Transforming Prior Authorization: A Leap Towards Efficiency with Touchless Prior Authorization

In the ever-evolving landscape of healthcare, the process of prior authorization has long been a cornerstone to support care quality and overall healthcare costs for prescribed treatments. However, the manual process is often fraught with administrative burdens and delays that can hinder timely patient care. Recognizing these challenges, Surescripts recently introduced Touchless Prior Authorization to give providers a dramatically more efficient prior authorization experience and minimize treatment delays for patients.

The Need for Change

Prior authorization is an essential part of our healthcare ecosystem to promote better health outcomes and cost-effective care by validating the necessity of high-cost therapies. Even with the advances like electronic prior authorization, the manual process can be cumbersome, leading to increased workload for providers and delayed access to necessary treatments for patients. This is where Surescripts’ innovative approach comes into play.

• In 2024, a survey found that doctors in an average medical practice completed 43 prior authorizations each week, often needing extra administrative staff to handle them.
• Another survey in 2024 found that 44% of patients who faced delays due to prior authorizations had to wait a week or more.
• Other research shows that about 40% of prescriptions delayed by manual prior authorizations are eventually abandoned.

Introducing Touchless Prior Authorization

In 2024, Surescripts began to automate the work of retrieving and sending patient clinical information so that prior authorization requests can be approved almost instantaneously.

Optum Rx was a crucial partner in piloting Touchless Prior Authorization, which they incorporated into their Optum Rx PreCheck Prior Authorization solution. This solution was piloted with Cleveland Clinic from August to October 2024.

“It is amazing to take what is already there in the chart to automate prior authorization without any effort from the physician, pharmacist or staff, says Dr. Eric Boose, associate chief medical information officer, Cleveland Clinic. I feel the promise and excitement of automation actually happening and working, and hope it grows quickly.”

Real-World Impact

The pilot drove impressive and immediate results.

• Median turnaround time plummeted from 8.5 hours to under 30 seconds
• Appeals dropped by 88%
• Denials due to insufficient information dropped by 68%

Download the White Paper

Modernizing electronic prior authorizations helps patients get on therapy faster

A Collaborative Effort

The success of Touchless Prior Authorization is a testament to the power of collaboration between participants in the Surescripts Network Alliance. By integrating cutting-edge technology with a deep understanding of the healthcare ecosystem, we created a solution that benefits all stakeholders involved—prescribers, payers, and most importantly, patients.

Looking Ahead

As we continue to navigate the complexities of healthcare, innovations like Touchless Prior Authorization pave the way for a more efficient and patient-centric approach to care. By reducing administrative hurdles and accelerating access to necessary treatments, Surescripts and our partners are setting a new standard for the industry.

Learn more about how prior authorization technology is transforming healthcare.