Integrated Electronic Prior Authorization (ePA) Solutions: Electronic Health Records, Pharmacy Dispensing System Vendors and Web Portal Options

About NCPDP Founded in 1977, NCPDP is a not-for-profit, ANSI-accredited, Standards Development Organization with over 1,600 members representing virtually every sector of the pharmacy services industry. NCPDP members have created standards such as the Telecommunication Standard and Batch Standard, the SCRIPT Standard for e-Prescribing, the Manufacturers Rebate Standard and more to improve communication within the pharmacy industry. Our data products include dataQ®, a robust database of information on more than 76,000 pharmacies, and HCIdea®, a database of continually updated information on more than 2.3 million prescribers. NCPDP's RxReconn® is a legislative tracking product for real-time monitoring of pharmacy-related state and national legislative and regulatory activity. www.ncpdp.org

About CoverMyMeds Founded in 2008, CoverMyMeds is the nation’s largest and most connected electronic prior authorization (ePA) solution. We help patients receive the medication they need to live healthy lives by automating the prior authorization (PA) process, saving health care professionals valuable time and reducing prescription abandonment. CoverMyMeds integrates directly within prescriber and pharmacists’ existing workflows as well as with health plans and payers to allow for near immediate determinations. More than 700,000 providers and over 49,000 pharmacies currently process ePA requests through the CoverMyMeds web portal, as well as via their electronic health record (EHR) or pharmacy system vendor. Our technology integrates with more than 500 EHR vendors, 80 percent of pharmacy system vendors and payers representing 75 percent of U.S. prescription volume. Providers using our solution successfully process more than 1.6 million PA requests every month. www.covermymeds.com

About HIMSS HIMSS North America, a business unit within HIMSS, positively transforms health and healthcare through the best use of information technology in the United States and Canada. As a cause-based non-profit, HIMSS North America provides thought leadership, community building, professional development, public policy and events. HIMSS North America represents 64,000 individual members, 640 corporate members and over 450 non-profit organizations. Thousands of volunteers work with HIMSS to improve the quality, cost- effectiveness, access, and value of healthcare through IT. Major initiatives within HIMSS North America include the HIMSS Annual Conference & Exhibition, National Health IT Week, HIMSS Innovation Center, HIMSS Interoperability Showcases™, HIMSS Health IT Value Suite, and ConCert by HIMSS™. HIMSS Vision: Better health through information technology.   www.himss.org

Matt Brennessel, Manager of Pharmacy Accounts, CoverMyMeds Matt’s team is responsible for managing the use of an electronic prior authorization (ePA) solution for many of the nation's retail, long-term care and specialty pharmacy operations. During Matt’s four years with the CoverMyMeds team, he worked directly with the nation’s largest pharmacy chains leading successful implementations, assisting in launching new pharmacy prior authorization (PA) solutions and helping to grow CoverMyMeds pharmacy-initiated PA volume from 200k per month to over 1.3 million. Matt is an active member of NCPDP (National Council for Prescription Drug Programs), and an adamant supporter of enhancing pharmacy, patient and provider experiences in health care through innovation.

Ryan Tarzy, EHR Business Development and Strategic Partnership, CoverMyMeds Ryan leads Business Development and Strategic Partnerships for the Provider vertical at CoverMyMeds. Ryan has over 15 years of experience as a founder or executive of digital health startups. In 2003 he co-founded MediKeeper, one of the early pioneers in digital health. He was also the co-founder of Playful Bee, an early childhood development startup with the mission of delivering all children to Kindergarten healthy and prepared for school. Previous to CoverMyMeds, he served as Senior Vice President of Business Development for PokitDok and Vice President of Business Development at Healthline Networks.

