How to Use the Medco Prior Authorization Form Online

Prior authorization plays an important role in managing prescription requests and ensuring that the therapies you prescribe meet the required guidelines. 

A Medco Prior Authorization Form is a document used by healthcare providers to request approval from Medco before prescribing certain medications. This process ensures that the prescribed drug is medically necessary, cost-effective, and meets the insurance plan's coverage criteria. 

Medco was acquired by Express Scripts in 2012 and no longer operates as a separate entity. If you're submitting a prior authorization request, it will go through Express Scripts. The Express Script prior auth physician system lets you streamline requests and improve your daily workflow. 

You will also notice that the express script prior auth method integrates easily with a physician’s existing processes, helping them manage authorizations without unnecessary delays. For older Medco prescriptions or policies, it’s best to check with Express Scripts directly to ensure you follow the correct process.

Let’s explore how a Medco prior authorization system simplifies administrative workload by providing a clear, online method to submit, track, and manage authorization requests.

Medco Prior Authorization

​Prior authorization (PA), also known as a "coverage review," is a process used by health plans, including Express Scripts (formerly Medco), to determine if a prescribed medication will be covered under a patient's prescription benefit. This process helps ensure that medications are used appropriately and are cost-effective.

However, the prior authorization process has been a subject of debate. While it aims to regulate and optimize patient care, it can also lead to delays in treatment. 

A 2024 survey by the American Medical Association revealed that 78% of physicians believe prior authorization can lead patients to abandon recommended treatments.

Role of Medco and Express Scripts in Medication Management

Medco Health Solutions and Express Scripts have been pivotal in the realm of pharmacy benefit management (PBM):

• Medco Health Solutions: Established as a leading PBM, Medco provided services to manage prescription drug benefits, aiming to improve clinical outcomes and control costs for clients and patients.
• Express Scripts: In 2012, Express Scripts acquired Medco, creating one of the largest PBMs (Pharmacy Benefit Managers) in the United States. This merger expanded their ability to negotiate drug prices, manage pharmacy networks, and implement clinical programs to enhance medication adherence and safety.

For physiotherapy clinics, collaborating with PBMs like Express Scripts can streamline the medication management process for patients, ensuring that prescribed therapies align with insurance requirements and are obtained without unnecessary delays. 

There has been increased scrutiny over the practices of PBMs and insurance companies, especially concerning prior authorizations and claim denials. Legislative efforts are underway to reform these processes, aiming to reduce administrative hurdles and improve patient access to necessary treatments.

With the shift towards digital healthcare solutions, providers can now access and submit prior authorization forms online. Express Scripts offers an intuitive portal to help physicians manage medication requests efficiently.

Accessing Medco Prior Authorization Form Online

For healthcare providers, efficiently managing prior authorizations is essential to ensure patients receive timely medications. Express Scripts, formerly Medco Health Solutions, offers an online platform to streamline this process. Below is a guide to accessing and utilizing the Medco prior authorization form online.

Steps to Locate the Medco Online Portal

To access the prior authorization form:

1. Visit the Express Scripts Provider Portal: Navigate to the Express Scripts provider portal at the Express Scripts Provider Portal.
2. Log In or Register: If you already have an account, enter your credentials to log in. New users must register by selecting the "Register" option and following the prompts.
3. Access Prior Authorization Tools: Once logged in, locate the prior authorization section, often labeled as "Coverage Review" or "Prior Authorization." Here, you can initiate new requests or manage existing ones.

What are the Requirements for Online Access?

Before accessing the online portal:

• Valid Provider Credentials: Ensure you have your National Provider Identifier (NPI) and other necessary credentials ready for verification during registration or login.
• Internet Access: A stable internet connection is required to access and utilize the online tools effectively.
• Supported Browser: Use an updated web browser like Google Chrome, compatible with the Express Scripts portal to ensure optimal functionality.

User Interface and Navigation Tips

To efficiently use the portal, navigate these options in the browser. 

