Prior Authorization

Our Prior Authorization solutions get prescriptions filled faster by delivering prior authorization insights, question sets and responses to help manage prospective and retrospective requests swiftly.

 

Electronic Prior Authorization



Electronic Prior Authorization lets healthcare teams accelerate medication delivery by obtaining prior authorization in real time at the point of care through a fully integrated solution.

Reduces administrative burdens and boosts patient satisfaction

See how health systems and technology vendors can help prescribers cut stress, delays and communication barriers from the prior authorization process.

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Increases efficiency and
speeds time to therapy

See how pharmacies can help specialty pharmacists and technicians execute prior authorizations in their pharmacy management system to get patients on medications in less time with less work.

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Prior Authorization Portal

The Prior Authorization Portal is a free, online way to submit fully electronic prior authorization requests prospectively or retrospectively when the service is not available within the EHR.

Eliminates manual prior authorization hassles

Users avoid the paper forms, faxes and phone calls associated with manual prior authorization—even when a pharmacy or benefit plan initiates the request.

Improves patient and physician satisfaction

Providers often receive prior authorization approvals while patients are in the office, allowing more time for meaningful patient engagement and eliminating surprises at the pharmacy.

User-friendly features create efficient workflows

Intuitive navigation, built-in logic and data-type validation help users swiftly answer only relevant questions. If more documentation is needed, they can send attachments through the same interface.

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Pharmacist perspectives on the specialty fulfillment process

Surescripts commissioned a survey of 414 specialty pharmacists to understand the challenges and bright spots in their work getting critical medications to patients.

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FAQ

Will clinicians be informed of approval or denial decisions in real time?

Yes, when health plans and pharmacy benefit managers are connected, clinicians get real-time approval, denial or partial denial decisions within the EHR, often minutes after submitting a completed question set.

How does the manual prior authorization process impact patient care?

A survey of U.S. physicians found that 94% say the prior authorization process delays care for at least some of their patients. By reducing manual work and wait time, Electronic Prior Authorization can dramatically reduce these delays.1

Will clinicians have to enter patient demographics or medication information into a form?

Electronic Prior Authorization is fully integrated into the EHR workflow, allowing the automatic transmission of patient and provider demographic and medication information to the correct payer, at the touch of a button, without extra work for the clinician.

Does my EHR have Electronic Prior Authorization?

Electronic Prior Authorization is already available in many of the top EHRs with more adopting the capability all the time. Visit this page to see if your EHR is one of them. Contact your vendor to request Electronic Prior Authorization.

What if my EHR does not yet have Electronic Prior Authorization?

If your EHR is still in the process of integrating Electronic Prior Authorization, you can use the Surescripts Prior Authorization Portal to swiftly submit prior authorization requests and receive responses online.

Does Electronic Prior Authorization only work if the request is sent at the point of prescribing?

Wherever the prior authorization process begins, Surescripts can make it more efficient. If a pharmacy encounters a prior authorization requirement, they can jumpstart the process with an RxChange for Prior Authorization message to the prescriber. Benefit plans can also proactively trigger an electronic request for the prescriber to complete.

What happens if a patient’s health plan is not connected to Electronic Prior Authorization?

Surescripts can still help by providing digitized question sets that make it easier to supply the information needed for authorization, often based on prior authorization criteria for the specific drug prescribed.

Related content

Let’s discuss how our Prior Authorization solutions can work for you

  1. American Medical Association, “2020 AMA prior authorization (PA) physician survey,” April 2021
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Let’s Discuss How Our Prior Authorization Solutions Can Work for You