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.

Powering the Prior Authorization Transformation

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 Prior Authorization Automation that provides a more automated and efficient prior authorization process, significantly improving medication access and reducing time to therapy for patients.

Here are a few of the challenges with prior authorization:

• For patients: About 40% of prescriptions delayed by the manual prior authorization process are abandoned.
• For payers: 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: Ninety-four percent of physicians say that the prior authorization process delays care.

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.

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.

The impact is clear: 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.