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    Uniform Prior Authorization Considerations


    Health plans and PBMs administer PA programs using multiple approaches.  These approaches include paper/facsimile processes and, in some cases, web portal processes.  In July 2013, the National Council for Prescription Drug Programs (NCPDP) published the new ePA transaction standards, which will help pave the way for the administration of PA programs through electronic prescribing systems. 

    There are three complications to implementing electronic prior authorization.   

    1. There is not a national standard for a paper PA form; and health plans have been unable to agree upon a standardized form.   

    2. There is not a functional, national standard for securely transmitting the electronic data.  Thus, legislation currently considered in several states could impact the approach that health plans and PBMs take to administer PA programs.   

    3. Legislation that would create standardized forms or state specific electronic standards could put limitations on expanding prior authorization to e-prescribing systems or be inconsistent with national standards developed by the National Council for Prescription Drug Programs.   
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