CVS Caremark Corp. plans to pilot real-time electronic prior authorization of prescriptions for its pharmacy benefit management clients to speed access to medications and enhance the patient experience.


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CVS to test electronic prior authorizations for Rx

May 16th, 2011

WOONSOCKET, R.I. – CVS Caremark Corp. plans to pilot real-time electronic prior authorization of prescriptions for its pharmacy benefit management clients to speed access to medications and enhance the patient experience.

The company said Monday that a successful test of real-time electronic prior authorization (ePA) would mark a first step toward the development of a technical standard that could spur broad industry adoption of that capability.

According to CVS Caremark, getting prior authorization for prescriptions currently is a cumbersome affair for prescribers, patients and pharmacists — requiring phone calls, faxes and hard-copy request forms. Some online solutions are available, but they're not real-time and don't integrate with electronic prescribing or electronic health record (EHR) tools.

The CVS Caremark 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 prescription for a patient, the company said. Prescribers will also have the option to access the process through a client portal. The prescriber will be able to send an ePA request detailing the coverage criteria related to a prior authorization request and get a real-time status update on an approval for the medication. Requests that are denied will be communicated after a manual review by clinical staff.

Surescripts is participating in the CVS Caremark-led ePA pilot to monitor the effort and understand how its results can be applied to the industry. Other participants include NaviNet, through its NaviNet Mobile Connect platform, as well as 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. MedPlus also has indicated its intent to deliver ePA functionality in a future release of its tool, CVS Caremark said, adding that other vendors also plan to offer ePA functionality.

"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 way to share critical prescribing information," Troy Brennan, chief medical officer of CVS Caremark, said in a statement. "The prior authorization process is currently evolving to keep pace as prescribers transition towards electronic prescribing and electronic patient records to better manage their patients' pharmacy care.

"This pilot is an important step toward demonstrating how the industry can integrate ePA with e-prescribing to streamline and speed up processing of prior authorizations to ensure that members have quick access to care that is medically appropriate and cost-effective," Brennan noted.

CVS Caremark added that the ePA pilot transactions will spur the creation of standards that could be used by any e-prescribing vendor. The company said it aims to share the transactions and the results from the implementation with the market and the appropriate ANSI-accredited standards organizations to help drive the adoption of ePA standards by payor and provider systems. Technical guidelines for the pilot test have been published and are available through CVS Caremark.

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