Anthem, Cigna & more launch prior authorization pilot

America's Health Insurance Plans, one of the largest trade groups for the health insurance industry, debuted a prior authorization pilot in January that aims to fast-track the process.

The Fast Prior Authorization Technology Highway, or Fast PATH, uses automation software from technology companies Availity and Surescripts to digitize prior authorization processes. Health insurers covering more than 60 million Americans have agreed to participate in the pilot. These include Anthem, Blue Shield of California, Cambia's affiliated health plans, Cigna, Florida Blue and WellCare.

The pilot concerns two common prior authorization processes: approval for prescription medications and approval for medical and surgical procedures.

  • For medications, the health plans will use Surescripts technology to allow physicians to immediately access a patient's pharmacy benefits while prescribing medication. This will allow them to see if the medication they want to prescribe requires a prior authorization and whether a clinically equivalent option is available that may not require prior approval. Additionally, physicians can submit requests for prior approval through their EHR and share out-of-pocket drug costs with patients.

  • For medical and surgical procedures, the health plans will use Availity technology to help providers know immediately whether their ordered procedure requires prior authorization. If prior authorization is needed, the provider can submit information through the Availity portal and receive a response through the same portal.

AHIP tapped RTI International, an independent, nonprofit research organization, to evaluate how well the technologies work under the Fast PATH initiative. 

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