time prescription benefit solution is an essential tool to drive better patient-centric care," said Rita Russell, RPh, Senior Director, Relationship Management at RelayHealth Pharmacy. "Education around RTPB solutions is vital for success. The ePA National Adoption Scorecard is a great resource to house this information, and in the future, will provide industry adoption trends as they become available."

Key metrics and takeaways from the 2018 ePA National Adoption Scorecard include:

Sixty-six percent of prescriptions rejected at the pharmacy require PA (this equals approximately 300 million PA requests). Of those, 36 percent are abandoned each year.¹
Only 31 percent of physicians reported knowing if a PA was required while prescribing a medication.²
Forty percent of providers cite PA around specialty medications as the main pain point when prescribing medication.³
On average, providers who exclusively use an electronic method for PA requests report spending 2.5 fewer hours on PA each week. However, few providers reported exclusively using an ePA solution, with 76 percent reportedly using more than one channel to complete PA requests.⁴
In January 2018, H.R. 4841, the Standardizing Electronic Prior Authorization for Safe Prescribing Act, was introduced in the U.S. Congress. This bipartisan bill is designed to drive ePA usage in the Medicare Part D Program, improving prescription access for Medicare beneficiaries.

"The purpose of the ePA National Adoption Scorecard is to educate readers on the current state and near future needs of critical patient-focused, health care IT solutions—such as ePA, RTPB and electronic specialty platforms," said Perry Lewis, VP of Industry Relations at CoverMyMeds. "Encouraging data discoveries from this year's report demonstrate a robust adoption of ePA. As more stakeholders exclusively utilize an ePA solution, I'm confident we'll see a corresponding increase in patient medication adherence and a decrease in avoidable medical spending."

This year's report also includes filmed interviews with physicians and payer partners who utilize ePA solutions to more efficiently submit and review PA requests.

The ePA National Adoption Scorecard is published by CoverMyMeds with an advisory group comprised of leaders from RelayHealth, Express Scripts, the National Council for Prescription Drug Programs, Cerner Corporation, Cardinal Health, the National Alliance of State Pharmacy Associations and the Virginia Association of Health Plans.

Those attending HIMSS18 March 5 – 9, 2018 may visit CoverMyMeds at booth 4612 for additional information related to the newly-released ePA National Adoption Scorecard. To view the full report, visit epascorecard.covermymeds.com.

About CoverMyMeds
CoverMyMeds, an independent business unit within McKesson, is a leader in electronic prior authorization (ePA) solutions and one of the fastest growing health care technology companies in the U.S. CoverMyMeds' software suite automates the medication prior authorization process for more than 500 electronic health record systems (EHRs), 62,000 pharmacies, 700,000 providers and most health plans and PBMs. By facilitating appropriate access to medications, the company can help its customers avoid billions of dollars each year in administrative waste and avoidable medical spending caused by prescription abandonment. Visit www.covermymeds.com for more information.

¹CoverMyMeds Analytics, 2017 (Based on two months of paid and rejected data from PioneerRx. Data only considers reject codes 70,75 and MR.)
² AIS Health "Despite Widespread Adoption, Electronic Prescribing Still has User Limitations." Nov 2013
³CoverMyMeds Specialty Follow Up Survey, 2017
⁴ CoverMyMeds Industry Provider Survey, 2016

SOURCE CoverMyMeds