Senate bill calls for Medicare Part D electronic prior authorization

Three U.S. senators have introduced legislation that would provide for the use of electronic prior authorization in Medicare Part D, a process that requests additional information about whether a patient needs or meets clinical criteria for a medication in order for it to be covered by the insurance plan.

Currently, prior authorization is completed through paper forms, faxes and telephone calls. However, the Electronic Prior Authorization in Medicare Part D Act—introduced by Senators Pat Roberts (R-Kan.), Tom Carper (D-Del.), and Chuck Grassley (R-Iowa)—calls for the use of electronic prior authorization (ePA) through a common electronic system so that patients can receive faster access to alternatives to opioid medications for chronic and acute pain, as well as improved access to medication-assisted treatment to treat opiate addiction.

“Switching to an electronic system will help people get access to the prescriptions already prescribed to them by their doctors,” said Roberts. “By streamlining the process, we can help ensure that Medicare patients who are trying to fill prescriptions for opioid use disorders encounter less hurdles to get the medicine they need to help stop this serious addiction.”

Also See: Industry groups take aim at speeding the prior authorization process

Health IT Now’s Opioid Safety Alliance—a working group of prescribers, dispensers, professional societies and patients advocating for the use of technology to fight the illegitimate use of opioids—praised the introduction of the legislation.

“The nationwide opioid epidemic is a public health emergency that demands policymakers use every last tool at their disposal to prevent and treat cases of addiction, including technologies such as ePA,” said Joel White, executive director of the HITN Opioid Safety Alliance. “Private insurers, doctors and pharmacies are already using ePA to great success—decreasing provider burden and limiting the potential for medication mismanagement, including in cases of powerful opioids. It is past time we bring that same technology into the Medicare space.”