Break the Bottleneck on Medication Prior Authorization

CVS Caremark is getting prior authorization approvals very quickly, often in seconds. And that’s just the start.

This won’t be news for anyone in healthcare, but the work of getting prior authorizations across the finish line means denials, appeals and rework. It’s a headache in healthcare and a problem for patients, one that could delay access to care. Despite its legitimate purpose of preventing overutilization and misuse, prior authorization can be a bottleneck that disrupts care at the exact moment when patients need care the most.

So, how do we get the right medication to the right patient at the right time?

The American Journal of Managed Care says the answer is to make full use of automated prior authorization. In “Rethinking Prior Authorization,” the author makes the case for embracing digital tools and establishing clear workflows, which can help to deliver timely care and curb frustration.

That’s exactly the path CVS Caremark has taken.

CVS Caremark has expanded the use of prior authorization automation for select specialty medications. When prior authorization requirements are met, CVS Caremark can immediately approve them. The process of automatically matching clinical data with determination criteria at the time of prescribing enables CVS Caremark to reach approvals as quickly as possible, often in as little as 22 seconds.

And this is just the beginning.

“CVS Caremark and Surescripts share a commitment to transform the prior authorization approval process through innovation.”

Dr. Michelle Gourdine

Senior Vice President, CVS Health, and Chief Medical Officer, CVS Caremark

Prior Authorization Automation currently supports 83+ medications, up from 40 in 2024, with more on the way. Thousands of prescribers are receiving approvals now—with a median approval time of just 18 seconds across these thousands of prescribers. On top of that, as detailed in our Surescripts Annual Impact Report 2025, requests handled by this tool went far more smoothly compared to other prior authorizations, with an 11% lower rate of denials due to lack of information, and a 17% lower rate of appeals.

Automation is the foundation:

• Determinations in seconds: Clinical data is automatically matched with determination criteria at the point of prescribing, with seconds-long median approval times across the Surescripts network.
• Better workflows: Clinical questions and patient-specific data are automatically routed directly to provider workflows to complete approval requirements with minimal manual intervention.
• Fewer denials: Automated information retrieval reduces denials caused by missing documentation to ensure that clinically appropriate medications reach patients faster.

“By helping to make prior authorization instant and seamless, we reduce administrative burden while maintaining clinical integrity, helping to ensure the people we serve receive the medications they need more quickly,” says Dr. Michelle Gourdine, Senior Vice President, CVS Health, and Chief Medical Officer, CVS Caremark.

Ushering in a New Era of Medication Access

This isn’t just a marginal improvement.

It’s a wholesale transformation of a process that has long frustrated prescribers, with an overwhelming majority of survey respondents citing prior authorization as a top impediment to getting the patient started on a new therapy quickly. This points toward a future in healthcare where we automate what can and should be automated, all while maintaining clinical rigor.

And it’s the kind of technology that organizations like CVS Caremark will use—and have already begun using—to break the bottleneck and ensure that the right medication reaches the right patient as quickly as possible.