• Dashboard Overview: After logging in, the dashboard provides an overview of your account, including pending authorizations and notifications.
• Initiate New Requests: To start a new prior authorization, select the "New Request" option. Follow the on-screen prompts to enter patient information, medication details, and relevant clinical information.
• Track Existing Requests: The portal allows you to monitor the status of submitted prior authorizations. Access the "Status" or "Pending Requests" section for updates.
• Support Resources: If you encounter issues or have questions, the portal offers support resources, including FAQs and contact information for provider support.

Once you have access to the portal, the next step is completing the prior authorization form correctly. Providing accurate and detailed information is essential to prevent delays and ensure faster approval. 

Download the Prior Auth Form for Medco here - Medco Prior Auth Form PDF

Here is a general Prior Authorization General Request Form by Express Scripts, utilized by physicians to request coverage approval for medications that require prior authorization under a patient's prescription plan.

Filling Out the Medco Prior Authorization Form

Completing the Medco (now Express Scripts) prior authorization form accurately is essential for timely medication approval. Below is a guide to assist physicians in this process. 

Necessary Information Required for Submission

When submitting a prior authorization request, physicians must have the following details:

• Patient Information: Full name, date of birth, address, insurance ID number, and contact information.
• Prescriber Information: Physician's full name, National Provider Identifier (NPI), contact details, and signature.
• Medication Details: Name of the drug, dosage, frequency, and duration of therapy.
• Clinical Justification: Diagnosis, relevant medical history, previous treatments tried and their outcomes, and rationale for prescribing the requested medication.

Accurate and comprehensive information helps expedite the review process.

Which are the Common Sections of the Form?

The prior authorization form typically includes the following:

• Patient Information: Demographics and insurance details.
• Prescriber Information: Physician's credentials and contact information.
• Medication and Medical Information: Details about the prescribed drug and the patient's medical condition.
• Clinical Information: Specific questions related to the medication's use, previous therapies, and supporting clinical data.

Being familiar with the form allows physicians to provide all necessary information, reducing the likelihood of delays due to missing or incomplete data.   

Important Guidelines for Physicians

To ensure a smooth prior authorization process:

• Use Electronic Prior Authorization (ePA) Systems: Utilize ePA platforms like ExpressPAth®, CoverMyMeds®, or Surescripts® for real-time submissions, reducing processing time.
• Provide Comprehensive Clinical Justification: Clearly document the medical necessity for the prescribed medication, including previous treatment failures and specific patient needs.
• Stay Informed About Formulary Changes: Regularly review updates to the formulary and prior authorization requirements to ensure compliance.

Adhering to these guidelines can enhance approval rates and improve patient care.

After submission, Express Scripts evaluates each request based on medical necessity, policy compliance, and clinical guidelines. Their review process determines whether a medication will be approved or if additional information is needed. 

Role of Express Scripts in Approvals

Express Scripts plays a central role in the approval process for prior authorizations, ensuring that medications are dispensed in accordance with health plan policies and clinical guidelines. Here's how Express Scripts contributes to the approval process:

1. Ensuring Compliance with Health Plan Policies

Express Scripts reviews prior authorization requests to ensure that prescribed medications align with the patient's health plan coverage and meet specific clinical criteria. This process helps manage healthcare costs while ensuring patients receive necessary treatments. Express Scripts' pharmacists regularly review the latest research on medications and consult with independent licensed doctors to develop prior authorization recommendations.

2. Streamlining the Approval Process

Express Scripts offers electronic prior authorization (ePA) tools that allow physicians to submit requests directly within their electronic health records (EHRs) or through web portals like ExpressPAth, CoverMyMeds, and Surescripts. These tools streamline the process by requiring minimal effort from physicians, who simply select the patient drug information and answer clinical criteria questions. Express Scripts responds electronically with approval or a request for further review, aiming for a turnaround time of 48 hours or sooner if required by law.

3. Enhancing Patient Safety and Plan Savings

Express Scripts' prior authorization program is designed to drive plan savings and enhance patient safety by monitoring the dispensing of high-cost medications and those with potential for misuse. The program ensures drug coverage consistent with the client's intent for the prescription benefit, maintaining both member and physician satisfaction.

4. Efficient Communication and Decision-Making

Express Scripts' prior authorization phone lines are available 24/7, allowing for immediate determinations if all necessary information is provided. This enables quick access to information and ensures effective treatment by monitoring patient responses to therapy. If a situation is urgent, physicians can request faster processing.

