Electronic Prior Authorization Information

Electronic Prior Authorizations (ePA)

Submitting an ePA

ePA is a fully electronic solution that processes Prior Authorizations (PAs), formulary and quantity limit exceptions significantly faster!

ePA provides clinical questions ensuring all necessary information is entered, reducing unnecessary outreach and delays in receiving a determination.
Receiving a decision faster allows patients to start therapy sooner.
ePA is easily accessible through a web-based portal or may be integrated into your Electronic Health Record (EHR) platform.

Receive determinations significantly faster than fax and phone with ePA

CVS Caremark^® has made submitting PAs easier and more convenient. Some automated decisions may be communicated in less than 6 seconds!

We've partnered with CoverMyMeds^®, Surescripts^® and Arrive Health®, making it easy for you to access ePA based on your daily workflow.

Frequently Asked Questions

ePA stands for Electronic Prior Authorization, which enables prescribers to submit their Prior Authorization (PA) through an electronic channel, greatly reducing the administrative burden in completing the PA process.

Prescriber requests PA question set via their Electronic Health Record (EHR) or online ePA portal.
CVS Caremark returns the PA question set.
Prescriber completes PA question set, submits via their EHR or online PA portal.
Pharmacy Benefit Manager automatically assesses clinical information and communicates decision via their EHR or online ePA portal.

Near real-time* decisions allowing patients to start therapy sooner.
Specific clinical questions provided electronically, reducing unnecessary faxes and phone calls.
Easily accessible through a web-based portal or your Electronic Health Record (EHR).

*May not result in near real-time decisions for all prior authorization types and reasons.

Utilizing ePA is 2-3 times faster than phone or fax.

The ePA solution supports Prior Authorization, quantity limit and formulary exception requests. Tier exception requests are not ePA compatible.

The ePA channel is fully functional (chart notes, attachments, supporting statements and an urgency indicator for life-threatening situations).

The ePA solution has various checkpoints, as it attempts to return question sets for completion, to identify and validate the plan member, insurance plan, medication and more. A medication can have different question sets depending on its formulation, strength and route of administration, or it could be covered under a Medicaid or Medicare Part D plan. This sometimes requires secondary review to ensure the correct question set is returned for that member.