ePA pilot helps Medicare patients get fewer high-risk meds

A pilot program found that Medicare beneficiaries were 57 percent less likely to receive prescriptions that may cause potential health risks through the use of electronic prior authorization (ePA).

Prime Therapeutics (Prime), one of its health plan clients and CoverMyMeds, an ePA platform, developed the pilot that alerted prescribers of risks during the ePA process. 

Health issues associated with high-risk medicines for this age group are a significant concern and only growing. An average of 10,000 baby boomers will turn 65 every day until the year 2029. 

Before the pilot began, Prime and its health plan client believed that high-risk medicine alerts and options for alternatives at the point of prescribing would result in prescribers choosing a safer, more appropriate drug, according to a release. During the pilot program period--during the first half of 2015--Prime's real-time ePA messaging was applied to 843 high-risk medication prescription requests for adults 65 and older covered by the health plan. Of the total number of prescriptions initially submitted, prescribers acted on the program's recommendations to consider an alternate, lower risk medication within the CoverMyMeds portal more than 50 percent of the time, significantly reducing the number of patients at risk.

In this pilot, the safer alternatives chosen decreased the number of high-risk medications ultimately provided to adults over 65. Both the Centers for Medicare & Medicaid Services (CMS) and the Healthcare Effectiveness Data and Information Set (HEDIS) have quality measures that focus on decreasing the use of high-risk medications in the elderly. The CMS Star ratings measure is defined as the percentage of members receiving more than two prescription fills of a high-risk medication. Prime has helped its health plan clients move to 5 Stars for many CMS Star ratings measures through a variety of programs focused on member and safety quality, including the ePA pilot.

"We wanted to test our ability to help our members avoid safety issues associated with high-risk medications, especially when we know there are safer options," said Scott Fries, Prime's senior vice president of government programs. "The pilot results clearly show how collaboration and innovation can work together to keep members safe, improve health outcomes, and positively impact Star ratings."