PBMs claim to impose formulary restrictions (e.g., prior authorizations, step therapies, and quantity limits) in order to ensure that the right patients receive the right drugs in the right manner.

However, living in the 21st century, one would think that PBMs would already have access to all of the patient information that they’re requesting from providers–right? If PBMs could access patient information electronically in real-time, there would be no need for prior authorizations and patients would be able to know the exact cost of their treatment when they’re sitting with their providers.

This would be revolutionary for market access as it could help to solve the problem of prescription abandonment. Research suggests that 66% of prescriptions that get rejected at the pharmacy require prior authorization, of which 30% are abandoned by patients.

Furthermore, in the spirit of rising health care costs: the Council for Affordable Quality Healthcare suggests that each manual prior authorization costs $3.50 for plans and $6.61 for providers. Electronic prior authorizations would bring the cost down to $2.80/transaction for payers and $0.03 for providers.

When there is so much to be said for electronic prior authorizations, why are manual prior authorizations still plaguing our health care system?

According to Point-of-Care Partners, a leader in the EHR frontier, electronic prior authorizations and real-time pharmacy benefit checks are a relatively new trend which are quickly gaining traction with the help of certain legislative rules. This phenomenon will also slowly permeate medical benefit drugs as well as devices, procedures, and services covered under the medical benefit, though that will take some time.

There are a number of market access teams who are taking matters into their own hands in order to help facilitate the transition to electronic prior authorizations and real-time pharmacy benefit checks in order to circumvent prescription abandonment.

It’s time to make big strides and turn heads–let’s go.