3 Key Learnings on ePA for Providers and Care Teams from #HIMSS25

Insights from Miranda Delatore DNP, RN, NEA-BC , Vice President of Product at CoverMyMeds

The #HIMSS25 conference sparked engaging discussions on the evolution of prior authorization—and what this could mean for providers and their care teams. Several trending topics highlighting regulatory updates, technological advancements, and strategies to enhance efficiency in healthcare with extra focus on GLP-1s and specialty medications were themes in many of my conversations.

Attendees didn't hold back in expressing their struggles with the administrative processes that consume time that could be used for patient care, all while juggling the rapidly changing landscape of the healthcare industry. Having faced similar pressures in my own clinical practice, I fully empathize with the daunting challenges that today's providers and care teams face.

These discussions were especially timely following the release of CoverMyMeds’ 2025 Medication Access Report: From Barriers to Bridges at HIMSS. This year’s report unveiled that 65% of patients have experienced a delay in accessing medication [1] and 94% of physicians say that the prior authorization process delays necessary patient care [2]. These delays aren’t just frustrating, they have real implications on the patient experience and outcomes.

I left the conference energized and with a renewed commitment to continue breaking down barriers for providers and the patients they support. Below, I've compiled key takeaways that recap the discussions our team had onsite.

1. Regulatory Updates: The Centers for Medicare & Medicaid Services (CMS) introduced updates to the Prior Authorization Rule, emphasizing expanded data sharing through the Patient Access API to support both provider and payer audiences [3]. This initiative aims to improve interoperability and streamline PA processes, reducing clerical tasks and enhancing patient care. Despite the current standards, and the availability of electronic prior authorization (ePA) solutions, many healthcare providers continue to rely on outdated manual methods like phone and fax for submitting prior authorization requests. This not only prolongs the process but also creates unnecessary process inefficiencies. Regulatory bodies like CMS are increasingly advocating for the adoption of ePA solutions, as research indicates a substantial reduction in processing times, with platforms like CoverMyMeds expediting determinations to an average of 5 hours compared to the 17-hour average for faxed requests [4].
2. Technology Advancements: The healthcare industry is undergoing a transformative shift with the integration of advanced technologies. The rise of artificial intelligence (AI) stands out as a key development, offering promising opportunities to streamline healthcare workflows. By harnessing AI, we can significantly reduce the burden of manual data entry, thereby easing the workload of care teams. However, it is crucial to integrate AI thoughtfully, ensuring a seamless blend of cutting-edge technology and clinical expertise. Maintaining the human connection remains essential to the patient experience, particularly in verifying patient data. Our aim is to innovate on a large scale, introducing new features that encompass all medications and payers, ensuring these advancements truly make a difference.
3. Strategies to Enhance Efficiencies in Healthcare: To enhance operational efficiencies, it is imperative to prioritize interoperability and system integrations. Providers often grapple with fragmented data across various platforms, a challenge compounded by the use of multiple applications in ePA workflows. Partnering with an ePA vendor that champions interoperability and EHR integration can centralize data, minimizing the need for multiple portals and mitigating the risks of data fragmentation. This strategy not only streamlines workflows but also enhances the overall efficiency of healthcare delivery, ensuring that care teams can focus more on patient care and less on administrative hassles.

Whether you’re solving for delays in medication access, overcoming data fragmentation or improving your prior authorization workflow, we have the tools and expertise to drive meaningful change. I look forward to continuing the conversation with many of you about how CoverMyMeds can help patients get on, and stay on, the medicine they need to live healthier lives.

For actionable strategies to help bridge gaps between access, affordability, and adherence, check out the 2025 Medication Access Report: From Barriers to Bridges.

Sources:

[1] CoverMyMeds Patient Survey, 2023.

[2] American Medical Association. “Health Insurance Denials, Delayed Care and Medication Access: How Prior Authorization Hurts Patients.” American Medical Association, 15 July 2024.

[3] Ribick, Andrea. The CMS Prior Authorization Rule and the Provider Access API - Your How-to Guide. HIMSS, Las Vegas, March 5, 2025.

[4] Based on review of October 2023 OptumRx ePA vs traditional prior authorization submissions for commercial purposes.