Minnesota prescription drug prior authorization standardization project

1. Minnesota prescription drug prior authorization standardization project Minnesota Department of Health (MDH) Project Overview and Background November 4, 2009

2. Overview • Background and legislative charge • Scope, workplan • Existing prescription drug PA website demo (example only) • Next steps

3. Background and legislative charge • 2009 session • Health care reforms in 2008 and follow-up • Ongoing interests in health care administrative simplification/cost reduction • Legislators heard a large regional provider’s experience with prescription drug PA • Burdens and costs associated with multiple PA processes, forms • Manual activity despite use of EHR • Legislative interest in facilitating PA process with prescribers at the point of care

4. Legislative charge • External proposal (Not MDH proposal) • Minnesota Statutes 2008, section 62J.497, subdivision 5, as added by Laws 2009, chapter 79, article 4, section 6, is amended to read: Subd. 5. Electronic drug prior authorization standardization and transmission.    (a) The commissioner of health, in consultation with the Minnesota e-Health Advisory Committee and the Minnesota Administrative Uniformity Committee, shall, by February 15, 2010, identify an outline on how best to standardize drug prior authorization request transactions between providers and group purchasers with the goal of maximizing administrative simplification and efficiency in preparation for electronic transmissions.    (b) No later than January 1, 2011, drug prior authorization requests must be accessible and submitted by health care providers, and accepted and processed by group purchasers, electronically through secure electronic transmissions. Facsimile shall not be considered electronic transmission

5. Project scope and workplan • Respond to statutory charge in timeframe, resources available • Approach: Develop key specifications for direct data entry web portal for prescription drug PA requests • No single, central web site for prescription drug PA is required or is being considered • MDH is not constructing the website for prescription drug PAs • Payers create their own sites based on specs

6. Project scope and workplan (cont.) Example web portal specs of interest: • Data collection needs regarding patients, patient clinical information, provider information, prescription drug information, insurer/payer information and other data; • Privacy and security, including registration, authorization, and authentication of system users; • Website content, organization, and display; • Other related data, data exchange, and response considerations, including data elements needed on all exchanges, and data to address context-specific information needs.

7. Project scope and workplan (cont.) • Understand, coordinate with national standards, HIPAA requirements, ongoing PA development •    HIPAA • X12 278 for “Dental, professional, and institutional referral certification and authorization” • NCPDP telecomm 5.1 for “Retail pharmacy drug referral certification and authorization” • HITSP • National level workgroups and development

8. Project scope and workplan (cont.) • Legislative proponent’s suggested example -- Minnesota payer prescription drug PA website

9. Next Steps • Additional meeting/teleconference • Tentatively scheduled Nov. 19 and Nov. 20 • More detailed discussions of direct data entry web portal specifications • Public comment period and review of public comments

10. MDH contact information • David Haugen, Director, Center for Health Care Purchasing Improvement • david.haugen@state.mn.us • 651-201-3573 • Website for additional information, updates: • http://www.health.state.mn.us/asa/drugauth.html