When electronic prior authorization (ePA) is required for a medication, the medication will have the applicable ePA Status indications for ePA-enabled users displayed in facesheet. When a status is ePA Pending, and does not require any action, it will appear in gray. When action is required (EPA Action Required, EPA Denied, or EPA Approved) the status will appear as orange. Once an EPA Approved medication has been e-prescribed or printed, it will appear in black and will no longer have an ePA designation in parentheses.
ePA Status Examples:
The following lists all of the various ePA Statuses that will appear on the Facesheet:
ePA Pending: Occurs when the user submits for an ePA and waiting back from the PBM.
ePA Approved: Occurs when the PBM accepts the ePA for the requested medication.
ePA Denied: Occurs when the PBM denies the ePA requested.
ePA Action Required: Occurs when there is some action required by the user, for instance when questions need to be answered.
ePA Deferred: Occurs when in the middle of the ePA process, the PBM requires the medication to go manual. This will rarely happen.
ePA Canceled: Occurs when the user cancels the ePA process.
ePA Closed: Occurs when the ePA process closes and the ePA process is complete.
When the ePA Status indicates that some action is required, you have the ability to access the ePA Status dialog by clicking the asterisk button next to the medication, and then clicking the Open ePA Status dialog option.
This will open the ePA Status dialog to the Workflow Processes tab which displays the various ePA transactions for the patient. You can then access the applicable item (Acknowledge Approval in the figure below) to open it in the Worklist tab.
Depending upon the stage of ePA process, and the level of access you have, you may then be prompted to Start answering a series of questions or provide additional information to Submit; Acknowledge an authorized prior authorization; Acknowledge a denied prior authorization; or Appeal a denied request, which entails a similar process of answering additional questions and/or providing additional qualifying information to Submit.
Do note, that throughout the prior authorization process you also have the ability to send the mediation without the authorization (which will be the patient’s responsibility) or discontinue the medication.
