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Electronic Prior Authorization Enables “Clinically Appropriate” Prescribing, Market Researcher Says

This article was originally published in The Pink Sheet Daily

Executive Summary

Automating prior authorization would be useful for drug classes, such as COX-2s and proton pump inhibitors, where coverage varies widely, MediMedia says. The firm maintains that implementation would be less complex than PBMs have asserted.

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PBMs Object To Real-Time Prior Authorization As Part Of E-Prescribing

Medco, Express Scripts and Cigna maintain that “automated” prior authorization is not feasible because it requires a discussion with the doctor. The PBMs recommend that HHS should support electronic transmission of prior authorization “where feasible.”

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Network providers RxHub and SureScripts are expected to testify. The National Health Statistics/Standards Subcommittee is charged with developing principles for electronic prescribing under the Medicare drug benefit.

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