INTELLIGENCE IN ACTION

Health Plans and PBMs Team Up to Get Patients Needed Medications Easier and Faster

June 19, 2019

Anyone who works in health IT knows how gratifying it is when we offer clinicians a tool that is so much better than old processes, and they run with it. And it’s especially transformative when technology replaces a manual process—one that absorbed a great deal of time and resources.

This is the case with medication prior authorization. The manual version is burdensome, unreliable and often causes patients to wait to pick up their needed prescriptions. The electronic version is better, faster and helps ensure that the medication is filled and waiting at the pharmacy as expected.

Read the press release: Health Plans and Pharmacy Benefit Managers Leverage Technology to Streamline Medication Prior Authorization for Virtually All U.S. Patients

While manual prior authorization is far from ideal, it does serve an essential purpose in healthcare. It is an important tool in managing things like opioid abuse. And it helps leverage health plan benefits efficiently to ensure quality care, reduce healthcare waste and control costs.

Last year, provider adoption of Electronic Prior Authorization grew by 128%, and transactions increased by 172% nationwide. Over the past 18 months, several national, regional and local PBMs and health plans have signed on, increasing the number of insured lives covered by nearly 20%.

The collaboration among participants in the Surescripts Network Alliance™ means that virtually all patients can get their medications quicker and with less hassle. And for those of us in health IT, it’s the perfect case study for what happens when we align our resources at the intersection of innovation and patient care.

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August 22, 2019

Surescripts Supports CMS in its Effort to Streamline Prior Authorization for Prescribers and Expedite Patient Access to Needed Medications

While we strongly support the CMS goal of accelerating the use of electronic prior authorization, Surescripts urges CMS to clarify in the final rule that NCPDP SCRIPT Standard v2017071 can be used for both Part D and non-Part D plans. Not doing so could result in reducing rather than accelerating utilization of electronic prior authorization.  Read more...
July 25, 2019

How Aurora Health Care Used Electronic Prior Authorization To Cut Clinic Staff Overtime By More Than Half

The reality of traditional prior authorization is this: While the prescriber, the PBM and the pharmacy team spend valuable time making phone calls, tracking down information and filling out forms, the patient waits. And waits. And waits. In other words, patients face delays in receiving their prescriptions, clinicians lose valuable time and the health system faces mounting overtime costs.

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May 20, 2019

Federal Government Issues Final Rule: Part D Plans Must Adopt a Real Time Benefit Tool

On May 16, the Centers for Medicare and Medicaid Services (CMS) issued its final rule: Medicare Advantage and Part D Drug Pricing Final Rule (CMS-4180-F).

We’ve been closely following this proposal as it relates to e-prescribing and the Part D prescription drug plan in particular. The rule is designed to accelerate the use of Real Time Benefit Tools (RTBTs), such as Surescripts Real-Time Prescription Benefit.

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