Healthcare Legislation

The Importance of Compliance with State Prior Authorization Mandates

Here, we explore why it's important for providers, pharmacists and health plans to stay up to date and remain compliant with state legislation.

Kim Diehl-Boyd
Kim Diehl-BoydVP, Industry Relations and Government Affairs
January 8th, 2018
How legislation plays a part in prior authorization

States are continuing to take note on the importance of mandates around electronic prior authorization (ePA), and the needle continues to move forward as relevant legislation is proposed and approved across the country. However, we often hear the question: Why is it important for providers, pharmacists and health plans to understand and remain compliant with state legislation?

The answer is pretty simple: It helps patients get their much-needed medications more quickly.

Let’s break it down a little further.

The reason state mandates continue to gain traction for ePA is to ensure the patient is getting the best chance of accessing the medications they need to be healthy by putting a standard process in place for providers, pharmacists and payers. Depending on what the state calls for — whether it be full requirement around the utilization of an electronic solution for PA, submission of a universal form, or both — the motives behind the mandate itself are worth complying with, considering providers and pharmacists’ similar desires of bettering patient access to medications and streamlining processes to cut down on administrative waste.

Health plans also benefit from cutting down manual hours managing paperwork as well as ensuring they are on par with PA request turnaround times and reducing the likelihood they will be exposed to time-consuming audits. Full compliancy with the respective state’s legislation is all it takes to achieve the former points.

The good news: CoverMyMeds is the number one way to remain compliant when it comes to ePA.

By utilizing our solution, you can ensure you’re compliant with any and all mandates, and that you’re in line with the processes of other parties involved — such as pharmacists or health plans.

For more information on which states have passed legislation and detailed information on what the requirements are, visit the Legislative section of our ePA Report.

Kim Diehl-Boyd
Kim Diehl-BoydVP, Industry Relations and Government Affairs

Kim oversees government affairs, policy initiatives, regulatory and industry engagement.

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