Hemal Desai, President BestRx Pharmacy Solutions Hemal is the president and lead developer at BestRx, a company that provides pharmacy management software for independent pharmacies. Hemal has been with BestRx since 2002 where he has been responsible for the management and development of adding new features to the BestRx system. Prior to working at BestRx, Hemal attended undergraduate school at the University of Illinois at Urbana-Champaign.​

Accreditation Statement The Institute for Wellness and Education, Inc., is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education.  Participants of the session who complete the evaluation and provide accurate NABP e-Profile information will have their credit  for 1.0 contact hours (0.10 CEU) submitted to CPE Monitor within 60 days of the event. Please know that if accurate e-Profile information is not provided within 60 days of the event, credit cannot be claimed after that time.   ACPE program numbers are: 0459-0000-17-024-H04-P and 0459-0000-17-024-H04-T Initial release date is Feb.14, 2017

Learning Objectives Outline best practices for implementing an integrated ePA solution in your business Articulate how a web portal solution supplements integrated solutions Identify your system vendor and interpret what an ePA integration implementation would look like Effectively integrate an ePA solution in your business

Pre-Test Questions What types of prior authorization management methods are available to your pharmacy or practice? What are the main considerations you take when evaluating a new tool for your pharmacy or practice? What does your current process for managing PA look like?

Prior Authorization, Defined Prior authorization (PA) is a requirement that your physician obtain approval from your health insurance plan to prescribe a specific medication for you. PA is a technique for minimizing costs, wherein benefits are only paid if the medical care has been pre-approved by the insurance company. PA is typically required due to quantity limits, step therapy, non-formulary medications and expensive specialty drugs. Issues with Prior Authorization: Prior to electronic prior authorization (ePA), a prior authorization required a fax based workflow to be completed by the provider and staff. Each health plan/PBM having their own set of unique requirements. Impact on Medication Adherence: 40% of medications requiring prior authorization are abandoned once rejected at the pharmacy

Administrative Waste More than 50% of providers indicate that they and their staff spend up to 20 hours per week on PA requests Pharmacists spend an average of 5 hours per week on PA requests

Prescriber Costs by the Numbers Nationwide, physicians spend $37 billion annually interacting with health plans. Much of that cost is directly related to prior authorization and medication formulary requirements. Prescribers/physicians carry a huge financial burden when addressing prescriptions that need a prior authorizations based upon eligibility or plan formularies. Most offices have dedicated staff who constantly deal with the process with PBM’s or health plans to obtain coverage. In addition you as a pharmacist must also have procedures and/or staff in place to handle the process.

Medication Non-Adherence Medication non-adherence costs more than $100 billion a year in excess. Nearly 30% of prescriptions written are never picked up 75% of patients fail to take medications as prescribed

Abandoned Prescriptions Recent studies reflect 265 million claims a year result in prior authorization requests. Based on Frost & Sullivan study

Completion and Turnaround Times PRE-ELECTRONIC ELECTRONIC FAX ePA Completion 15-20 Minutes 3-5 Minutes Web: 3-5 Minutes EHR: Seconds Turn Around Time 3-5 Days 2-4 Days Approved: Real-time Denied: <24 Hours

Electronic Prior Authorization (ePA) RETROSPECTIVE PROSPECTIVE ALL PAYER Ability to receive PA requests started by a pharmacy Allows prescriber to start a PA request in E-Prescribing workflow Supports completion of PA requests for any health plan or PBM

ePA Workflow: Retrospective Initiates Request Call CP! Completes Request Electronic Connection Pharmacy Prescriber or Staff Plan/PBM Explain provider as party that submits PA to plan

ePA Workflow: Prospective Initiates and Submits Request at Point of Prescribing Call CP! Electronic Connection Prescriber or Staff Plan/PBM Pharmacy

EHR Implementation Best Practices

EHR Implementation Best Practices Commit to the three standard workflows that allow providers to accommodate any type of PA Request Prospective Retrospective Administrative Determine which style of integration is best for your EHR Native Solution Embedded Web Solution Narrative for workflows: Failing to implement a full comprehensive solution could affect user adoption.  Maybe talk about the indicator technology and how we will see the shift in prospective? Narrative for Integration Style: There are ePA solutions that have the luxury of offering both.  Depending on the EHRs development team size and bandwidth, typically plays a large role in the style of integration.  Keeping the user experience consistent plays a huge role as well. (Mention how in the last webinar, Cerner mentioned first hand pros and cons of their Native solution- reiterate those points)

PA Dashboard Best Practices Column Displays PA Statuses Patient Name New Provider Name Sent to Plan Medication Approved/ Denied Date Closed PA Origin   Narrative: Having a thorough PA dashboard makes it easier for providers and their staff to manage and monitor PAs in an organized fashion. 

