Electronic prior authorization for prescribers

Welcome! Optum Rx understands that your time is valuable and limited, so we offer digital tools that create efficiencies and reduce the time you spend on your administrative tasks.

We will spend the next few minutes guiding you through the use of electronic prior authorization, e-PA. But first, let's quickly review the benefits of prior authorization.

Prior authorization benefits your patients, your practice, and the overall healthcare system in a variety of ways, managing costs, controlling medication misuse, and protecting patient safety to help ensure the best possible therapeutic outcomes.

To simplify the PA request process, Optum Rx offers e-PA. e-PA transforms the existing paper PA process into a real-time exchange of information to determine insurance coverage for a prescribed medication.

By submitting e-PA requests, you can experience benefits such as faster PA determinations at no additional cost, less administrative paperwork, and minimized therapy disruption for your patients.

The e-PA process is quick, simple, and consists of four primary steps.

Step one: Initiate a request. Submit your patient's information such as name, member ID, and requested medication in an e-PA portal. Here's a helpful hint: Make sure the patient's name and date of birth are spelled and formatted exactly as shown on the member's insurance card.

Step two: Optum Rx reviews the request for coverage. If applicable, we will send you plan- specific clinical questions immediately.

Step three: You respond to clinical questions sent by Optum Rx.

Step four: Optum Rx reviews and sends you the case resolution details, such as if the case is approved or needs additional information and review.

There are several e-PA portals you can use, like CoverMyMeds, SureScripts, PreCheck MyScript, DrFirst, CenterX or Allscripts to submit a request. Let's go through a CoverMyMeds e-PA request together.

Access the CoverMyMeds portal by visiting the Optum Rx prior authorization page.

To begin, create a username and password, then log into the e-PA portal.

Here is your dashboard. This is the homepage with tabs to help locate your existing requests. New requests that have not yet been sent to the plan are in the Current tab. The Sent to Plan tab displays a list of your submitted prior authorizations. The Status indicates a final determination, such as approved or denied. Use the Search tab to find a specific request.

Now, let's submit a new e-PA. Click on New Request on the left side of the dashboard. The medication screen will appear.

Type in the name of the medication and select the specific drug option for the request. Next, complete the patient's insurance information by searching insurance plan or PBM name.

Then the Forms section will populate. Click the Start Request button.

Complete the patient medication and information form. Additional questions will generate depending on your response in each field. Answer all the required fields.

Here's a few more helpful hints: Number one: Please ensure all questions including diagnosis and tried/failed alternatives are answered accurately and completely. Number two: Another way to avoid e-PA delays is to attach all necessary chart notes to your submission. Number three: Finally, make sure the quantity is based on unit of measure consistent with dispensing standards and directions for use. For example, medications dispensed in pen form require the number of milliliters, not the number of pens you need.

The Send To Plan button will turn orange. Now, submit to Optum Rx. That's it! You've now initiated an e-PA.

Save time and streamline your PA submission process by reducing patient medication disruption, managing costs, ensuring safety and quality, and receiving faster PA determinations.

Start using e-PA today. To learn more, visit business.optum.com and search “prior authorization.” Bookmark this page for future quick reference.