Implementation and impact assessment of integrated electronic prior authorization in an academic health system

Abstract

ObjectiveTo describe the system-wide implementation of integrated electronic prior authorization (ePA) and its impact within a centralized prior authorization (PA) department in an academic health system. SettingPrescription drugs have been among the fastest growing areas of health care and continue to advance; therefore, costs associated with medications are continually rising. Pharmacy benefit managers implement tools such as PAs in an effort to manage costs. PAs are often viewed as inconvenient and irritating by both patients and clinical staff. Practice descriptionThe pharmacy ambulatory clinical care center (PAC3), a centralized PA department, provides PA services to some clinics within the system. Since 2014, the system has worked to optimize the manual (by telephone and fax) PA process. However, it is still a time-consuming, multistep process. Practice innovationA resolution to the PA problems that health systems face is ePA, which involves processing PAs electronically through an online portal or integrated within an electronic health record. The system began the implementation process with the selection of an ePA vendor, followed by implementation within the electronic health record. Once the software was ready, the system took a phased rollout approach and implemented ePA in a few specialty and primary care clinics at a time. EvaluationAn average of 24% of PAs processed by PAC3 were completed by ePA. The system saw a 25% increase in the number of PAs processed per month by 1 PA coordinator full-time equivalent. In addition, a 62% decrease in the PA turnaround time allowed patients to receive medications faster. ResultsNot applicable. ConclusionePA offers several benefits to the system including decreased turnaround time. This allows patients to receive medications and start therapy earlier. The ePA process also increased efficiency, allowing PAC3 to centrally manage PAs for additional clinics, thereby decreasing the workload in the clinic.