Humana is working with a health IT company to roll out an electronic prior authorization model that enables physicians to simplify prescription prior authorization requests so patients can get quicker access to their medications.
Under the agreement with CoverMyMeds, physicians submit drug prior authorizations directly to the insurer through an online portal. The requests begin processing immediately, and providers receive a notification of the status of the member's prior authorization, sometimes while the patient is still at the provider's office, Humana said in a news release.
Prior authorization assures that certain medications are used properly in appropriate situations, protects the member from dangerous drug interactions or side effects, and checks that the prescription's expense is covered. Humana's web-based model with CoverMyMeds eliminates several steps from the current prior authorization process.
In a pilot of the model, Humana found that one quarter of prior authorizations placed received a response electronically within minutes of submission. Physicians who used it overwhelmingly said the website was user friendly, and many found it helpful to receive an online status of their prior authorization determination.
"Depending on the prescription, some medications require prior authorization before coverage, which, as of now, is a time-consuming process for all parties," said Scott Greenwell, chief pharmacy officer of Humana Pharmacy Solutions, in the release, adding that prescriptions can now be approved and ready in real-time.
Many physicians still submit prior authorizations through fax machine or phone call, and insurers tend to have their own forms for determination. Automating the process can reduce administrative costs and inefficiencies and potentially save time and money.
In a document last year, the American Medical Association (AMA) supported standardization of the prior authorization process as part of overall administrative simplification under the Health Insurance Portability and Accountability Act (HIPAA).
To achieve the optimal return on investment, tools for electronic prior notification will need to provide the maximum level of automation for payers and physicians and be payer-agnostic, AMA said. Payers already use HIPAA electronic standards for electronically checking patient eligibility.