INTELLIGENCE IN ACTION

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

August 22, 2019

In June, the Centers for Medicare and Medicaid Services (CMS) proposed a rule that will allow clinicians to choose to complete prior authorizations electronically.

In order to offer a streamlined workflow, the proposed rule, which would go into effect on January 1, 2021, also requires the adoption of NCPDP SCRIPT Standard v2017071 for all electronic prior authorizations for drugs covered under Medicare Part D.

“This proposed rule would reduce the time it takes for a patient to receive needed medications and ease the prescriber burden by giving clinicians the flexibility and choice to complete prior authorization transactions electronically,” said Seema Verma, CMS Administrator

Read Surescripts’ comments on the proposed CMS rule.  

According to the American Medical Association:

  • 64% of physicians report waiting an average of at least one business day for prior authorization decisions.
  • 30% of physicians report waiting at least three business days.
  • 92% of physicians say that the prior authorization process has a negative impact on patient clinical outcomes and delays access to necessary care for some of their patients
  • 78% of physicians say it causes some of their patients to abandon treatment.

In contrast, electronic prior authorization delivers a response within minutes in most cases—often while the patient is still in the doctor’s office. The patient then picks up their medication at the pharmacy as expected, and begins treatment without delay.

Last year, provider adoption of Surescripts Electronic Prior Authorization grew by 128%, and transaction volume 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%.

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.

We applaud the government in its efforts to leverage interoperability and electronic prior authorization at the point of care. Prescribers and pharmacists want to step away from the phone and fax machine and get back to patient care. And patients deserve a safe, secure and reliable prescribing process free from avoidable administrative delays. We know that when the medication is ready and waiting at the pharmacy, patients are more likely to adhere to their treatment plan and achieve the outcomes their physician intended.

Learn more about Surescripts Electronic Prior Authorization.

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