Version 14.19

ePA Introduction

Have you ever ordered a prescription only to find out later that your staff received a call from the Pharmacist requesting a Prior Authorization (PA) be completed? The PA process is known for its complexity, frustration, inefficiency and costliness. PA requirements create disruptions to your office and the pharmacy’s workflow.

Perhaps most importantly, the manual process delays patients’ ability to fill and take their medications, sometimes causing prescription abandonment and medication non-adherence. It causes patients to feel frustrated when filling their prescriptions.

Office Practicum takes the pain out of Prior Authorization by integrating a fully automated electronic workflow called ePA for a seamless, faster and more efficient user and patient experience.

This workflow has been proven to reduce administrative processing time for providers and their staff, to eliminate unnecessary phone calls between the practice and pharmacy and to secure an approval from the payer earlier, thereby enabling patients to fill their prescriptions when they arrive at the pharmacy.

Office Practicum has elected to integrate ePA with CompletEPA® from Surescripts®, our nation’s ePrescribing network connected to over 900,000 healthcare professionals impacting more than 270 million insured lives. Through their direct connections to the major Pharmacy Benefits Managers (PBMs), we felt Surescripts would be the best partner to implement the most efficient workflow.

For each prescription you write, OP indicates whether a PA is required at the plan level based on the formulary. Formulary identifies at the plan level whether a PA may be necessary, but formulary does not consider a patient’s individual circumstances. At this point, the prescription is considered “indicated” for PA. As a result, once the prescription is sent or printed, OP will send the prescription to the pharmacy for processing and also send the PBM a request to verify whether a PA is required. The PBM will either respond that it is not necessary or require the prescriber to complete a Question Set pertaining to the therapy in order to solicit an approval or denial response. Keep in mind, even if a drug is flagged for PA at the plan level, the patient may already have an active approval by the payer for that drug, thus eliminating the need for another PA for that prescription.

OP also displays alternative medications providing you with the option of selecting a more cost-effective medication and perhaps one which does not require a PA.

For prescriptions that are found to require a PA at the patient level, OP has implemented a workflow for you or a clinical staff member to submit a PA electronically instead of completing paperwork and faxing it back and forth. The best part about it is that OP transmits for you the information we already know such as prescriber information, patient information and details about the medication prescribed. You only need to worry about answering the questions pertaining to the treatment itself. Health plan responses are delivered back to the EHR.

Since the PA is prospective, meaning that the need for a PA is identified at the point of prescribing, OP submits the request early in the process, thereby improving the chance the medication prescribed will be available for pick up the first time the patient arrives at the pharmacy. As a result, you may have just avoided prescription abandonment by the patient and improved medication adherence. Plus you saved yourself and the pharmacist from communicating back and forth until completion and approval of the manual PA process.

Benefits of ePA:

• Significantly reduces burden on resources, enabling staff to work top-of-license.
• Improves provider and patient satisfaction.
• Increases medication adherence as patients get their prescriptions faster.
• Enables timely and effective treatment.

Version 14.10

ePA Introduction

Have you ever ordered a prescription only to find out later that your staff received a call from the Pharmacist requesting a Prior Authorization (PA) be completed? The PA process is known for its complexity, frustration, inefficiency and costliness. PA requirements create disruptions to your office and the pharmacy’s workflow.

Perhaps most importantly, the manual process delays patients’ ability to fill and take their medications, sometimes causing prescription abandonment and medication non-adherence. It causes patients to feel frustrated when filling their prescriptions.

Office Practicum takes the pain out of Prior Authorization by integrating a fully automated electronic workflow called ePA for a seamless, faster and more efficient user and patient experience.

This workflow has been proven to reduce administrative processing time for providers and their staff, to eliminate unnecessary phone calls between the practice and pharmacy and to secure an approval from the payer earlier, thereby enabling patients to fill their prescriptions when they arrive at the pharmacy.

Office Practicum has elected to integrate ePA with CompletEPA® from Surescripts®, our nation’s ePrescribing network connected to over 900,000 healthcare professionals impacting more than 270 million insured lives. Through their direct connections to the major Pharmacy Benefits Managers (PBMs), we felt Surescripts would be the best partner to implement the most efficient workflow.

For each prescription you write, OP indicates whether a PA is required at the plan level based on the formulary. Formulary identifies at the plan level whether a PA may be necessary, but formulary does not consider a patient’s individual circumstances. At this point, the prescription is considered “indicated” for PA. As a result, once the prescription is sent or printed, OP will send the prescription to the pharmacy for processing and also send the PBM a request to verify whether a PA is required. The PBM will either respond that it is not necessary or require the prescriber to complete a Question Set pertaining to the therapy in order to solicit an approval or denial response. Keep in mind, even if a drug is flagged for PA at the plan level, the patient may already have an active approval by the payer for that drug, thus eliminating the need for another PA for that prescription.

OP also displays alternative medications providing you with the option of selecting a more cost-effective medication and perhaps one which does not require a PA.

For prescriptions that are found to require a PA at the patient level, OP has implemented a workflow for you or a clinical staff member to submit a PA electronically instead of completing paperwork and faxing it back and forth. The best part about it is that OP transmits for you the information we already know such as prescriber information, patient information and details about the medication prescribed. You only need to worry about answering the questions pertaining to the treatment itself. Health plan responses are delivered back to the EHR.

Since the PA is prospective, meaning that the need for a PA is identified at the point of prescribing, OP submits the request early in the process, thereby improving the chance the medication prescribed will be available for pick up the first time the patient arrives at the pharmacy. As a result, you may have just avoided prescription abandonment by the patient and improved medication adherence. Plus you saved yourself and the pharmacist from communicating back and forth until completion and approval of the manual PA process.

Benefits of ePA:

• Significantly reduces burden on resources, enabling staff to work top-of-license.
• Improves provider and patient satisfaction.
• Increases medication adherence as patients get their prescriptions faster.
• Enables timely and effective treatment.