Q&A with Surescripts’ Matt Koehler on Closing the Last Mile in Specialty Access

I recently sat down with Surescripts’ Matt Koehler to talk about where and why specialty access breaks down and how to remove friction so providers and care teams have more clarity and consistency, and patients can start therapy faster.

• Q: When you hear the phrase “the last mile in specialty access,” what does it mean to you?

  A:

  To me, the last mile is the final stretch between a prescription being written and a patient actually starting therapy. It’s also where things like benefit details, prior authorization and handoffs between systems can create delays that disrupt treatment—even when the therapy is clinically appropriate.

  Q: Why does that final stretch break down so often in specialty workflows?

  A:

  Prior authorizations can get stuck inside portal queues, stuck between systems, or stuck when information is missing. And even when a prior authorization is valid for a year, refill timing doesn’t always align. For example, a prior authorization can expire right before a refill and then interrupt therapy if the renewal is delayed.

  Q: How have you seen these challenges affect patients directly?

  A:

  I lived it. In my family’s case, refills were available for my son’s medication, but the prior authorization expired and the new one got stuck in a queue. This meant he missed two weeks of therapy. And for individuals and families like mine, that kind of disruption isn’t just inconvenient—it can have real clinical consequences.

  Q: Where does Prior Authorization Automation make the biggest difference?

  A:

  It helps at the moment delays typically happen: when clinical details and benefit requirements need to quickly be matched to determination criteria. By reducing manual steps and rework, Prior Authorization Automation accelerates determinations and approvals and cuts out some of the touch points that slow everything down. That means more timely and actionable information for providers and care teams, and faster and more confident therapy starts for patients.

  Q: How does closing the last mile change outcomes for care teams?

  A:

  Reducing friction gives care teams time back to focus on patients instead of chasing stuck requests or re-entering information. It also supports clearer conversations with patients about what to expect, so there’s less confusion about coverage, timing and cost responsibility.

  Q: What would success look like if the last mile were truly closed?

  A:

  Ultimately, success means patients can start and stay on therapy because approvals happen quickly and reliably. With Prior Authorization Automation, we’re seeing a median approval time of about 18 seconds for supported medications and a 34% automated approval rate for in-scope medications. We’re also planning to continue expanding the number of medications that are supported so even more patients can benefit.

  Q: What do you hope readers take away from this conversation?

  A:

  That prior authorization isn’t the problem—it’s the friction around the process. That’s the problem. And if we can remove those friction points through automation and deliver timely and actionable information when it’s needed, we can help patients start therapy sooner and stay on it with greater confidence.