Powering the Prior Authorization Transformation

We’ve all been there—you wake up in the middle of the night and after a while you realize you’re not going to fall back asleep anytime soon. Maybe a glass of water or a snack will do the trick. You stumble to the kitchen, flip on the light and review your options.

Without thinking, we expect that when we flip on the light switch, the light will turn on (barring some unforeseen circumstances, of course).

We don’t often stop to think about what it takes for that ordinary action to bring light to a dark room—especially when we’re on our way to grab a midnight snack. And I'd bet that many would agree that we are grateful we don’t have to think twice about where electricity comes from and how it makes it to our kitchen light.

In much the same way, when we’re sick, we shouldn’t have to think twice about the steps that happen between receiving a diagnosis from a clinician, being prescribed treatment and taking the first dose of a medication. For that matter, prescribers, care managers and pharmacists ought to be alleviated from time-intensive manual process traditionally required for prior authorizations.

Powering the Prior Authorization Transformation

It’s a challenge that’s worth overcoming because it impacts all sides of healthcare—clinicians, care managers and most importantly, the patients in their care.

While advances in intelligent prior authorizations have been made over time, it took an innovative collaboration with Surescripts Network Alliance participants to meaningfully transform this process.

It’s led us to develop Surescripts Touchless Prior Authorization that provides a more automated and efficient prior authorization process, significantly reducing—not just shifting—the burden on all sides of the patient care team.

Until now, the technology solutions available to simplify prior authorizations, while a step in the right direction, they focused on a single stakeholder, ultimately just shifting the burden. One analysis found that conducting prior authorizations electronically or via a portal remains one of the most time-consuming administrative tasks for providers, requiring an average of 16 minutes to submit a request through a portal. But the proof is in the data that the challenges were not unique to providers, impacting the care team and patients alike:

• For patients: prior authorization delays and barriers can reduce satisfaction and throw treatment off track—sometimes with serious consequences. About 40% of prescriptions delayed by the manual prior authorization process are abandoned.
• For payers: prior authorization aims to protect patient safety and support overall better-quality care—but cumbersome manual processes undercut these goals. As of 2023, over one-third of medical plans had an entirely manual prior authorization process that depended on phone, mail, fax and email.
• For providers: prior authorization delays combined with administrative burdens stoke frustration and burnout while increasing staffing demands. Ninety-four percent of physicians say that the prior authorization process delays care, and virtually all (95%) felt that prior authorization somewhat or significantly increases burnout.

Flipping the Switch with Innovation and Collaboration

With a strong foundation of nationwide interoperability in place, Surescripts is poised to fix prior authorizations at a meaningful scale. We’ve continued to build on the partnerships and technologies we’ve already established to quickly make an impact for patients, providers and payers.

The information required to make and validate prior authorization decisions often exists somewhere within a patient’s records. Leveraging existing interoperability, Surescripts partnered with two health systems and a PBM to dramatically simplify prior authorization for GLP-1 drugs.

Innovating to automate prior authorizations allows for greater efficiency for payers while giving providers hours of time back each week.

Most importantly, providing automated prior authorizations can help get patients started on high-quality, affordable, evidence-based treatment that is covered by their health plan—without delay.

Almost as easy as flipping a switch.