Electronic Prior Authorization Information
Electronic Prior Authorizations (ePA)
Submitting an ePA
An ePA is a fully electronic solution to process prior authorizations (PAs), formulary and quantity limit exceptions significantly faster!
- ePA provides clinical questions to ensure that all necessary information is entered, reducing unnecessary outreach and delays in receiving a determination.
- With ePA, CVS Caremark® is able to provide some approvals in real time.
- Receiving a decision faster may allow 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 six seconds!
We've partnered with CoverMyMeds® and Surescripts® to make it easier 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. Here’s how ePA works:
- The prescriber requests the PA question set via their electronic health record (EHR) or online ePA portal.
- CVS Caremark returns the PA question set.
- The prescriber completes the PA question set and submits the responses via their EHR or online PA portal.
- The pharmacy benefit manager automatically assesses the clinical information and communicates a decision via the EHR or online ePA portal.
- Near real-time* decisions may allow some patients to start therapy sooner.
- Specific clinical questions are 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 two to three 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, including 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.
There are two ways to get started with your selected vendor:
Access ePA through a web-based portal or an electronic health record (EHR) integrated solution. Choose one below.
1. Secure online portal: Registration takes only a few minutes and there is no cost for prescribers.
2. EHR Integration
CVS Health may use AI to help review and process coverage requests, including approving requests that meet coverage criteria requirements. AI is not used to deny coverage requests. Any decisions to deny coverage based on medical necessity are made by licensed healthcare professionals.
Disclaimer
CoverMyMeds® is a registered trademark of an entity not affiliated with CVS Caremark.
Surescripts® is a registered trademark of an entity not affiliated with CVS Caremark.