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Annual Report Reveals Impact, Adoption, Legislation of ePA and Examines Real-Time Prescription Benefit, Specialty Medication Landscape
COLUMBUS, OH, Feb. 20, 2018 — Electronic health record systems (EHRs) representing 79 percent of market share, 100 percent of pharmacies and nearly the entire payer industry are committed to implementing an electronic prior authorization (ePA) solution, according to new research released today by CoverMyMeds. The 2018 ePA National Adoption Scorecard summarizes the current state of ePA in the industry, quantifies the impact of prior authorization (PA) to patients and providers, and highlights current ePA adoption and implementation rates by market leaders. To access the report, visit epascorecard.covermymeds.com.
According to the 2018 National Adoption Scorecard, the industry as a whole recognizes the importance of an ePA solution and how it benefits all stakeholders. As progress is made, the report indicates the future focus of health care will likely shift to other areas of improvement in the industry, such as solutions for real-time prescription benefit (RTPB) transactions and specialty medication—two new sections added to this year’s report.
“A real-time prescription benefit solution is an essential tool to drive better patient-centric care,” said Rita Russell, RPh, Senior Director, Relationship Management at RelayHealth Pharmacy. “Education around RTPB solutions is vital for success. The ePA National Adoption Scorecard is a great resource to house this information, and in the future, will provide industry adoption trends as they become available.”
Key metrics and takeaways from the 2018 ePA National Adoption Scorecard include:
“The purpose of the ePA National Adoption Scorecard is to educate readers on the current state and near future needs of critical patient-focused, health care IT solutions—such as ePA, RTPB and electronic specialty platforms,” said Perry Lewis, VP of Industry Relations at CoverMyMeds. “Encouraging data discoveries from this year’s report demonstrate a robust adoption of ePA. As more stakeholders exclusively utilize an ePA solution, I’m confident we’ll see a corresponding increase in patient medication adherence and a decrease in avoidable medical spending.”
This year’s report also includes filmed interviews with physicians and payer partners who utilize ePA solutions to more efficiently submit and review PA requests.
The ePA National Adoption Scorecard is published by CoverMyMeds with an advisory group comprised of leaders from RelayHealth, Express Scripts, the National Council for Prescription Drug Programs, Cerner Corporation, Cardinal Health, the National Alliance of State Pharmacy Associations and the Virginia Association of Health Plans.
Those attending HIMSS18 March 5 – 9, 2018 may visit CoverMyMeds at booth 4612 for additional information related to the newly-released ePA National Adoption Scorecard. To view the full report, visit epascorecard.covermymeds.com.
CoverMyMeds, an independent business unit within McKesson, is a leader in electronic prior authorization (ePA) solutions and one of the fastest growing health care technology companies in the U.S. CoverMyMeds’ software suite automates the medication prior authorization process for more than 500 electronic health record systems (EHRs), 62,000 pharmacies, 700,000 providers and most health plans and PBMs. By facilitating appropriate access to medications, the company can help its customers avoid billions of dollars each year in administrative waste and avoidable medical spending caused by prescription abandonment. Visit www.covermymeds.com for more information.
1 CoverMyMeds Analytics, 2017 (Based on two months of paid and rejected data from PioneerRx. Data only considers reject codes 70,75 and MR.)
2 AIS Health “Despite Widespread Adoption, Electronic Prescribing Still has User Limitations.” Nov 2013
3 CoverMyMeds Specialty Follow Up Survey, 2017
4 CoverMyMeds Industry Provider Survey, 2016
SAN FRANCISCO, March 1, 2018 – RelayHealth Pharmacy Solutions and CoverMyMeds, part of the McKesson Rx Technology Solutions business, today announced RxBenefit Clarity™ (RxBC), a groundbreaking decision support solution that can provide precise prescription benefit and prior authorization (PA) information across all payers at the point of prescribing. Leveraging the nation’s leading pharmacy network, RxBenefit Clarity delivers the most accurate patient pay and real-time benefit information in the prescribing workflow today.
When writing a prescription, providers strive to make decisions based on unique clinical situations and individual care plans developed in consultation with their patients. Providers face significant obstacles in this process, including a dependency on inaccurate or incomplete drug formularies, patient co-pay information and prior authorization requirements. This lack of insight causes medication fulfillment gaps, which often lead to costly non-adherence—adding up to as much as $280 billion in avoidable costs each year.1,2
Real-Time Prescription Benefit (RTPB) solutions that rely solely on formulary and benefit information to help physicians make a prescribing decision are limited in their effectiveness and accuracy. Additionally, RTPB solutions focused on meeting the needs of one stakeholder may fail to meet the needs of the provider and patient by presenting inaccurate patient cost-share information or overly complex treatment options.
