ePrior Authorization’s Real Benefits: Reducing Frictional Costs and Speeding Time to Therapy

Authors: Ken Kleinberg, Jocelyn Keegan, Tony Schueth, Michael Solomon

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This new and comprehensive report by Point-of-Care Partners (POCP) on electronic prior authorization (ePA) is aimed at providing advice to payers, providers, life sciences companies, and the stakeholders supporting them. It will be especially valuable to aspirational and progressive payers and providers involved in value-and risk-based contracts, as well as organizations that are similarly challenged to improve patient safety while also containing rising costs.

The report leverages Point-of-Care Partner’s unique perspective and relationship in the market with payers, providers, and their vendors. POCP’s experts drew on their extensive experience with ePA, ePrescribing, medication management, and transactions in support of value-based care together with industry interviews to craft this compelling report with a focus on:

  • Current market conditions and market drivers for ePA, including analysis of the differences of ePA adoption (and why ePA in many areas has stalled), opportunity, and return on investment between regular and specialty medications (and why they should be such a high focus), and between pharmacy vs medical benefit (and why they should come together).
  • Required ePA technical components, including integrated workflow vs portals, and interoperability/transaction standards, including the current and future use of X12 (and why the 278 has been a hinderance), National Council for Prescription Drug Programs (NCPDP) Script (and why it has been so successful), and evolving Health Level 7 (HL7) standards such as Fast Healthcare Interoperability Resources (FHIR) (which shows substantial promise), and their relationship to real-time benefit check.
  • An ePA maturity model to help advise organizations where they are and what they need to do to progress to the fourth stage, the ideal ePA; adoption challenges of ePA; multiple ePA cases studies; and lessons learned.
  • ePA vendor profiles featuring the most comprehensive list ever compiled of more than 40 representative and leading ePA ecosystem vendors segmented by their primary ePA focus into seven categories: specialty/intermediary ePA, payer and utilization management (UM), ePrescribing network, clinical content, PBM, EHR, and Revenue Cycle Management (RCM).
  • A future ePA outlook, including the impact of artificial intelligence/natural language processing, use of blockchain, which regulations will have the greatest impact (including views on proposed critical CMS and ONC regulations), and what it will take to reach a seamless future of provider/payer convergence.
  • Specific, actionable advice for payers, providers, converged value-based entities, vendors, and other key stakeholders to drive ePA success.

ePA Solutions Ecosystem Profiled Vendors

Cigna/Express ScriptsAnthem/AIM SpecialtyAllscriptsAvailityChange/InterQualAllscripts/VeradigmAgadia
MedImpactAsembiaathenahealthInfinixHearst MCGDrFirstCognizant/Trizetto
Optum/OptumRxCenterXCernerRecondoWolters KluwerSurescriptsCVS/Novlogix
Prime Therapeutics CoverMyMedseClinicalWorksZappRxHearst/MHK
and 10 other companiesand 5 othersand 1 otherand 2 others

ePA vendor profiles featuring the most comprehensive list ever compiled of more than 40 representative and leading ePA ecosystem vendors segmented by their primary ePA focus into seven categories

What’s covered in the report?

Here’s some of what you’ll get in this comprehensive 107-page report:

1. Understanding the Many Different PA Paths Retrospective vs. Prospective ePA

2. ePA adoption challenges and how to address themePA Adoption Challenges

3. Identifying the greatest short and longer-term opportunities for ePA


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Want to learn more? Want to learn more? Click here for a report preview or call us at 877-312-7627, option 4  or drop us an email at info@pocp.com.

Jeanette Nelson

Jeanette Nelson