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Why the Delays at Pharmacies? How Electronic Prior Authorization and Real-Time Prescription Benefit Can Help 

healthcare technology medication adherence pharmacy Prior Authorization

Pharmacies are crucial in ensuring patients have timely access to their medications. However, prescription pickup delays have become a common concern for both patients and healthcare providers. These delays can cause more than an inconvenience. They disrupt treatment plans and potentially compromise patient health. Let’s delve into the leading factors behind pharmacy delays and explore how Electronic Prior Authorization (ePA) and Real-Time Prescription Benefit (RTPB) can help combat this growing issue. 

The Leading Cause of Delays at Pharmacies: 

Several factors contribute to pharmacy delays, with staffing and supply issues being significant contributors. Outside of these shortages, two more leading causes of delays are the traditional paper-based prior authorization process and drug-cost surprises at the pickup window.  

Prior authorization is a requirement imposed by insurance providers to ensure appropriate medication usage and cost control. It involves obtaining pre-approval before a medication can be dispensed. However, this process’s manual and paper-based nature can be time-consuming and prone to errors, leading to significant slowdowns at the start of treatment. Delays in obtaining prior authorization, often related to cost considerations, can prolong the time it takes for the pharmacy to dispense the medication to the patient. 

High medication costs can result in patients facing financial difficulties or insurance coverage gaps. In such cases, patients may need to explore alternative options, such as switching to a different medication or seeking financial assistance programs. When these resources are not available, they often abandon their medication. Addressing these affordability concerns requires additional communication and coordination between the pharmacy, healthcare providers, and the patient, which can contribute to longer processing times. Price transparency is an ongoing issue for providers and patients alike.  

The Role of Electronic Prior Authorization (ePA):

Electronic Prior Authorization (ePA) is a digital solution used to streamline the prior authorization process. It eliminates paper forms and enables healthcare providers to submit and process authorization requests electronically. This technology allows for real-time coverage verification and speeds up the approval process, reducing delays and improving patient satisfaction. By leveraging ePA, the communication channel between healthcare providers, pharmacies, and insurance companies can be streamlined and more efficient. 

The AMA found that a little more than one out of four physicians (26%) reported that their electronic health record system (EHR) offers ePA. Within this same study, the AMA shared that 84% of physicians reported an increase in prescriptions requiring prior authorization. 

The Role of Real-Time Prescription Benefit (RTPB):

Real-Time Prescription Benefit (RTPB) is another technology that can significantly combat prescription pickup delays. RTPB provides real-time information on medication costs and coverage at the point of prescribing. Integrating RTPB into your EHR/EMR allows healthcare providers to instantly access patient-specific health plan and formulary information, copay details, and covered therapeutic alternatives. This empowers providers to make informed decisions about medication choices, considering both clinical appropriateness and patient affordability. By reducing surprises at the pharmacy counter, RTPB helps mitigate delays and ensures patients aren’t blindsided at the pickup window.  

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Combatting Delays with ePA and RTPB:  

The implementation of ePA and RTPB can offer multiple benefits in combatting delays at pharmacies: 
  1. Efficiency and Speed: ePA enables pharmacies to submit prior authorization requests electronically, reducing manual paperwork and streamlining the process. RTPB provides real-time information on medication coverage, ensuring accurate decisions are made at the point of prescribing. 
  1. Enhanced Communication: ePA facilitates direct and secure communication between pharmacies, healthcare providers, and insurance companies. This enables prompt resolution of any authorization issues and minimizes time to therapy. 
  1. Improved Patient Experience: By leveraging ePA and RTPB, providers will establish trust with their patients and can help them experience shorter wait times at the pharmacy. They are less likely to face unexpected denials or copay surprises, leading to improved satisfaction. Happy patients give higher ratings on patient satisfaction surveys!  
  1. Cost Savings: Streamlining the prior authorization process and providing real-time cost information at the point of care can help reduce administrative costs for pharmacies and healthcare providers while optimizing medication choices based on affordability. When patients can afford their medication, adherence usually improves. 

Delays in prescription pickups at pharmacies can have significant implications on patient outcomes. Adopting ePA and RTPB technologies presents promising solutions to this issue. By streamlining the prior authorization process and providing real-time medication coverage information, ePA and RTPB can work together to significantly reduce delays, improve patient satisfaction, and enhance overall healthcare efficiency. As the healthcare industry continues to embrace digital innovations, it is essential to prioritize these technologies to ensure timely access to medications for all patients.