Cerner EHR Demonstration

eRX Make sure to note that if you’re a user that does not have ePA available in their EHR, or if all features are not yet available, web portal is a great supplemental option

RX Written and PA Created in ePA Worklist Make sure to note that if you’re a user that does not have ePA available in their EHR, or if all features are not yet available, web portal is a great supplemental option

Completing the Request Make sure to note that if you’re a user that does not have ePA available in their EHR, or if all features are not yet available, web portal is a great supplemental option

Request Submitted Make sure to note that if you’re a user that does not have ePA available in their EHR, or if all features are not yet available, web portal is a great supplemental option

Request Determined Make sure to note that if you’re a user that does not have ePA available in their EHR, or if all features are not yet available, web portal is a great supplemental option

Non-Integrated Office Recommendations How to identify whether your EHR provides an ePA solution? Ask your account rep Go to https://info.covermymeds.com/prescribers/ What is the best way to have the discussion with EHR re: their implementation roadmap? Talk to your EHR Account Manager Make an integration request Volunteer to be a pilot user

Pharmacy System Implementation Best Practices

Step 1: Identify if an ePA Solution is Available Your pharmacy system vendor may already have a free ePA solution. Resources for verifying: Online resources CoverMyMeds Integrated Systems CoverMyMeds ePA Scorecard Contact Your System Vendor Contact Your Switch Vendor Would it make sense to show a snapshot of either of these websites?

ePA Solution Examples: EasyButton Allows pharmacy to start and deliver ePA request within current workflow Available for all drugs and any health plan Integrated in 80% of pharmacy dispensing systems May need to doublecheck on this mock up to see if we can use it, may be an old screenshot from one of our integrated system vendors.

ePA Solution Examples: IntelligentPA IntelligentPA automatically sends notice to prescriber Pharmacy receives PA claim rejection 10-Minute Resolution Window OR Pharmacy resolves claim to cancel PA notification or manually cancels

Other Best Practices Encourage your pharmacy to offer an ePA solution Online Portals Contact your switch vendor How to become a pilot site for new solutions This slide needs a little work, may want to add another topic to include or scrap this.

BestRx’s Integrated ePA Story

Road to ePA Launched an ePA solution in 2011 Implemented the solution based on clear pain points in process voiced by users Provides BestRx with competitive advantage by offering an enhancement to the solution that streamlines the PA process

PA Pain Points: Pharmacists Obtaining proper forms for each plan Manually filling out form Obtaining prescriber’s fax number/ sending fax Follow-up to determine if PA was submitted to plan Follow-up with plan to find out if there has been a determination Keeping the patient up-to-date

Benefits of ePA in BestRx: No manual data entry No need to dig for proper form Progress of PA can be followed electronically or via callback feature Makes updating patients less challenging Minimal training involved for new techs Eliminates need for additional staff More time spent helping patients No manual data entry. With a click of a button we can automatically populate the relevant claim data onto CMM's web portal. No need to search for the proper PA form for the particular plan. CMM automatically know this based on insurance info. No need to manually fax/email the prescriber. This can be done directly from CMM's portal. This also eliminates the need for old-fashioned fax lines in the pharmacy. The progress of the PA can be followed on the CMM portal or by using their callback feature. BestRx utilizes the callback feature to frequently obtain the status of the PA and populate directly within the BestRx system. Since the progress can be easily followed, it is easy to update patients on the status of their prescriptions. Minimal training involved and new technicians can be fully versed with sending ePA's fairly quickly. With the new IPA feature, it makes it even easier to send PA's as there is not pharmacist intervention required. Less clicks/keystrokes means the pharmacist can process more prescriptions. The automation provided by using ePA can eliminate the need for additional staff at busier pharmacies. With more time on their hands, pharmacists can spend more time helping patients rather than dealing with cumbersome paperwork. My advice to webinar participants who do not have an integrated solution would be to talk to your vendor and explain to them how much time you are spending on PA's. Then compare that to the time your colleagues using systems that have ePA implemented are spending on PA's and stress how important that time savings would be to your pharmacy. For pharmacies that ePA implemented but have suggestions on improving the process, talk your software vendor representative. Most of the best suggestions we receive come from our clients. They are using the system every day in the real world and their input is more valuable than anything that can be simulated or discussed at the software vendor's office

