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Surescripts
The key to faster submissions and approvals
Whether your job is to request prior authorizations, submit clinical content for review or make final determinations, your organization needs the right tools and intelligence at your fingertips and within your workflow. By streamlining prior authorizations, Surescripts can help you work more efficiently and ensure patients get the right medication, covered under their prescription benefit plan, without unnecessary delays.
10 minutes
of active work time eliminated from the average prior authorization1
2+ days
of prior authorization wait time saved for patients1
<4 minutes
to return the average approval2
What can Electronic Prior Authorization do for you?
Choose your organization type to see how Electronic Prior Authorization can help you streamline your team’s processes and improve medication-related decision-making.
Fast-track prior authorizations at the point of care
Make your prior authorization workflows more efficient than ever. Alleviate delays and frustration with a fully integrated solution that lets users proactively initiate requests and receive quick responses.
Simplify authorization workflows
Make it easier to proactively submit clinical information to pharmacy benefit plans for efficient determinations and quickly respond to pharmacies.
Improve time to therapy
Surface prior authorization responses within the workflow so prescriptions can be processed sooner.
Automate user tasks and workflows
Create routing rules for prior authorization tasks so others can assist prescribers in managing requests, submitting clinical information and following up on denials and approvals.
Improve prescription pickup rates
Ensure prescriptions are ready for patients when they go to the pharmacy. One health system improved its pickup rate by six percentage points using Surescripts.1
How it works for EHR vendors
A provider prescribes a new medication and sees that prior authorization is needed.
Eligibility and formulary data is provided in the E-Prescribing workflow, including prior authorization requirements.
They start a request and receive a dynamic prior authorization question set in the EHR.
The request triggers the benefit plan to send the appropriate question set to your electronic health record (EHR).
The prescriber or their staff answer the questions and receives a decision in minutes.
Users complete only the required information, without leaving your EHR. Benefit plans respond within the same workflow.
The prescription is already authorized by the time the patient arrives at the pharmacy.
Fast approval increases speed to therapy to support adherence.
Make prior authorization easier and ultra-efficient
Enable faster prior authorization decisions by securely delivering plan-specific question sets, decisions and responses to provider workflows. Eliminate the inefficiencies and administrative burden of manual processes.
Optimize prior authorization workflows
Automatically send questions, receive answers and attachments, send responses and initiate renewals.
Get question sets answered fast
Transmit plan- and drug-specific questions sets directly to provider workflows. Eliminate communication barriers and inefficiencies.
Decrease time to decisions
Determine whether a prescription is covered sooner. In an AHIP study, the median time to a decision decreased 69% compared with manual prior authorization.3
Get medications to members sooner
Improve time to therapy and get better, faster information from prescribers. Average wait time dropped by more than two days for one health system using Electronic Prior Authorization.1
How it works for health plans
A prescriber initiates a prior authorization request and receives a custom question set.
Surescripts transmits a dynamic electronic question set tailored to the medication from the benefit plan to the EHR.
The provider is prompted to enter only the information you need.
Staff are guided through entering the required clinical details and, if necessary, submitting attachments.
The provider receives your determination in the same workflow.
Quickly send approvals, denials or requests for more information based on the information submitted.
When the prior authorization is about to expire, the provider gets an alert.
Surescripts lets you or your pharmacy benefit manager (PBM) proactively prompt prescribers to initiate renewals.
If a provider contacts your call center, you can guide them through an electronic workflow.
With the Prior Authorization Portal, call centers can ease the process even for those without an integrated solution.
Fast-track prior authorizations at the point of care
Make your prior authorization workflows more efficient than ever. Alleviate delays and frustration with a fully integrated solution that lets your team proactively initiate requests and receive quick responses within the EHR.
Simplify authorization workflows
Make it easier to proactively submit clinical information to pharmacy benefit plans for efficient determinations and quickly respond to pharmacies.
Improve time to therapy
Get responses sooner so patients spend less time waiting for their prescriptions.
Automate user tasks and workflows
Create routing rules for prior authorization tasks so others can assist prescribers in managing requests, submitting clinical information and following up on denials and approvals.
Improve prescription pickup rates
Ensure prescriptions are ready for patients when they go to the pharmacy. One health system improved its pickup rate by six percentage points using Surescripts.1
How it works for health systems
A prescriber sees that prior authorization is needed for a medication.
Eligibility and formulary data is provided in the E-Prescribing workflow, including prior authorization requirements.
They start a request and receive a dynamic prior authorization question set in the EHR.
A prior authorization request automatically triggers the PBM or health plan to deliver the appropriate question set.
The prescriber or a staff member answers the questions and receives a decision in minutes.
Staff complete only the required information, without leaving the EHR. Benefit plans respond within the same workflow.
The prescription is already authorized by the time the patient arrives at the pharmacy.
Fast approval increases speed to therapy to support adherence.
Fast-track prior authorizations for specialty medications
Quickly understand when prior authorization is required and expedite the process on behalf of the prescribers and patients you serve.
Accelerate the prior authorization process
Connect directly with the pharmacy benefit manager or health plan to initiate and complete prior authorization requests.
Improve speed to therapy
Jump-start the prior authorization process, leveraging your services expertise and the electronic workflow to help reduce a common barrier to timely treatment.
Align with pharmacy benefits
Leverage insights from eligibility information and drug-specific questions sets to help patients maximize their coverage.
How it works for patient access vendors
Your team sees prior authorization is required for a medication and initiates a request.
The request is automatically delivered to the pharmacy benefit plan.
Staff receive and complete the question set.
Surescripts displays only the patient and treatment questions that are truly needed for a decision.
Staff submit the request, and the PBM quickly returns a decision.
