Prior Authorization

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The ePA National Adoption Scorecard details the current state of electronic prior authorization (ePA). The Scorecard follows the increase in ePA availability in electronic health records (EHR) systems with payers and at pharmacies, which represent the majority of the market share. The original ePA National Adoption Scorecard report was published in March 2015; it is updated and republished semiannually.

In addition to availability updates, this release of the report includes new information on ePA legislation by state.


The ePA National Adoption Scorecard compiles data from several publications as listed in the sources section of this report. Availability data is based on public announcements as well as direct communication from companies. Where noted, TS&H' connections to more than 360 EHRs, all payers, and 45,000 pharmacies, is used to supplement and advise key takeaways.

Companies interested in working with the TS&H research team, or updating report data, may contact epascorecard@TS&

Summary of ePA availability

ePA availability changes often as EHR systems, payers and pharmacies work with ePA vendors to make functionality available to end users. As of the third quarter (Q3) 2015, the current availability of ePA is as follows:

  • EHR and E-Prescribing: 70% committed, 47% available, 47% live
  • Payers: 87% committed, 68% available, 68% live
  • Pharmacies: 83% committed, 82% available, 72% live

ePA: critical for the health care industry

Prior authorization (PA) was implemented years ago to provide the most appropriate and cost-effective health care services. The traditional paper-based PA process results in administrative waste and abandonment of prescriptions by patients.

  • PA costs the industry billions of dollars annually.
  • Prescribers and their staff spend more than 20 hours per week on PA requests.
  • 40% of PA requests are abandoned because of complex policies and procedures./li>

These challenges make it critical that the health care industry adopt a solution that creates cost and administrative efficiencies and ensures patients are not lost in the PA process.

Electronic prior authorization provides real-time information to all participants in the PA decision-making process through interconnectivity.

TS&H data demonstrates that the use of ePA significantly reduces the time spent on each PA request, up to 80%, from as many as 15 to 20 minutes to as few as 3 to 5 minutes. Turnaround time of a PA request is decreased from 3 to 5 business days to within hours in most cases, and mere moments when auto-determination is leveraged.

Early epa success

Although the idea of ePA has existed for years, only now is the industry experiencing the positive impact of a more efficient electronic solution.

One example is a regional health plan serving millions of members. The plan, which implemented ePA in June 2014, decreased PA reviews by 40% and increased auto-determinations by 35% as a result of ePA functionality powered by TS&H. More than half of the plan’s prescribers currently use ePA.


To create the best PA process for the industry, we recommend swift and complete ePA adoption by EHR vendors, payers and pharmacies leveraging functionality from ePA vendors outlined in the key success factors section of this report.

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