BestRx Pharmacy System Demonstration

Initiate PA Request No manual data entry. With a click of a button we can automatically populate the relevant claim data onto CMM's web portal. No need to search for the proper PA form for the particular plan. CMM automatically know this based on insurance info. No need to manually fax/email the prescriber. This can be done directly from CMM's portal. This also eliminates the need for old-fashioned fax lines in the pharmacy. The progress of the PA can be followed on the CMM portal or by using their callback feature. BestRx utilizes the callback feature to frequently obtain the status of the PA and populate directly within the BestRx system. Since the progress can be easily followed, it is easy to update patients on the status of their prescriptions. Minimal training involved and new technicians can be fully versed with sending ePA's fairly quickly. With the new IPA feature, it makes it even easier to send PA's as there is not pharmacist intervention required. Less clicks/keystrokes means the pharmacist can process more prescriptions. The automation provided by using ePA can eliminate the need for additional staff at busier pharmacies. With more time on their hands, pharmacists can spend more time helping patients rather than dealing with cumbersome paperwork. My advice to webinar participants who do not have an integrated solution would be to talk to your vendor and explain to them how much time you are spending on PA's. Then compare that to the time your colleagues using systems that have ePA implemented are spending on PA's and stress how important that time savings would be to your pharmacy. For pharmacies that ePA implemented but have suggestions on improving the process, talk your software vendor representative. Most of the best suggestions we receive come from our clients. They are using the system every day in the real world and their input is more valuable than anything that can be simulated or discussed at the software vendor's office

PA Auto-Initiated: IntelligentPA

Claim Reject Notification: IntelligentPA

PA Status Report

Discount Drug Mart Discount Drug Mart partnered with CoverMyMeds to address the administrative inefficiencies, delays in therapy, patient frustration and prescription abandonment caused by the prior authorization (PA) process. They had the following objectives: AUTOMATE: Initiate a PA request electronically within Discount Drug Mart’s PioneerRx Pharmacy Software, which lands in the provider’s hands for completion either electronically or via fax. EXPEDITE: Accelerate the PA process in an effort to decrease the time pharmacists spend on PA requests and reduce follow-up phone calls to providers. ADHERE: Decrease time to therapy for the patient by eliminating manual faxes and phone calls.

Results PHARMACY UTILIZATION Since rollout, 96 percent actively utilize CoverMyMeds to manage prior authorization for medication, with an average of 60 requests initiated per month per store. INCREASE IN ACCESS The rate at which a provider completed a PA request electronically doubled when online access instructions were provided and the paper PA form was withheld. FASTER TIME TO THERAPY Patients were able to receive their medication 50 percent faster by electronically initiating a PA request, compared to the manual process of faxing and following up by phone.

Post-Test Questions Which of the following is not a current solution for prior authorization? Fax Patient Submission Pharmacy Software Integration Web Portal

Post-Test Questions True or False: You must have a compatible EHR or pharmacy system vendor to manage PA electronically. True False

Post-Test Questions Which of the following ways is the most efficient method for managing PA? Pharmacist Initiating the request at the time of claim rejection at the pharmacy Prescriber initiating the request at the point of prescribing in their EHR or E-Prescribing software Prescriber initiating the request after notification of claim rejection

Post-Test Questions How can a provider submit a pharmacy- initiated PA request? Via fax Via web portal Via EHR All of the above

Post-Test Questions What is a pharmacy-initiated request called? Prospective Retrospective Interceptive None of the above

Questions?

Save the Date Best Practices for Electronic Prior Authorization (ePA) Implementation and Adoption: Eliminating Barriers to Workflow Integration for Pharmacists and Providers Tuesday, March 28 | 2:00pm – 1:30pm CT/1:00pm – 2:30pm ET Although the manual prior authorization (PA) process is outdated, tedious and filled with overhead expenses, adopting the optimal electronic method can be challenging, just like implementing any new technology can be. The last webinar of the series will discuss barriers to changing pharmacists’ and providers’ normal workflow and strategies for rolling out a new process in your pharmacy or practice.

Save the Date HIMSS17 NCPDP17 – 40th Anniversary Conference HIMSS’s annual conference and exhibition will be held February 19-23, 2017. We hope to see you in Orlando. For more information on HIMSS17, please visit www.himssconference.org. NCPDP17 – 40th Anniversary Conference NCPDP’s annual technology & business conference will be held May 8-10 in Scottsdale, AZ. For more information, please visit www.ncpdp.org.