Submitting a prior authorization form is more than just filling out paperwork—it’s about ensuring that patients receive the medications they need without unnecessary delays. Express Scripts’ online submission system streamlines this process.

Submitting the Completed Express Scripts Form

Efficient submission of prior authorization requests ensures timely patient access to necessary medications. Express Scripts offers an online platform to streamline this process.

1. Submission Process via the Online Platform

Submit prior authorization requests electronically through Express Scripts' electronic prior authorization (ePA) system. This secure method allows for real-time processing and reduces administrative burdens. Providers can utilize platforms like Surescripts or CoverMyMeds to initiate these requests.

2. Verification and Confirmation of Submission

After submitting a prior authorization request, it's essential to verify its receipt and monitor its status:

• Confirmation: Upon submission, the ePA system typically provides an immediate confirmation, indicating that Express Scripts has received the request.
• Status Tracking: Providers can log into their ePA platform to track the progress of submitted requests. Express Scripts aims to review and respond to ePA requests promptly, often within 48 hours. 

Troubleshooting Common Submission Issues

While the electronic submission process is designed for efficiency, providers may occasionally encounter challenges:

• Technical Difficulties: If issues arise with the online platform, providers should contact Express Scripts' technical support at (800) 711-5672, available 24/7.
• Incomplete Information: Ensure all required fields in the prior authorization form are filled out accurately. Missing or incorrect information can delay processing.
• Submission Errors: If a submission error occurs, recheck the information for accuracy and completeness. If problems persist, contacting Express Scripts directly can provide a resolution.

Once a request is submitted, monitoring its progress is essential to ensure timely approvals.

Tracking the Status of Prior Authorization

Efficient management of prior authorization requests is essential for healthcare providers to ensure timely patient care. Express Scripts offers several tools to assist in tracking these requests.

Methods to Track Authorization Requests

You can track prior authorization requests through various methods:

• Electronic Health Records (EHRs): Many healthcare systems use EHRs to manage and track prior authorization requests. These systems often integrate with insurance company portals, allowing providers to submit and monitor requests electronically.
• Online Portals: Insurance companies provide online portals where providers can submit and track prior authorization requests. These portals typically offer real-time updates on the status of requests.
• Automated Software: Some healthcare facilities use automated software like SpryPT to streamline the prior authorization process, which can help track requests more efficiently.

Understanding Different Status Updates

Understanding the different status updates for prior authorization requests is important for managing patient care:

• Pending: This status indicates that the request is being reviewed by the insurance company.
• Approved: The treatment or service is covered by the insurance.
• Denied: The request is rejected, often requiring an appeal or additional documentation.
• On Hold: Additional information is needed before the request can be processed.

How to Deal with Delays and Denials?

Delays and denials in prior authorization can impact patient care and provider workload. Here are strategies to manage these challenges:

• Delays: Follow up regularly with insurance companies to expedite the review process. They can also consider using automated systems to streamline communication and reduce administrative burdens.
• Denials: When a request is denied, review the reasons for denial and submit an appeal if necessary. This may involve providing additional clinical information or clarifying the treatment plan.

Suggested read: Medicare Part B Medication Prior Authorization Guide

Conclusion 

Navigating the prior authorization process is crucial for ensuring patients receive timely and appropriate care. The Express Script prior auth system offers a structured and user-friendly platform that simplifies medication approvals, reducing administrative burdens on healthcare providers. By utilizing electronic prior authorization (ePA) tools and real-time tracking features, physicians can streamline requests, minimize delays, and enhance overall workflow efficiency.

While prior authorization remains a necessary step in managing prescription approvals, tools like Express Script prior auth ensure a smoother experience for both providers and patients. Staying informed about best practices, utilizing digital submission methods, and proactively addressing potential delays can significantly improve authorization success rates. As legislative efforts continue to refine prior authorization processes, healthcare providers should embrace technology-driven solutions to optimize medication management and patient care. 

​Transform your clinic's efficiency by automating prior authorizations with SpryPT's advanced AI-driven solution. Experience up to a 60% reduction in manual submission time and an 80% decrease in errors, allowing you to focus more on patient care. Schedule a free demo today!