J Am Pharm Assoc (2003). 2022 Nov-Dec;62(6):1843-1847. doi: 10.1016/j.japh.2022.07.011. Epub 2022 Aug 9.
Prior authorization (PA) is a utilization management tool used by health plans and pharmacy benefit managers where the payer requires additional documentation from health care providers before authorization of payment for a medication or procedure. PA processes are hypothesized to be more efficient if electronic transmission is utilized instead of manual submission.
To evaluate the impact of electronic PA (ePA) on approval rate and time to decision and to assess health care provider perception of using ePA.
America's Health Insurance Plans selected 2 technology companies, Availity and Surescripts, and used an independent research organization (Research Triangle Institute [RTI]) to conduct a provider survey and analyze over 40,000 PA transactions from participating health plans. RTI examined processing time, provider experience, and other measures for PAs both before and after provider implementation of ePA.
Providers used these tools for roughly 62% of PAs in the 6 months after implementation. The median time from PA request to decision fell from 18.7 hours to 5.7 hours. Providers using ePA reported observing some benefits relative to the number of phone calls and faxes required after ePA implementation.
The primary benefit of ePA implementation was reduced time to decision. Additional benefits may occur with greater adoption since 38% of PAs were still manual after implementation of ePA.
事先授权（PA）是一种由健康计划和药品福利经理使用的利用管理工具，在这种工具中，支付方在授权支付药物或程序之前需要从医疗保健提供者那里获得额外的文件。假设如果使用电子传输而不是手动提交，PA 流程会更有效率。
评估电子 PA（ePA）对批准率和决策时间的影响，并评估医疗保健提供者使用 ePA 的看法。
美国健康保险计划选择了 2 家技术公司，Availity 和 Surescripts，并利用一个独立的研究组织（研究三角研究所 [RTI]）进行了一项供应商调查，并分析了来自参与健康计划的超过 40,000 份 PA 交易。RTI 审查了 PA 前后的处理时间、供应商的经验以及其他措施。
供应商在实施 ePA 后的 6 个月内大约使用了这些工具处理 62%的 PA。从 PA 请求到决策的中位数时间从 18.7 小时下降到 5.7 小时。使用 ePA 的供应商报告称，在实施 ePA 后，与需要的电话和传真数量相比，他们观察到了一些好处。
实施 ePA 的主要好处是决策时间缩短。随着 ePA 实施后仍有 38%的 PA 是手动处理的，可能会出现更多的好处。
