The health intelligence platform behind virtually every prescription

Twenty-five years ago, two organizations saw the same broken system from different angles—and each set out to fix it. A few years later, I was starting my own career in pharmacy, learning firsthand what happens when the chain of trust behind a prescription breaks—the callbacks, the delays, the guesswork. The platform that resulted, and the partnerships that made it work, have shaped how prescriptions move, how data stays accurate and how the industry navigates change.

In 2001, SureScript Systems formed to enable electronic prescribing between prescribers and pharmacies. That same year, RxHub formed to connect payers and providers. In 2008, they merged to become Surescripts—and in doing so, proved the thesis that would define everything that followed: that solving healthcare’s hardest problems requires bringing the right partners together on a shared platform. I’ve spent my entire pharmacy career watching that thesis play out, year after year.

E-Prescribing as the foundation

An e-prescribing connection is relatively easy to establish. What's behind it is harder to see—until something goes wrong.

Think about what's in motion every time a prescription is sent: a clinician's intent, a patient's therapy and a pharmacist's ability to dispense safely and quickly. When everything works smoothly, no one notices. When it doesn't—if a prescription disappears during a system outage or incomplete dosing information sends a pharmacist chasing a callback—the consequences land on the patient first.

Here's what's behind the Surescripts platform and why it's not just the e-prescribing infrastructure, but the insights and connections pharmacies, EHR vendors and prescribers have relied on for more than two decades.

Nationwide reach, built in

Surescripts connects 2.32 million healthcare professionals and provider organizations—including virtually every ambulatory prescriber in the country, plus long-term and post-acute care and specialty pharmacies. At the end of 2025, 1.39 million prescribers and 98.3% of pharmacies were actively using Surescripts E-Prescribing.

At this scale, a prescription sent from anywhere reaches a pharmacy. There are virtually no coverage gaps requiring manual workarounds or care settings that can’t be reached. In 2025, Surescripts processed 2.64 billion prescriptions—the volume at which everything below must hold, every time.

Reliability isn’t just staying up

In 2025, Surescripts maintained 99.998% average uptime—the result of redundant systems, proactive monitoring and rigorous disaster recovery protocols. That's a meaningful number.

But availability alone doesn't account for what happens when other systems in the chain experience interruptions. Surescripts preserves prescription requests during technology downtime and delivers them the moment a connection is reestablished. A prescription sent during a pharmacy system outage doesn't disappear—it waits, protected, until the connection returns.

For pharmacies, uninterrupted prescription flow isn't a nice-to-have, it’s a must. For EHR vendors, prescribing workflows need to be available when clinicians need them, without exception.

Security held to the highest standard

Surescripts holds a HITRUST r2 Certification as well as certifications from the Electronic Healthcare Network Accreditation Commission (EHNAC) and DirectTrust. Additionally, an annual SOC 2 Type 2 audit assesses the design and effectiveness of our controls across security, availability and confidentiality. And we follow the NIST Cybersecurity Framework, which is the same standard required of U.S. federal agencies.

These certifications matter because they require independent validation, not self-attestation. When it comes to security, we're not just checking compliance boxes. We're operating at the level the sensitivity of this data demands.

Identity management at the front door

We’ve obtained formal identity proofing attestations from every EHR vendor connecting to Surescripts for E-Prescribing, ensuring every prescriber passes rigorous identity verification before they’re allowed to participate—a baseline requirement for everyone, not just extra scrutiny reserved for higher-risk activity.

We enforce the National Institute of Standards and Technology (NIST) Identity Assurance Level 2 (IAL2) requirements, exceeding industrywide requirements for non-controlled substances. For pharmacies, that means confidence in who’s on the other end of a prescription. For EHR vendors, it means prescriber identity is reinforced at the point of care, before a prescription is processed.

A coordinated response when something looks wrong

Certifications and identity verification establish a baseline. What we're particularly proud of is how Surescripts responds when something looks wrong.

When unusual activity surfaces—whether caused by fraudulent prescribing or a prescribing system error—our fraud and crisis management team partners with customers to investigate, and a dedicated fraudulent prescribing task force reviews cases holistically, drawing on expertise in anomaly detection, compliance, privacy and more. That collective visibility is powered by the breadth of the Surescripts Network Alliance®, which surfaces anomalies that no single organization could identify alone.

The right prescription at the right time

Connectivity and uptime mean little if the prescription that arrives is ambiguous or incomplete. Incomplete dosing information drives pharmacist callbacks. Unclear instructions create patient safety risk. A prescription that arrives incorrect can be as consequential as one that doesn't arrive at all.

In 2025, 94% of prescriptions processed by Surescripts contained a valid quantity unit of measure (QUOM)—reducing the ambiguity that drives pharmacist callbacks and delays fills. Surescripts Sig IQ translated 60.0% of Medication History responses from free text into Structured & Codified Sig format. And the Surescripts Quality Index Score has increased more than 300% since 2016.

Data quality at this level isn't passive. It reflects sustained investment in the completeness and accuracy of the data we process—because every prescription is a patient safety issue.

Standards we helped write

Many platforms comply with NCPDP SCRIPT standards. We helped develop, vet and deploy them. Active participation in shaping standards, as opposed to just reacting to them, means we're positioned to support partners through transitions before they become disruptions.

Innovation for the future

In 2025, 24.9% of retail pharmacy locations were enabled for RxTransfer, up from 6% in 2024. That's not passive adoption—it reflects active cross-industry support for a capability transitioning from available to standard practice. The Surescripts Network Alliance brings pharmacies, EHR vendors, health plans and other participants together to solve problems in ways that work in the real world. And Surescripts continues to engage governing bodies on the policy dimensions of electronic prescribing to help shape the landscape our partners navigate.

A proven partner through change

Regulations shift, standards evolve and markets change. We're proud of how we've helped partners navigate change—through multiple NCPDP SCRIPT standard upgrades, evolving regulatory requirements and the introduction of new capabilities.

And because we've lived the operational reality, those standards work in practice—not just in theory.

The infrastructure you can depend on

The billions of prescriptions Surescripts processes each year are the visible part of what Surescripts delivers. The prescriptions preserved through outages and delivered intact, partnership to address fraudulent prescribing and the data quality improvements that prevent a wrong dose from reaching a patient—those are the invisible part. And for a patient waiting on a medication, the invisible part is what matters most.

Each of these capabilities stands on its own. But their real value is cumulative.

As regulatory expectations evolve and interoperability becomes more critical, organizations need more than a connection—they need a partner that supports both prescribing and dispensing workflows across a connected and collaborative healthcare ecosystem.

Reliable, secure, accurate and built on the standards that govern the industry: this is the platform the country's healthcare system runs on. And it's only getting better.