An electronic prior authorizations (ePA) is automatically initiated when you accept a medication and save it to the patient chart and one of the following conditions is met:
- If the selected medication requires a prior authorization through a Real-Time Prescriptions Benefits (RTPB) request.
Note: The patient's Pharmacy Benefits Manager (PBM) must be enrolled into Real-Time Prescriptions Benefits.
- If the patient's formulary file indicates that a prior authorization is required for the selected medication.
Note: If the automatic ePA initiation fails, the Initiate ePA link in the medication details section becomes available.
You can also manually initiate an ePA for new and renewed medications in NextGen® Enterprise EHR. Additionally, you can do the following:
- Complete and submit the criteria to the PBM for review.
- View approval or denial responses.
- Initiate appeals, if required.
- View prior authorization transactions history.
Note: If a medication requires prior authorization and you attempt to send it in an electronic prescription without initiating an ePA, a message appears stating that prior authorization is necessary for the selected medication.
If you attempt to send an electronic prescription for a medication before receiving prior authorization approval, a message appears displaying the medications for which prior authorization is not yet approved. You can send the medication without the prior authorization details or send other medications, or cancel the prescription. If you select
Send All, the prescription is sent to pharmacy with the
PA Requested status. The pharmacy can request for prior authorization and receive the approval.
Note:
- After you initiate an ePA for a medication, the medication cannot be modified.
- When you renew a medication, prior authorization information from the previous medication instance is not transferred to the renewed medication.
