CoverMyMeds — Electronic Prior Authorizations for Improved Medication Access

Depending on who you ask, prior authorizations (PAs) are either an efficient way to control medication costs or yet another administrative burden that take up valuable caregiver time, and too often stand in the way of a patient receiving a prescribed medication or service.

Pharmacy benefit manager (PBM) OptumRx emphasizes the role PAs have in helping to “manage costs, control misuse and protect patient safety,” while CVS Caremark cites their importance in minimizing the risk of an adverse reaction and identifying possible therapeutic alternatives.

Physicians seem to have a less favorable attitude about PAs, which the American Medical Association (AMA) defines as “a cost-control process that requires health care professionals to obtain advance approval from health plans before a prescription medication or medical service qualifies for payment and can be delivered to the patient.”  A statement from the AMA notes: “…physicians and other providers find these programs to be time-consuming barriers to the delivery of necessary treatment.” Read more >