Prior Authorization Processes Bring Extreme Frustration


For providers, the term “prior authorization” (PA) often evokes feelings of extreme frustration, according to a survey conducted by Surescripts, an information technology company that supports e-prescription. Prior authorization is used to determine if certain drugs, such as high cost medications used for cancer treatment, are covered by a patient’s health insurer and able to be prescribed. Although designed to control costs, providers have grown extremely aggravated with the process, spending five to eight hours per week handling these requests when manual processing is the only option, a press release from Surescripts noted.

Many EHR software systems have incorporated electronic prior authorization capabilities, but the functionality may not yet be a standard option, despite vendor acknowledgment that it can improve clinician workflow and quality of care.  Providers noted three key benefits of having access to electronic prior authorization functionality:

  1. More efficient workflow
  2. Time savings
  3. Reduced administrative burden

When it comes to the inefficiencies of manual PA processing, the survey and other existing research indicated that:

  • 80% of prior authorization requests require extra work, rework or phone/fax follow upsii
  • 30% of a practice’s incoming calls are from patients looking for their prescriptions
  • Manual processing of PAs is archaic, and physicians and their clinical support staff recognize that making the process electronic is becoming increasingly important and necessary.

Of providers surveyed:

  • 83% said that adding electronic prior authorization is a priority
  • 64% agree or strongly agree that their EHR vendor should provide the functionality to help alleviate the pain points of prior authorization

Once implemented, the impact that electronic prior authorization has on a provider’s workflow is truly game changing, according to the press release. Dr. Barry Wendt, CMIO for St. Elizabeth Healthcare, noted that “it’s paperless, it’s on the EMR, it’s documented on the EMR, and it’s a much, much quicker turnaround than what we had before.” Tanya Beecher, an RN at St. Elizabeth’s, also recognized just how much having the solution has changed the PA process for the better. “It’s so fast. It’s so easy to complete PAs now. You can just open the encounter and see everything you need right in front of you,” she said.

EHR vendors recognize the value of having an electronic PA solution as well, with 88% citing that they are aware of the importance of this functionality to their customers. Similarly, 86% recognize that electronic PA functionality is something that their customers expect their technology to provide in order to help them manage the process.

But what about the impact on patients? 66% of physicians say that it can take two or more days, on average, for patients to get their medication when a prior authorization is involved,viii and 40% of prescriptions are abandoned at the pharmacy due to delays. These delays mean decreased medication adherence and ultimately affect care quality, both of which can be improved when PAs are processed electronically.


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