Electronic Prior Authorizations (ePA) and the Evolution of Prior Authorizations 

A healthcare provider at a computer with a form blurred and a checkmark, alluding to the fast approvals available with electronic prior authorizations (ePA).

In the fast-paced world of healthcare, timely access to medications is crucial. Serve You Rx’s Electronic Prior Authorization (ePA) program, established by the NCPDP, is designed to facilitate real-time medical determinations during prescribing. This electronic system allows for the seamless transmission of prior authorization information between the provider and payer, significantly enhancing the efficiency of the authorization process. 

The Benefits of ePA 

The adoption of ePA by providers is on the rise, and for good reason. The benefits of this innovative process are manifold: 

  • Quicker Access to Treatment: Patients receive their medications faster, ensuring timely care. 
  • Fewer Pharmacy Rejects: Reducing rejected prescriptions at pharmacies means fewer patient delays. 
  • Reduced Administrative Burden: Fewer phone calls between providers, pharmacies, and PBMs (Pharmacy Benefit Manager) streamline operations. 
  • Improved Medication Compliance: By reducing patient abandonment of prescriptions, our program helps increase medication compliance. 
  • Enhanced Satisfaction: Both providers and patients benefit from a smoother, more efficient process. 

The Impact of ePA 

The potential impact of integrating ePA into our offerings is substantial: 

  • For Our Clients and Partners: With ePA, we maintain a competitive offering in the marketplace, open new business opportunities, and improve client retention. 
  • For Our Members: A more streamlined prior authorization process ensures timely access to medications, boosting member satisfaction and, consequently, client satisfaction. 

What Is Electronic Prior Authorization?

Our ePA system offers a web-based solution for receiving prior authorization requests, bypassing traditional methods like phone and fax. Key features include: 

  • Capabilities: Initial prior authorization requests, renewal requests, and appeals. 
  • Auto Decision Capability: Real-time prescriber notification of prescription approval or denial. 

How It Works 

  1. Request: Prescribers initiate a medication prior authorization within their e-prescribing workflow. 
  2. Question Set: The prescriber receives an electronic question set specific to the member, prescription benefit plan, and medication. 
  3. Response: The prescriber completes and returns the question set electronically. 
  4. Review: PBM (or payer) reviews the question set and provides prior authorization approval or denial.  

The Serve You Rx ePA Program 

We launched our ePA program in 2023 and continue to drive provider adoption. 

We’re committed to enhancing the prior authorization experience, ensuring quicker medication access, and improving overall satisfaction for providers, members, and clients. The ePA program is a testament to our dedication to innovation and excellence in healthcare services. 

By Senior Clinical Pharmacist Christine Bretzmann

About Serve You Rx   
Serve You Rx is a full-service pharmacy benefit manager (PBM) with unquestionable flexibility and an unwavering commitment to doing what’s best for its clients. With a fervent focus on those it serves, including insurance brokers, consultants, third-party administrators, and their clients, Serve You Rx delivers exceptional service and tailored, cost-effective benefit solutions. Independent and privately held for over 37 years, Serve You Rx can implement new groups in 30 days or less and say “yes” to a wide variety of viable solutions. Known for its adaptability, quality, and client-centricity, Serve You Rx aims to be a benchmark for better client service.

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