EHR association voices support, deadline concerns for prior authorization standard
The members of the Electronic Health Record Association (EHRA) voiced their support for the adoption of the Centers for Medicare & Medicaid Services (CMS) version 2017071 standard for electronic prior authorization (ePA) as applied to prescription drugs for the Medicare Part D program.
WHY IT MATTERS
Electronic prior authorization is a process established in the National Council for Prescription Drug Programs (NCPDP) SCRIPT standard that enables patient and drug-specific prior authorization criteria and a real-time approval for medication prior authorization.
Beyond the benefit of achieving regulatory compliance, the new standard aims to improve the process of getting prescriptions filled in two major ways for healthcare professionals and the patients they serve, including features that reduce confusion and replace manual processes and increased e-prescribing routing and medication history transaction options.
However, the EHRA recommended pushing the target date for e-prescribing requests and responses using the standard back to 24 months after the final rule is published to allow for the necessary software changes and deployment across various client bases.
THE LARGER TREND
Starting January 1, 2020, all electronically transmitted prescriptions must be sent using the new SCRIPT Standard version 2017071, replacing SCRIPT Standard 10.6. SCRIPT 2017071 is not fully backwards-compatible with SCRIPT 10.6, which could result in operational issues for late adopters.
The biggest benefit to time-crunched pharmacists may be the ability to communicate with a provider electronically – everything from asking for a new prescription, a refill, clarification or verification, helping eliminate multiple phone calls or other back-and-forth communications procedures.
The EHRA also recommended HIPAA should be updated to reference the same standards to further align prior authorization for e-prescribing across other federal programs, pointing out some states are pursuing different standards for electronic prior authorization.
ON THE RECORD
“We recommend that CMS work with states to align on common standards, in order to reduce redundant development and maintenance efforts for the same capabilities,” the EHRA said in a statement. “Our members believe that aligning the use of 2017071 e-prescribing and prior authorization standards across use-cases is a positive step.”
In a June press release, the CMS stated that the proposed use of the NCPDP SCRIPT standard would promote “better clinical decision-making” and would “ensure that patients receive medically necessary prescription drugs…by adopting standards that ensure secure transmissions and expedite prior authorizations.”
The CMS also called for potential strategies to mitigate burden in order to support successful adoption of this policy and is looking for ways the CMS can support plans as they transition to the ePA standard by the 2021 deadline.