Here’s new information about electronic prior authorization for drugs covered under pharmacy benefits

If you use an electronic prior authorization, or ePA, tool to request authorization for drugs that are covered under pharmacy benefits, here’s what you need to know.

ePA for Medicare Advantage members, too

Starting Aug. 3, you can use CoverMyMeds and other free ePA tools such as Surescripts^® and ExpressPAth^® to submit requests for most of these drugs for our Medicare Advantage members. These are members who have coverage through Medicare Plus Blue^SM or BCN Advantage^SM plans.

You can already submit ePA requests for members who have Blue Cross Blue Shield of Michigan or Blue Care Network commercial coverage.

New feature in CoverMyMeds

For those who use CoverMyMeds to submit ePA requests, there’s a new feature that helps ensure you’re identifying the correct insurance plan.

In the Plan or PBM Name field, you can now enter the bank identification number, or RxBIN, and the RxGroup found on the member’s ID card.

To locate the correct plan for one of our members, enter this information:

• 610014 as the RxBIN for both Blue Cross and BCN.
• One of these RxGroups:
  • Blue Cross commercial: BCBSMRX1 or BCBSMAN
  • BCN commercial: MiBCNRX
  • Medicare Plus Blue: BCBSMAN
  • BCN Advantage: BCNRXPD

Remember to look for the RxBIN and RxGroup on the member’s ID card.

Reminder: Submitting ePA requests using CoverMyMeds

To complete an ePA request using your CoverMyMeds online account, follow these steps:

1. Go to covermymeds.com/epa/express-scripts.** (Create a free account if you don’t already have one.)
2. Start a prior authorization request:
   • Click New Request and select Michigan in the Patient Insurance State field.
   • New: In the Plan or PBM Name field, enter the RxBIN andthe RxGroup found on the patient’s member ID card.
   • Enter the medication, select the appropriate form and click on Start Request.
3. Complete the request:
   • Complete all information fields marked Required and click on Send to Plan.
   • CoverMyMeds displays a list of patient-specific, clinical questions. Answer all questions that are marked Required.
4. Confirm the request:
   • Click Send to Plan again to confirm that you’ve submitted the request.

After Blue Cross or BCN has reviewed the prior authorization request you submitted, the determination will appear in your CoverMyMeds account.

CoverMyMeds often returns approval decisions within minutes of submission, depending on the complexity of the request or the need for additional review.

More about ePA

You can use CoverMyMeds or other ePA tools instead of submitting requests by fax or phone. This allows you to spend less time on administrative tasks and more time on patient care.

Other benefits of using ePA tools include:

• Automatic approvals for select drugs and improved turnaround time for review and decisions
• Easy use by prescribers, nurses and office staff
• All documentation and requests kept conveniently in one place

Here are some answers to frequently asked questions about ePA.

• Why should I use ePA?
  
  You’ll save time. You can send 11 ePA requests in the time it takes to fax just one (based on Comcast and Verizon broadband rates and a fax speed of 33.6 kbps) and patients can receive medications faster.
  
  The process is easy and intuitive. Providers and their authorized personnel can log in online, submit requests and access determinations.

• What about ePA tools within the electronic health record?
  
  Using an ePA tool within your electronic health record, or EHR, makes it even easier to submit electronic requests and gives you:
  • Clear direction on clinical requirements
  • Streamlined questions that are specific to the prior authorization request you’re submitting
  • The ability to attach required documentation
  • Secure and efficient authorization administration all in one place
  • The capability of renewing existing authorizations proactively, up to 60 days before they expire

  Typically, an ePA tool can be integrated into your current EHR workflow. Check with your vendor to ensure you have software that accommodates an ePA tool.

  If an ePA tool isn’t available within the EHR you use, you can always create a free online account through CoverMyMeds or other ePA tools, such as Surescripts^® and ExpressPAth^®, to submit requests. Registration takes only a few minutes.

Questions?
If you have questions, call the Pharmacy Clinical Help Desk at 1-800-437-3803.

**Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.