How a Pharmaceutical Manufacturer Accelerated Patient Access with Surescripts Electronic Benefit Verification

Prior to implementing Electronic Benefit Verification, the manufacturer’s patient access vendor agents relied heavily on manual benefit verification processes to confirm coverage—spending hours navigating fragmented systems and calling and faxing PBMs and health plans. The process was slow, inefficient, and costly—especially as prescription volumes increased.

Manual follow-ups also created workflow backlogs and delays, particularly during peak periods. Agents often had to reach out multiple times and rework incomplete information which slowed the verification process and patients’ therapy journey.

These inefficiencies strained workflows and human experiences—burdening agents with cumbersome manual work and disrupting patients’ ability to start therapy quickly.

To address these challenges, the manufacturer needed a solution that could deliver real-time, patient‑specific pharmacy benefit intelligence—eliminating the need for phone calls, faxes, and manual claims review. They also needed a solution that could seamlessly integrate into their existing customer relationship management (CRM) workflows and support multiple brands at scale.

The manufacturer implemented Surescripts Electronic Benefit Verification to help their patient access vendor agents get accurate pharmacy benefit details directly from health plans and PBMs. This enabled patient access agents to instantly retrieve real-time, patient-specific pharmacy benefit data—without needing Social Security numbers—and dramatically reduce the manual follow-ups that previously slowed the process.

Deployment followed a phased rollout built through close collaboration between the manufacturer, its third-party patient access vendor and Surescripts. Daily check-ins, rapid feedback loops and a structured ramp up of users ensured the rollout was smooth, supported and adaptable as teams gained experience with the new process.

As part of the rollout, patient access agents began using the secure Electronic Benefit Verification portal—which provided immediate access to electronically verify patient benefits and enabled them to replace verifications via phone and fax in their day-to-day workflows.

This phased approach and continued collaboration between key stakeholders delivered early wins and quickly scaled—setting the stage for deeper automation and broader adoption over time.

Following implementation, the manufacturer closely monitored operational performance and accuracy using Surescripts Electronic Benefit Verification. As an initial validation step, the team processed 80 benefit verifications using both verification methods. Agents first completed the verifications manually by calling health plans and PBMs. The same 80 verifications were then processed using Electronic Benefit Verification—enabling a direct comparison of accuracy, efficiency and time to completion.

The findings were clear: 79 of the 80 transactions, or 98.8%, matched exactly. And the single mismatch was due to human error during details confirmation in the manual process—not the electronic result.

With accuracy validated, the manufacturer expanded use of the solution—and within just eight weeks, Electronic Benefit Verification delivered meaningful and measurable improvements, including:

• Operational lift across teams: More than 150 patient access agents are now using Electronic Benefit Verification and integrating the solution into their regular daily workflow.
• High transaction volume scaled fast: More than 14,800 successful electronic benefit verification responses, with volume steadily increasing.
• Major time savings: An estimated 370 hours per week saved by reducing manual phone calls and faxes to PBMs and health plans.
• Strong user experience: Patient access agents reported strong positive feedback on the solution’s ease of use, speed and accuracy of returned data.

Near real-time benefit intelligence powers speed to therapy.
Replacing manual, phone-based pharmacy benefit verification with Electronic Benefit Verification fundamentally changed how quickly and effectively patient access agents could act. Immediate visibility into coverage status and prior authorization requirements enabled faster triage and earlier downstream actions—directly supporting faster therapy initiation. This proactive approach also helped reduce last-minute issues at refill and prompted teams to intervene before gaps in therapy occurred.

Flexibility in deployment accelerates adoption.
The manufacture evaluated multiple implementation options for Electronic Benefit Verification—including portal access, API integration and scheduled flat-file process—and determined that portal access was the best fit for existing workflows, partner implementations and program goals.

Vendor alignment is critical to operational efficiency.
By directing the patient access vendor to use a standardized Electronic Benefit Verification solution, the manufacturer reduced process variability and eliminated unnecessary rework. With one accurate, real-time source of benefit intelligence, workflows became more consistent, backlogs decreased and overall throughput increased—allowing teams to expand capacity without adding new resources.

Scalability matters as programs grow.
As volumes increase and new brands are added, fast and reliable transaction processing becomes essential. Using Electronic Benefit Verification to design benefit verification as a scalable capability—rather than a point solution—positions organizations to support future growth without operational disruption.