Prior Authorization Navigator
Premium Subscription Service
A Comprehensive Resource for State & National Rules, Statutes & Standards for Prior Authorization of Prescription Medications
Point-of-Care Partners’ Prior Authorization Navigator is a succinct yet comprehensive analysis of state and federal rules, statutes and standards governing the prior authorization of medications. It enables healthcare stakeholders to readily understand the varied approaches that states are taking to address the inefficiency of today’s paper/phone/fax prior authorization (PA) processes, which may include requiring timely responses to PA requests, standardizing PA forms and mandating electronic prior authorization (ePA).
In many states, laws and rules are formed by an overlapping web of government entities including insurance commissions as well as pharmacy boards. The Prior Authorization Navigator is a central source for stakeholders to understand the current environment of and future changes in the PA ecosystem.
We do the time-consuming research to deliver analysis in an easy-to-read, summarized set of business rules for busy software product managers.
Up-To-Date Regulatory Intelligence
- Which states require electronic submission of PAs or will require it (and when)?
- How can the PA information be transmitted?
- Which states have standardized their prior authorization forms? Do their rules require expert interpretation?
Attain peace of mind with comprehensive research of state-by-state rules, regulations and laws, both adopted and proposed, on prior authorization.
What’s the Benefit?
Answer these questions and more:
- Know in advance about newly proposed and enacted prior authorization regulatory changes that affect your organization
- Gain significant time and cost savings by avoiding last-minute changes due to latent information
- Proactively develop and apply supporting software, service, procedural and process updates to support coming changes in PA standards promulgated by the National Council for Prescription Drug Plans (NCPDP) and other entities
- Gain confidence in your organization, and among your clients, that your product or service is designed to ensure superior workflow that complies with local and federal regulations
- Benefit from POCP expert analysis for each state’s position
What does the Navigator cover?
Fully updated quarterly with intermittent alerts for urgent changes, the Navigator presents PA regulations for the 50 states and Washington, D.C.
- Status of pending and active legislative initiatives with citations, summarized by feature and by individual state
- Status of proposed and adopted rules with citations
- Links to prior authorization forms and format requirements
- Quarterly updates as a navigable database
- One-click access to full text of state and federal legislation, rules and standards
How do I access the Navigator?
Prior Authorization Navigator is offered on a subscription basis via an online portal and includes:
- A 50-state grid
- Training discussion to review material
- Quarterly updates
- Written summary of changes included in the quarterly update
- Access to POCP subject matter experts for content-related questions and clarifications
How do I subscribe?
Contact us to receive more information about the Prior Authorization State Navigator.
Track the Growth of Electronic Prior Authorization (ePA) in Your State
ePA automates the prior authorization process by electronically enabling a PA request for medication and a real-time response. Many but not all states require the use of industry standard for ePA. As ePA subject matter experts, Point-of-Care Partners can help PBMs, payers and EHR vendors implement the new standard and assist drug manufacturers in understanding the impact of ePA.