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Electronic Prior Authorization Information

Electronic Prior Authorizations

Submit a Prior Authorization request electronically

ePA is a fully electronic solution that processes PAs, formulary and quantity limit exceptions significantly faster!

  • ePA provides clinical questions ensuring all necessary information is entered, reducing unnecessary outreach and delays in receiving a determination
  • Receiving a decision faster allows patients to start therapy sooner
  • ePA is easily accessible through a web-based portal or may be integrated into your Electronic Health Record (EHR) platform

Electronic Prior Authorization eliminates unnecessary steps when compared to non-ePA methods

Non-ePA relies on fax-based communication and manual review, resulting in a turnaround time of hours to days

  • Prescriber requests pharmacy benefit manager (PBM) to fax PA Question Set
  • Prescriber receives PA Question Set to complete via fax
  • Prescriber completes PA Question Set
  • Prescriber faxes PA Question Set answers back to PBM
  • PBM reviews Question Set answers, communicates decision or returns to prescriber for corrections or to acquire additional information

ePA enables automated processing, resulting in a turnaround time of minutes to hours

  • Prescriber requests PA Question Set via EHR or online ePA portal
  • Prescriber completes PA Question Set, submits via EHR or online PA portal
  • PBM auto-scores, communicates decision via EHR or online ePA portal

Receive determinations significantly faster than fax and phone with ePA

Did you know submitting prior authorizations (PAs) by fax or phone can take anywhere from 16 hours to 2 days to receive a determination?

CVS Caremark has made submitting PAs easier and more convenient. Some automated decisions may be communicated in less than 6 seconds!

We've partnered with CoverMyMeds? and Surescripts?, making it easy for you to access electronic prior authorization (ePA) via the ePA vendor of your choice. Here is what your colleagues are saying about ePA:

"PAs are so much easier to do online. Saves valuable time that we could use to be helping our patients instead of sitting on hold. I think everyone should use this service."

"Easy to use, easy to navigate, love the way it saves patient information for future prior authorizations. Overall, very satisfied with the site."

"So much easier than phone calls to an insurance company and subsequent follow-up phone calls - everything I need is in one place."

"It saves a significant amount of time - up to 45 minutes per medication authorization in some cases. The ePA process decrease the amount of chasing multiple attempts to fax and chart review for the nursing staff."

Testimonials obtained from and authorized by an external party.

Frequently Asked Questions

What is ePA?

Electronic prior authorization enables automated processing, resulting in turnaround time of minutes-hours*

  • Prescriber requests PA question set via their electronic health record (EHR) or online ePA portal
  • Prescriber completes PA question set, submits via their EHR or online PA portal
  • PBM automatically assesses clinical information and communicates decision via their HER or online ePA portal

*May not result in near real-time decisions for all prior authorization types and reasons.

Why should I use ePA?

  • Near real-time* decisions allowing patients to start therapy sooner
  • Specific clinical questions provided electronically, reducing unnecessary faxes and phone calls
  • Easily accessible through a web-based portal or your electronic health record (EHR)

*May not result in near real-time decisions for all prior authorization types and reasons.

How much faster will I receive a determination using ePA instead of fax?

The median turnaround times between channels are:

  • Med D, ePA will take 5.9 minutes (30x faster) compared to 2.9 hours through fax.
  • Commercial, ePA will take 7.5 minutes (95x faster) compared to 12 hours through fax.
  • Specialty, ePA will take 4 hours (10x faster) compared to 41 hours through fax.

Based off Caremark PA Internal Analyses, 2019

How does the ePA process work?

The prescriber requests a PA question set using their preferred online portal (CoverMyMeds or Surescripts) or EHR. After completing the PA question set, the prescriber submits it through the online PA portal or EHR. CVS Caremark automatically assesses clinical information and communicates a decision via EHR or online ePA portal.

Why should I use ePA when I can just call the plan and obtain a determination?

ePA is more than five times faster** than fax or phone and, in some cases, gives you automated decisions in less than six seconds. Multiple ePAs can be processed in the same amount of time that it takes to complete a single case via phone, so prescribers can spend more time on patient care.

**Internal analysis of more than 300K cases from CVS Caremark PA data, 2019.

How much faster is the average time to fill using ePA instead of fax?

Based on a recent analysis comparing two types of ePA users - those who use it frequently and those who rarely use it - it was revealed that the average time to fill a script among frequent ePA users was 2 days faster than fax.

ePA leads to a 25% faster fill and improves member experience by allowing patients to start therapy sooner.

What types of requests does ePA support?

The ePA solution supports PA, quantity limit and formulary exception requests. Tier exceptions are not ePA compatible.

What general functionalities does ePA support?

The ePA channel is fully functional (chart notes, attachments, supporting statements and an urgency indicator for life-threatening situations).

Why do I receive some question sets immediately, and other times it takes longer?

The ePA solution has various checkpoints, as it attempts to return question sets for completion, to identify and validate the plan member, insurance plan, medication, and more. A medication can have different question sets depending on its formulation, strength, and route of administration, or it could be covered under a Medicaid or Medicare Part D plan. This sometimes requires secondary review to ensure the correct question set is returned for that member.

How can I start using ePA?

Go to Cover My Meds Go to SureScripts

Complimentary demo of CoverMyMeds' ePA and how it works

CoverMyMeds Walkthrough - Downloadable

Surescripts Walkthrough - Downloadable

ePA FAQs - Downloadable

Two ways to get started with your selected vendor

Access ePA through a web-based portal or an EHR-integrated solution. Choose one below.

1. Secure online portal - Registration takes only a few minutes and there is no cost for prescribers.

2. EHR Integration

If you are unable to submit requests using ePA, please visit the Prior Authorization Fax Information page for alternative submission options.

CoverMyMeds? is a registered trademark of an entity not affiliated with CVS Caremark.
Surescripts? is a registered trademark of an entity not affiliated with CVS Caremark.
?2019 CVS Caremark. All rights reserved. 91-41448A 100219

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