In contrast, RxBC is focused on helping patients get the medication they need to live healthy lives by acquiring real-time patient benefit coverage information and actual out-of-pocket costs directly from the pharmacy where the patient will fill their prescription. RxBenefit Clarity also notifies the provider when a PA is needed to fill a prescription, and gives the prescriber the option to proactively initiate an electronic prior authorization (ePA). Accurate patient cost share information and formulary restrictions allow the provider to select the most appropriate therapy for the patient.
“RelayHealth Pharmacy Solutions and CoverMyMeds created the industry’s most reliable prescribing decision support solution based on years of research and long-term partnerships across the entire pharmacy ecosystem, including pharmacies, providers, payers and life science companies,” said Nathan Mott, president of McKesson Rx Technology Solutions. “Each year, RelayHealth Pharmacy Solutions processes more than 18 billion pharmacy transactions—RxBenefit Clarity puts similar functionality in the hands of the provider, enabling them to have more informed conversations with patients that help drive adherence. The solution is truly pioneering the future of prescribing decision support within the EHR.”
NewCrop, LLC will soon make RxBenefit Clarity available to the more than 64,000 providers using the NewCrop platform.
“RxBenefit Clarity empowers providers to make medication therapy decisions with their patients, eliminating barriers that often lead to prescription abandonment,” said Randy Barnes, Executive Vice President of NewCrop. “What makes RxBenefit Clarity unique is its extraordinary accuracy, delivering medication benefit transparency, including the patient pay amount and whether a medication requires prior authorization. Providing medication benefit information at the time of prescribing will enable providers and patients to make informed decisions together, considering affordability and benefit coverage before the prescription is sent to the pharmacy.”
RelayHealth Pharmacy Solutions’ and CoverMyMeds’ combined network includes more than 62,000 pharmacies, 500 EHRs, 700,000 providers and most payers. As a result of their network, RxBenefit Clarity can provide coverage for all payers without requiring payer-by-payer implementation or network alliances.
RxBenefit Clarity can be easily integrated into any EHR through an API. For more information, visit go.covermymeds.com/RxBC.
Those attending HIMSS18 March 5 – 9, 2018 can register for The Evolution of RxBenefit Transparency Lunch and Learn on Wednesday, March 7 at 11:15 a.m. in room 101 to learn more about RxBenefit Clarity, or visit CoverMyMeds at booth 4612 for additional information.
1Annals of Internal Medicine. “Interventions to Improve Adherence to Self-administered Medications for Chronic Diseases in the United States: A Systematic Review” December 4, 2012, Vol 157, No.11
²D.P. Goldman. “Pharmacy Benefits and the Use of Drugs by the Chronically Ill,” JAMA, May 2004.
NewCrop is the leading electronic prescribing service and has been deployed in a wide range of EHRs and medical networks since 2003. The company’s user interface allows for rapid installation of fully expedited e-Prescription networking, as well as Meaningful Use certifications, lab integration, secure messaging, registry reporting, DEA-compliant EPCS audit, and more. All services are available as an integrated user interface and/or data services for all individual features, facilitating easy and flexible installations to fast track network and ONC Health IT certifications. For more information, visit www.newcroprx.com.
About RelayHealth Pharmacy Solutions
RelayHealth Pharmacy Solutions (RHPS), part of McKesson Rx Technology Solutions, manages the nation’s leading pharmacy network, providing essential healthcare connectivity among retail pharmacies, physicians, health plans, pharmacy benefit managers, government agencies and pharmaceutical manufacturers. Processing more than 18 billion healthcare transactions annually we deliver prescription benefit transparency to physician EHRs and help more than 50,000 retail pharmacies streamline operational efficiency, improve medication accessibility and adherence and deliver value-added, cost effective clinical services that improve patient health and outcomes. For more information, visit http://www.relayhealth.com/RHPS.
CoverMyMeds, part of McKesson Rx Technology Solutions, is a leader in electronic prior authorization (ePA) solutions and one of the fastest growing health care technology companies in the U.S. CoverMyMeds’ software suite automates the medication prior authorization process for more than 500 electronic health record systems (EHRs), 62,000 pharmacies, 700,000 providers and most health plans and PBMs. By facilitating appropriate access to medications, the company can help its customers avoid billions of dollars each year in administrative waste and avoidable medical spending caused by prescription abandonment. Visit www.covermymeds.com for more information.