Once the PBM receives the data and makes a determination, approvals typically arrive within minutes.
Get clear information on any follow-up required.
Work with the plan if you receive denials or requests for more information.
Make prior authorization easier and ultra-efficient
Enable faster prior authorization decisions by securely delivering plan-specific question sets, decisions and responses to provider workflows. Eliminate the inefficiencies and administrative burden of manual prior authorization.
Optimize prior authorization workflows
Automatically send question sets, receive answers and attachments, send responses and initiate renewals.
Get question sets answered fast
Transmit plan- and drug-specific questions sets directly to provider workflows. Eliminate communication barriers and inefficiencies.
Decrease time to decisions
Determine whether a prescription is covered sooner. In an AHIP study, the median time to a decision decreased 69% compared with manual prior authorization.3
Get medications to members sooner
Improve time to therapy and get better, faster information from prescribers. Average wait time dropped by more than two days for one health system using Electronic Prior Authorization.1
How it works for PBMs
A prescriber initiates a prior authorization request and receives a custom question set.
Surescripts transmits a dynamic electronic question set tailored to the medication from the benefit plan to the EHR.
The provider is prompted to enter only the information you need.
Staff are guided through entering the required clinical details and, if necessary, submitting attachments.
The provider receives your determination in the same workflow.
Quickly send approvals, denials or requests for more information based on the information submitted.
When the prior authorization is about to expire, the provider gets an alert.
Surescripts lets you or your pharmacy benefit manager (PBM) proactively prompt prescribers to initiate renewals.
If a provider contacts your call center, you can guide them through an electronic workflow.
With the Prior Authorization Portal, call centers can ease the process even for those without an integrated solution.
A smarter prior authorization process
We collaborate across healthcare to bring more intelligence into prior authorization workflows—which means less administrative burden and better experiences for everyone.
One connection to a whole network
Get the connections you need to all the providers, pharmacies and payers involved in medication prior authorizations by partnering with Surescripts.
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Adding intelligence to data
We’re constantly innovating to further optimize the process with enhancements such as validating patient identity, NDC codes and provider credentials.
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Integrated workflows
We are pioneers in bringing prior authorization into the familiar, efficient workflows care teams already use within their EHRs and other technology platforms.
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Real-world results
Find out more about Electronic Prior Authorization
Can Electronic Prior Authorization help complete prior authorizations either before or after the prescription reaches the pharmacy?
Yes. Organizations are gaining the most efficiency from the prospective prior authorization workflow, which lets them initiate the process and gain approval before the pharmacy has to take action. However, you can also use Electronic Prior Authorization to complete or continue retrospective prior authorizations that are triggered at the request of the pharmacy.
I’ve found that other prior authorization solutions have often indicated that prior authorizations were needed incorrectly. Does Surescripts have a more accurate way to validate that prior authorizations are truly required?
Yes. Prior authorization indicators are sent directly from the PBMs or health plan and reflect the prior authorization status based on the benefit plan design. We help payers supply that up-to-date information through On-Demand Formulary and through Real-Time Prescription Benefit inquiries. As a result, prescribers are presented with a more accurate reflection of the need for prior authorization.
If a prescriber doesn’t use an EHR that integrates with Electronic Prior Authorization, can they still submit prior authorization requests electronically?
Yes. Thousands of prescribers and their staff use the free Surescripts Prior Authorization Portal to gain a fully electronic connection to PBMs. The portal gives them easy tools to organize their workflow, manage requests and submissions, and access timely approvals or other determinations.
What are “question sets”? Do they replace old-fashioned paper forms or PDF forms?
Question sets are dynamically generated based on the type of medication and the type of clinical information a payer may need for a given patient and medication. They will appear in the EHR or portal and ask for only the necessary demographic and clinical information about the patient and their treatment.
Unlike paper or PDF forms, questions sets will only display the questions that are appropriate and often will have the patient’s demographic information already filled in. This makes electronic prior authorizations much faster to complete.
Is the overall use of electronic prior authorization increasing or decreasing?
Increasing. In 2022, we saw a 44% rise in prior authorizations processed electronically, and now 84% of prescribers use EHRs equipped with Surescripts Electronic Prior Authorization.2
If a prescriber has questions about the Electronic Prior Authorization process, status, connections or best practices, what’s the best way to get answers?
We encourage prescribers who use Electronic Prior Authorization within their EHR to start with their EHR vendor. In many cases, the answer to your question is just a support ticket away.
Prescribers using the Surescripts Prior Authorization Portal can contact our Surescripts support team directly.
We also have resources for health plans, PBMs and pharmacies that have teams working directly with prescribers and health systems. We work with many such partners to help educate their prescriber-facing teams or call centers to understand how prescribers are seeing prior authorization details and processing requests. If your teams could benefit from a better understanding of how Electronic Prior Authorization comes to life for prescribers, please contact us below or reach out to your Surescripts account team.
How do organizations get connected to Surescripts Electronic Prior Authorization?
Surescripts is always expanding its partnerships for medication-related prior authorizations. We guide EHRs, health plans and other organizations throughout proven certification process step by step.
To get the conversation started, click the “Get in touch” button below.
Keep pace with healthcare innovation
- Surescripts, “How Aurora Health Care Used Electronic Prior Authorization To Cut Clinic Staff Overtime By More Than Half,” July 25, 2019.
- Surescripts, “2022 National Progress Report,” March 2023.
- Paige Minemyer, “AHIP Study Finds Electronic Prior Authorization May Make It Easier for Providers To Say Goodbye to Their Fax Machines,” Fierce Healthcare, March 24, 2021.
Connect with our team to explore how we can partner to increase patient safety, reduce costs and ensure quality care.
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