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Surescripts
At its best, prior authorization aims to protect patient safety and support cost-effective care. But widespread dissatisfaction with the process shows that it frequently falls short—even for the payers putting prior authorization requirements in place. In response, health plans announced a plan to simplify prior authorization in June 2025. Mike Tuffin of the health insurance trade group AHIP commented, “Health plans are making voluntary commitments to deliver a more seamless patient experience and enable providers to focus on patient care, while also helping to modernize the system.”
Existing data shows how heavily prior authorization burdens patients. 95% of physicians in an American Medical Association survey report care delays when treatment requires prior authorization, and 47% say that the prior authorization process has led to immediate care or emergency room visits.
Some research suggests that prior authorization issues are particularly common for medications. A KFF survey found that people taking prescription drugs were more than twice as likely to have experienced prior authorization problems as those who weren’t.
To better understand how we might solve medication prior authorization pain points, Surescripts commissioned a survey of 503 prescribers (including physicians, physician assistants and nurse practitioners) and pharmacists. Their responses—along with on-the-ground feedback about emerging solutions—illuminate how we can transform the prior authorization workflow to benefit patients.
A time- and resource-intensive workflow creates delays
What is it that makes prior authorization such a persistent problem? Our survey suggests that time to therapy is a key concern.
When asked how long it should take to get a patient started on a new therapy, 95% of prescribers said it should take no more than six days. In practice, however, 18% reported that it typically takes a week or more.
What’s behind this gap? According to 87% of pharmacists and 83% of prescribers, the biggest impediment to improving speed to therapy is obtaining prior authorization—no surprise considering that 88% of pharmacists and 70% of prescribers said the process often or always delays treatment.
Sometimes, it prevents treatment altogether. Nearly half of prescribers said prior authorization requirements often prevent them from prescribing a medication their patients need.
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Some feel that delays and denials are increasing: 51% of prescribers and 47% of pharmacists said they’d seen denials increase in the past year.
Patient impact is a critical concern
The clinicians we surveyed are intensely worried about prior authorization's effect on their patients: 87% of pharmacists and 89% of prescribers said that prior authorization requirements negatively impact health outcomes.
Some feel that delays and denials are increasing: 51% of prescribers and 47% of pharmacists said they’d seen denials increase in the past year.
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Worse still, 19% of both groups reported that the medication prior authorization process has led to a serious adverse event for a patient—and they perceive a host of other negative impacts.
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Clinicians want prior authorization to happen in real time, at the point of care
These are serious problems—and yet mitigating some of them can be surprisingly straightforward. Technology now exists to address many prior authorization pain points:
- Real-time benefit tools can flag medications that require prior authorization and suggest alternatives.
- Electronic prior authorization allows prescribers to submit requests proactively at the point of care and receive responses in their workflow.
- Pharmacies can use the RxChange transaction to alert prescribers to prior authorization issues within their e-prescribing workflow.
- With recent prior authorization advances, requests can be automatically sent for determination by drawing on existing clinical documentation in the patient’s EHR—with little or no provider action required.
Our survey shows that prescribers are eager to use these innovations: 91% said they were at least somewhat open to adopting a solution to obtain prior authorization for medications electronically in real time, at the point of care.
They believe this type of solution would benefit patient care.
Accelerated medication access with 18-second approvals
Prior authorization doesn’t need to be a barrier to timely, clinically appropriate treatment. With Surescripts Prior Authorization Automation, it’s now possible to automatically retrieve and send the patient information needed for determination almost instantaneously. When all prior authorization criteria are met, requests are approved with a median time of 18 seconds.
This type of innovation is only possible by leveraging interoperability, intelligence and collaboration from across healthcare. One partner in this work is Lauren Hackenberg, Senior Director of Provider Capabilities at Optum. In an interview at HIMSS25, she pointed out that Prior Authorization Automation not only prevents delays but may improve accuracy: “We would actually argue that there's more clinical rigor when we're pulling that clinical information from the EHR—versus the manual entry that goes on with prior authorization today.”
The data supports her argument. For in-scope prescriptions processed through Prior Authorization Automation (now encompassing over 100 medications), results include:
- 11% fewer denials due to lack of information
- 17% fewer appeals
- 34% automated approval rate
Faster prior authorization is a win for patients
“A touchless system [is] the dream we’ve all been wanting … Anything that expedites [prior authorization] to get the benefits of those new therapeutics for our patients is a win.”
Danny Lee, M.D.
Chief Medical Informatics Officer, Johns Hopkins Community Physicians
Surescripts partnered with APCO Insight to conduct an online survey of 250 pharmacists and 253 prescribers between May 28 and June 16, 2025.
Pharmacist requirements:
- Current role as a pharmacist at a retail pharmacy, hospital or health system
- 2–30 years of experience
- 25+ prescriptions filled each week
Prescriber requirements:
- Current role as a physician, physician assistant or nurse practitioner
- At least 50% of work time spent on patient care
- One or more prescriptions written each week
Recommended citation: Surescripts, “Data Brief: Healthcare Professionals Highlight Medication Prior Authorization Challenges & Solutions,” May 2026.