Allows Medication Prior Authorization requests to be processed and managed electronically from within Epic. There are two types of Medication Prior Authorizations which include:

  • Prospective PA: Prior authorization (PA) that is initiated at the point of prescribing.
  • Retrospective PA: Prior authorization (PA) that is initiated by pharmacy where script is to be filled.

Resources

The following resources provide information on e-PA functionality.

  • CoverMyMeds ePA Requests for Clinic Staff (CMM900) - (Video: 20 min)UThe process for clinic staff to generate ePA requests that are sent to the Central Pharmacy Prior Authorization team to manage. This process is only for clinics which are live with Pharmacy Central PA Management program.

  • E-Prescribing - Payer (AMB050) - (eLearning: 10 min) Use e-prescribing to verify pharmacy benefits, confirm the patient’s consent, view medication history, send a prescription to a mail order pharmacy, and view formulary information.

  • Pharmacy Prior Authorization Management - (Handout) For clinics and providers that are enabled, UIHC Pharmacy Staff will take ownership of completing all Prescription Prior Authorizations (PAs). As part of this implementation, some new tools will be implemented to help manage these Prior Authorizations (PA).

  • Processing Prior Authorizations Requests from the In Basket - (Handout) For clinics and providers that are enabled, UIHC Pharmacy Staff will complete all their Prescription Prior Authorizations (PAs). Pharmacy Staff work these request/s from In Basket messages that are sent from the clinic.

  • Verify Pharmacy Benefits – Medical & Rx Benefit Crosswalk - (Handout) A patient’s pharmacy benefit plan (prescription coverage) is not necessarily the same as their medical insurance coverage. When more than one pharmacy benefit plan exists, a primary must be verified with the patient and selected.

  • Verifying Primary Prescription Coverage for Clinical Staff - (Handout) Many Pharmacy Benefit Managers (PBMs) currently send information to SureScripts about their subscribers (patients), including medications that are covered or may require prior authorization to be covered by insurance. For patients who are currently subscribers to PBMs which make this information available, their information is automatically pulled into Epic the night before the visit. This PBM information is also automatically updated when the patient is checked in and can be manually queried if needed.

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