Unlocking the Potential of Electronic Prior Authorizations for Specialty Medication

You can’t talk about transforming healthcare without talking about electronic prior authorization (ePA). Outdated ePA processes drain resources and frustrate everyone involved.

Most prior authorizations still rely on a messy mix of paper forms, faxes, and disconnected health information systems. Specialty medications come with even more complications, often requiring both medical and pharmacy benefit reviews. This creates confusion and delays. EY notes, “... given the impact that prompt prior authorizations could make, as well as the world’s increasing dependence on technology, digitization of PA processes seems more than logical; it may even help save lives.”

The good news? Smarter technology is already making things better, cutting through the chaos with more efficient workflows that reduce preventable errors and accelerate approvals.

How Electronic Prior Authorization Tech Can Reduce Friction in Patient and Provider Experiences

Because PA policies vary by payer—and even by plan—identifying if a drug or procedure needs a PA is the first hurdle. Six out of 10 physicians say that it’s difficult to determine if a prescription medication or medical service needs a PA, according to AMA survey data. Instead of tedious legwork to discover PA requirements and filling out prior auth forms from scratch, ePA pulls patient and prescription details directly from the EHR or e-prescribing system. This reduces manual work and helps ensure ePA submissions have the details payers want without gaps—or even information overload—that could lead to a preventable denial.

For Patients: Smoother Experiences, Better Outcomes

• Efficient processing of prior authorizations improves speed to therapy—which can be especially critical for time-sensitive specialty drug treatments. 

• Faster access to medications also decreases prescription abandonment and increases medication adherence.  

For HCPs: Less Paperwork, More Capacity for Patient Care

• Greater efficiency and accuracy reduce operational costs associated with submission, status tracking, and reworking denials.  

• Improving the speed and quality of prior authorization submissions gets patients on therapy quicker and helps keep the revenue cycle running smoothly.  

For Pharmacies: Faster Fills, Stronger Connections

• Fewer manual entry errors and data gaps mean fewer claim denials, quicker approvals, and more efficient workflows.

• Less hands-on PA management gives pharmacists and pharmacy staff time to focus on patient counseling and medication therapy management, building customer satisfaction and loyalty.

Two Big Reasons for the Urgency to Fix ePA Processes

First, the prior authorization burden continues to grow, with 84% of HCPs reporting that the number of PAs needed for prescription medications has risen over the last five years. That won’t be changing soon, either, since specialty medications represent 75% of drugs in development pipelines. Their complexity and cost make them more likely to require ePAs, driving a steady increase in PA volume across the healthcare system.

Second, numerous state and federal mandates are poised to address challenges associated with prior authorizations. While the timeline for regulatory changes is in flux, the need to develop and implement compliance-ready ePA processes remains.

The Best Path Forward: End-to-End Medication Management  

Electronic prior authorization is no longer a nice-to-have—it’s necessary for improving access, efficiency, and outcomes in specialty medication workflows. With more efficient processes and easier data sharing, healthcare organizations can ease the administrative burden, reduce delays, and help more patients get the therapies they need—faster.

Ready to optimize specialty medication workflows from start to finish?

Let's talk about how DrFirst helps organizations with prescribing, electronic prior authorization, and patient access technologies, opening the door to faster, safer, and more coordinated care.