Medication prior authorization from the providers perspective: A prospective observational study

Abstract

Data were obtained from eight unique community provider offices (8 sites) at which 29 prescribers practice. The pain points identified represented five main categories: 1) information transfer gaps; 2) format disparities; 3) outdated technologies; 4) care consequences; and 5) workarounds. Prescribers and their staff suggested improvements that included real time eligibility and formulary alerts regarding PA during the e-prescribing process, accurate, up-to-date formulary data with easy-to-access alternatives, and embedded PA that is integrated with electronic medical record data. Three sites used medication PA portals such as CoverMyMeds® for information gathering, but at the time of data collection, no sites used these PA portals for prospective electronic prior authorization (ePA) or the electronic process of requesting authorization from health plan payers for coverage.