Update on the Electronic Prior Authorization Landscape

ACPE UAN #:   0233-0000-16-021-H04-P

Release Date:  Thursday, April 21, 2016

Expiration Date:   Thursday, April 21, 2019

Activity Type:  Knowledge-based  

Contact Hours:   1.25

Activity Fee:  Member:  $15.00             Non-Member:  $30.00

 

As an accredited provider, AMCP strictly adheres to the ACPE Standards for Commercial Support and other relevant guidelines and standards to ensure the independence of continuing pharmacy education (CPE) activities.  It is AMCP’s intent that all CPE activities be independent, objective, balanced, evidence-based and free of any commercial bias.   

Target Audience: This repurposed session from the AMCP Annual Meeting 2016 is designed to provide insights and solutions for pharmacists who practice in managed care settings, to help them maintain and enhance their knowledge, skills, and abilities. 

Activity Overview

While paper, phone and fax are still the predominate means for facilitating prior authorization (PA), online payer portals are becoming more common. Significant strides are being made to standardize and fully automate prior authorization within prescriber workflow for both non-specialty and specialty medications. Concurrently, steps are being taken to deliver accurate formulary and benefit data in real-time prior to ePrescribing in order to support prospective electronic prior authorization (ePA) and the selection of the most cost effective medications.

This session will provide an overview of the PA and ePA landscapes, and explore how the industry is converging to address ePA barriers and promulgate adoption of fully automated prior authorization. In addition, it will validate the need for standardized, evidence-based PA criteria through presentation of real data gleaned from the experience of Blue Cross Blue Shield of Michigan. 

Learning Objectives:  

  1. Explain how advanced payer portals can improve the prior authorization process and patient access to medication.
  2. Discuss the financial and clinical impact of payer portals.
  3. Describe how industry front-runners are using technology to manage prior authorization for medications and therapy covered under both the pharmacy and medical benefits.
  4. Summarize key prior authorization trends, costs and options available to automate prior authorization of medications.

Schedule of Educational Activity

This CPE online activity consists of a pre-recorded audio/slide presentation, a pre-test (to establish prior knowledge, not required to pass), a post-test with a score of 70% or higher, and a specific online activity evaluation. 

Faculty Relevant Financial Relationships Disclosure: AMCP asks everyone who is in a position to control the content of a continuing pharmacy education activity to disclose all relevant financial relationships with commercial interests. If AMCP determines that a conflict of interest exists as a result of a financial relationship you have (or that your spouse/partner has), we will need to take appropriate steps to resolve the conflict of interest.

  • James R. Lang, PharmD, MBA, reports having no financial relationships with any commercial interests during the past 12 months.
  • Tony Schueth, MS, is the owner of Point-of-Care Partners, LLC and reports having no other personal financial relationships with any commercial interests during the past 12 months.
  •  AMCP staff report no relevant financial relationships pertinent to this activity: Puneet Singh, PharmD and Ruby Singh, PharmD, BCPS.

Method and CPE Requirements:   

Participants should claim continuing pharmacy education (CPE) credit for this online activity, only if they have not claimed credit for the live activity presented at the AMCP Annual Meeting 2016. 

CPE credit will be processed through the AMCP Learn portal and reported directly to CPE Monitor.  Please allow 24-72 hours for processing and posting in your NABP account.

To receive CPE credit for an AMCP Learn online activity you must:

  • View the entire pre-recorded audio/slide presentation.
  • Successfully complete the post-test with a score of 70% or higher (The post-test will provide feedback.)
  • Complete a specific online activity evaluation.

System Technical Requirements/Viewing Requirements: System Requirements Courses and learning activities are delivered via your Web browser and Acrobat PDF. For all activities you should have a basic comfort level using a computer and navigating the web site.  View the minimum technical and system requirements for online educational activities.

Credit Information

Activity Number Credit Amount Accreditation Period
ACPE UAN #0233-0000-16-021-H04-P 1.25 Contact Hours April 21, 2016 - April 21, 2019