ePA for pharmacy now available through the Surescripts portal

Starting Aug. 31, 2020, you’ll have the option to submit pharmacy prior authorizations for Priority Health members electronically.

Why are we making this change?

We know our provider partners spend substantial time on prior authorizations and that it’s a common pain-point for many practices. That’s why we’ve partnered with Surescripts to implement an electronic prior authorization (ePA) solution  for Rx drugs that will eliminate the need for time-consuming paper forms, faxes and phone calls, and allow us to return faster decisions to you. You won’t be required to submit prior authorizations electronically. We’ll continue to process pharmacy prior authorizations submitted via paper fax or by phone.

What are the benefits?

ePA streamlines the prior authorization process for both you and Priority Health. As a provider, you can save time and increase efficiency, as well as reduce administrative costs associated with faxing (or phoning-in) prior authorizations. In addition to submitting requests electronically, you can also check on request status without having to call us. It also helps our pharmacy team streamline coverage decisions, so your requests can be completed faster. In turn, this creates a positive patient experience that can increase medication adherence and improve outcomes.

How does it work?

There are two solutions for providers who would like to use ePA. If you’re not sure which option is available to you, you can contact your dedicated provider performance specialist or our pharmacy call center.

1. ePA within the EHR

Providers whose EHR has Surescripts ePA enabled can complete prior authorizations and electronically route them to Priority Health for approval. Learn more about how electronic prior authorization within your EHR works.

2. Surescripts Prior Authorization Portal (Live as of Oct. 1, 2020)

This option is for providers whose EHRs do not have Surescripts ePA enabled, or any provider who wishes to use the portal. Using the portal, providers and their staff can respond to prior authorizations requests or process requests prospectively. Within the portal, they’ll be able to complete question sets and route them to Priority Health for approval. Learn more about how the Surescripts Prior Authorization Portal works.

Learn more

You can learn more about ePA for pharmacy by visiting our electronic prior authorization for pharmacy page within the Provider Manual.