Readers Write: What EHR Vendors Need to Know About Implementing Minnesota’s Electronic Prior Authorization Law

What EHR Vendors Need to Know About Implementing Minnesota’s Electronic Prior Authorization Law
By Tony Schueth

It’s January 2016 and electronic prior authorization (ePA) is now “required” by law in Minnesota. There has been surprisingly little fanfare about this deadline, and it’s my observation that most electronic health records (EHRs) and providers are not ready to comply. Here’s what EHR vendors need to know about implementing Minnesota’s law, also known as MS §62J.497.

It’s not necessarily a mandate. Minnesota really wants clinicians to do PAs electronically using standards from the National Council for Prescription Drug Programs (NCPDP), but there are no penalties for non-compliance. According to a state fact sheet:

• “Starting January 1, 2016, prescription drug authorizations – including prior authorizations (PA) and formulary exception requests – must be exchanged electronically, using the NCPDP SCRIPT Standard version 2013101.”
• “The law does not require prescription drug PA and/or formulary exceptions. However, for those entities subject to the law, if PA requests and responses and/or formulary exception requests and responses are exchanged, starting January 1, 2016, they must be exchanged electronically based on the NCPDP SCRIPT Standard version 2013101.”
• No later than January 1, 2016, drug prior authorization requests must be accessible and submitted by health care providers, and accepted by group purchasers, electronically through secure electronic transmissions. Facsimile shall not be considered electronic transmission.”

While the language is very strong, the statute doesn’t definitively say that every single PA must be done electronically.

State officials acknowledge they may be out in front of everyone else: “technological updates to enable this functionality can take time, and manual methods for prior authorization may need to be used until electronic functionality is available with all partners.” Kudos to Minnesota for showing leadership.

Should you wait?

Despite Minnesota’s lack of a true mandate, I wouldn’t recommend waiting for the regulatory axe to fall in Minnesota. The paper-, fax-, and phone-based prior authorization (PA) process is time-consuming and burdensome to physicians and expensive for payers. In contrast, ePA promises efficiencies.

It’s early in the adoption cycle, kinks need to be worked out, and implementation isn’t uniform. That said, pharmacies and prescribers ultimately will prefer ePA over current processes to help keep pace with the PA requirements associated with the increasing number of drugs used to treat the rising number of the chronically ill. Furthermore, large integrated delivery networks will select EHRs that are compliant with the statutes and regulations in their service area. These EHRs must be able to handle transactions, such as ePA, regardless of site of care.

What about e-prescribing of controlled substances?

Minnesota has had 62J.497 on the books to mandate e-prescribing for all prescriptions effective since 2011 and the state has some of the strongest e-prescribing adoption in the country. We have heard anecdotally that Minnesota has a goal of having all controlled substance prescriptions being electronically prescribed by the end of 2016. While that appears to be just a goal, there are two aspects of controlled substances prescribing that should be kept in mind.

The first is that e-prescribing of controlled substances (EPCS) is permitted both at the federal and state level. Even so, the facts about the legality of EPCS are often surrounded by confusion. Because of this misperception and the fact that there are no penalties for non-compliance, demand by prescribers is just beginning to appear. But that is changing.

The second is interfacing with the state’s prescription monitoring program (PMP), which is up and running under the auspices of the state’s board of pharmacy. All dispensers (pharmacies or providers that dispense from their offices) licensed by the State of Minnesota must report on a daily basis all controlled substance II-V and butalbital prescriptions that were dispensed. To satisfy the reporting requirements, all EHRs should be able to interface with the PMP to provide the necessary information.

New York takes a different approach

What is interesting is the contrast of Minnesota’s electronic prescribing and ePA “mandate” with New York’s I-STOP. The spirit (and language) of the rules are very similar for both states, except, of course, that I-STOP doesn’t mention ePA. The key difference is that I-STOP articulates the penalties for non-compliance. New York has the right to impose professional misconduct penalties (including fines and possible license revocation) for non-compliance with I-STOP.

As a result, it appears that most EHR vendors with clients in New York have enabled their products to handle e-prescribing – including EPCS – and have emphasized their readiness.

I applaud both states’ efforts to lead and urge EHR vendors not to wait until the last minute to roll out products in either state. Your customers will appreciate it. Furthermore, your competitors will have solutions available for those who aren’t either prescribing electronically or facilitating ePA yet.

Tony Schueth is CEO of Point-of-Care Partners of Coral Springs, FL.