Health Plans and Pharmacy Benefit Managers Leverage Technology to Streamline Medication Prior Authorization for Virtually All U.S. Patients

Nationwide, Regional and Local PBMs and Health Plans Remove the Administrative Burden, Costs and Treatment Delays Related to Manual Prior Authorization

ARLINGTON, VA. – June 19, 2019 – In an effort to reduce administrative costs and increase medication adherence, more health plans and pharmacy benefit managers (PBMs) are replacing the manual prior authorization process with Surescripts Electronic Prior Authorization, embedded in prescribers’ electronic health record (EHR) software or through its prior authorization portal. 

Over the past 18 months, several national, regional and local PBMs and health plans representing virtually all U.S. patients have signed on, increasing the number of insured lives covered by Surescripts Electronic Prior Authorization by nearly 20%.

“Together with our health plan and PBM partners, the Surescripts Network Alliance® is having a significant impact on patient-provider satisfaction and medication adherence,” said Tom Skelton, Chief Executive Officer of Surescripts. “By removing the administrative burden from prior authorizations in real time at the point of care, we’re helping ensure that patients take home the right medication the first time, and adhere to their treatment.”

On June 17, in an effort to reduce administrative burden on providers and promote patient access to medications, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to require all Medicare Part D plans to support electronic prior authorization transaction standards based on the National Council for Prescription Drug Programs (NCPDP) SCRIPT standard version 2017071.

The prior authorization process is intended to provide medication safety and cost benefits to patients and health plans, but the manual process can be administratively burdensome. Surescripts Electronic Prior Authorization reduces that burden by streamlining the process and improving communication, which helps patients get needed medications faster and with less hassle.

A large Wisconsin-based health system used Surescripts Electronic Prior Authorization to reduce administrative work for healthcare providers and speed time to therapy for patients. After implementing the solution, the wait time from prescription to fulfillment decreased by nearly two-thirds. The time to complete the process overall decreased from 22 to 12 active minutes, improving physician, nurse and organizational buy-in and cutting overtime costs by 20%. After a few months, the health system saw an 8% increase in first-fill medication adherence.

Electronic prior authorization can be especially beneficial for the prescribing of specialty medications for complex and chronic illnesses like rheumatoid arthritis and multiple sclerosis. A recent Surescripts survey found that 80% of providers don’t have access to information about prior authorization requirements when they begin the prescribing process. With electronic prior authorization, prescribers will have that information at their fingertips, which can greatly expedite the prescribing and approval of these often costly medications.  

In 2018, adoption of Surescripts Electronic Prior Authorization increased by 128%. The top five specialties using Surescripts Electronic Prior Authorization are family practice, internal medicine, psychiatry, pediatrics and neurology.

Visit Surescripts for more information on electronic prior authorization, and join Surescripts June 19–21 at AHIP Institute and Expo 2019 at Booth 625. On Thursday, June 20, at 2 p.m. CT, Josh Sturm, Surescripts Vice President of Key Accounts for Health Plans, will present “Reducing Friction at the Point of Care: How to Engage with Providers for the Best Prescription Decision.”