Automation of payor-driven product selection in the electronic health record: Implementation and impact for biosimilars and iron products

PURPOSE: To reduce administrative burden and support timely access to payor-preferred therapies, The Ohio State University Wexner Medical Center (OSUWMC) initiated an electronic health record (EHR)-based program in 2021 to automate product selection for biologics and biosimilars, which was later expanded to intravenous (IV) iron in 2024. SUMMARY: The program was designed by pharmacy informaticists in collaboration with managed care, finance, and clinical stakeholders. Advanced order groups were utilized in the treatment plan workflows, with payor and formulary logic embedded to enable automatic product selection at order entry. Postimplementation surveys of pharmacists (n = 17) and prior authorization (PA) team members (n = 5) demonstrated satisfaction: 94% of pharmacists and 60% of PA team members reported being very or somewhat satisfied. Pharmacists estimated a time savings of 3.2 minutes per treatment plan modification, while PA team members estimated a time savings of 8.8 minutes per authorization, totaling approximately 460 staff hours saved over 2 years. Turnaround time (TAT) was defined as the interval from PA submission to payor approval using EHR timestamps, and the data were cleaned to exclude duplicate referrals, reauthorizations, manufacturer assistance program cases, and TATs of more than 60 days. In the 3 months before implementation, the median total TAT was 1.77 days (interquartile range [IQR], 0.11-7.95 days; n = 153) vs 1.81 days (IQR, 0.53-7.80 days, n = 226) in the 3 months after implementation, a 0.04-day increase (P = 0.29). The average TAT improved from 5.75 days to 5.22 days, a 0.53-day (9%) reduction. Staff reported fewer manual substitutions, fewer delays in therapy initiation, improved accuracy of product selection, and reduced billing risk. CONCLUSION: The OSUWMC autoselection program improved operational efficiency, reduced administrative workload, and supported timely patient care. Its adaptability and interdisciplinary design offer a scalable model for other health systems pursuing EHR-based strategies to align with payor requirements.