At the end of last year, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that requires that Part D prescription drug plans support a new electronic prior authorization transaction standard for their Part D e-prescribing programs. This rule aims to decrease delays in patient treatment and reduce providers’ administrative burden.
As a result, all Part D plans will need to comply with this rule starting January 1, 2022, or risk CMS enforcement. Fortunately, Surescripts Electronic Prior Authorization tool can help Part D plans to become compliant. Surescripts Electronic Prior Authorization integrates with electronic health records software, enabling healthcare professionals to quickly obtain prior authorizations for prescriptions in real-time at the point of care while eliminating time-consuming paper forms, faxes and phone calls. When this prospective workflow is used, medication pickup rates at integrated pharmacies improve by six percentage points.
By allowing rapid prior authorization approvals while patients are in the office, healthcare providers have more time for meaningful patient engagement. For patients, approvals in the office mean surprises and delays at the pharmacy are eliminated.
There’s broad consensus among health plans about the importance of moving toward industry-wide adoption of electronic prior authorization. Specifically, 84% of health plans identified automating the prior authorization process as one of the biggest opportunities for improvement in a recent survey by America’s Health Insurance Plans (AHIP). The study also found that the vast majority of health plans reported positive impacts from prior authorization programs in terms of quality of care, affordability, and safety.
For all of these reasons, Surescripts applauds CMS’s commitment to streamlining the prior authorization process and putting patients over paperwork. Learn more about how Surescripts Electronic Prior Authorization helps health insurance providers, EHR software vendors and prescribers work together to improve patient care.