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Surescripts
Overview
Drive savings and adherence at the point of care
Powered by comprehensive pharmacy benefit information, Real-Time Prescription Benefit helps address cost concerns, boost adherence and avoid coverage barriers. Clinicians receive patient-specific pricing and coverage details directly from the benefit plan, including prior authorization flags, days’ supply options and up to five covered therapeutic alternatives that may cost less or avoid prior authorization. It all adds up to fewer surprises at the pharmacy counter and a better experience for everyone involved.
494.9 million
Real-Time Prescription Benefit responses delivered to prescribers in 20221
$61.17
average savings per prescription when used to find a less costly alternative (67% higher than in 2021)1
8.1
percentage-point gain in fill rate when used to identify lower-cost alternatives2
A closer look
Make the most of Real-Time Prescription Benefit
Choose your organization type to see how Real-Time Prescription Benefit can help you optimize medication decisions for affordability and adherence at the point of care.
Powerful prescribing and pricing intelligence for your EHR
Put accurate, actionable drug pricing information at prescribers’ fingertips to enable them to choose medications that patients can adhere to and afford. Display drug alternatives from patients’ benefit plans and discount pricing to help the uninsured access medication.
Accurate (not estimated) cost data
Show providers accurate, comprehensive pricing and coverage insights, built into your e-prescribing tools and workflow.
Avoid prior authorizations
Display therapeutic alternatives that align with the benefit plan, cost less or may not require the prior authorization process.
Increase pricing visibility
Give prescribers insights into lower-cost options for patients based on their preferred pharmacies.
Help the uninsured
Display drug discount pricing options to prescribers for patients without pharmacy benefit plan coverage.
How it works for EHR vendors
Connect your EHR’s e-prescribing tool to Surescripts for real-time benefit details.
Integrating Real-Time Prescription Benefit allows you to match patients, validate coverage and get benefit data.
The prescriber initiates a prescription and enters the patient’s preferred pharmacy.
Prescribers receive cost information based on the requested days’ supply, drug choice and preferred pharmacy.
The prescriber reviews medication pricing and lower-cost alternatives in your EHR.
With up to five drug alternatives and three channel options displayed, prescribers can make a confident choice.
The prescriber can also choose alternatives that do not require prior authorization.
Real-Time Prescription Benefit displays accurate prior authorization status and opportunities to avoid it altogether.
After an informed discussion, the patient picks up the prescription with no surprises.
The patient avoids unexpected costs at the pharmacy, while prescribers avoid rework and pharmacy call-backs.
Share your plan design and intelligence with providers
Inform prescribers and pharmacies of your benefit-plan drug pricing, clinical alternatives and coverage details to help them assist your members with the best medication treatment options. With these insights in their workflow, they can proactively improve adherence for better outcomes and member satisfaction.
Optimize plan compliance
Give clinicians accurate, member-specific information on costs, coverage and medication alternatives—helping them choose treatments that cost less and avoid unnecessary prior authorization.
Drive medication adherence
Empower prescribers and pharmacies to discuss options with your members that they can afford and are more likely to pick up and keep taking as prescribed.
Improve member satisfaction
Help your members experience the best medication pricing your benefit plan offers.
Empower providers
Equip providers—both prescribers and pharmacies—with clinical alternatives and pricing options that help them make the best prescribing decisions at the point of care.
How it works for health plans
Connect your plan or participate with your pharmacy benefit manager (PBM).
Expand data sharing to include pricing and alternatives.
Providers see benefit plan insights within the EHR or pharmacy management system.
Inform providers about member-specific pricing and benefit options within existing prescribing and pharmacy workflows.
The provider picks the medication that is clinically best and aligns with plan design.
Insights into lower-cost choices and channel alternatives help providers make choices that better support adherence.
The provider also factors in prior authorization details and step therapy requirements.
By supplying up-to-date information on coverage requirements, you help improve speed to therapy.
Optionally, the prescriber can use Electronic Prior Authorization in the same workflow.
Add Surescripts Electronic Prior Authorization to speed determinations. Learn more about Electronic Prior Authorization.
Bring accurate medication pricing and benefit details to prescribers
Improve patient and prescriber satisfaction by making it easier to choose medications that patients can adhere to and afford. Show drug alternatives to avoid prior authorizations and leverage robust reporting capabilities to assess impact.
Accurate (not estimated) cost data
Display accurate, comprehensive pricing and coverage insights within your e-prescribing tools and workflow.
Proactively identify lower-cost alternatives
Give prescribers up to five drug alternatives and three channel options to help them select the right medications covered under their patients’ pharmacy benefits.
Avoid prior authorizations
See therapeutic alternatives that may not require prior authorization to avoid the process altogether.
Expand pricing visibility in your workflow
Review accurate pricing and benefit details within your e-prescribing screens and make one-click changes to pick lower-cost options for your patients.
How it works for health systems
A patient arrives for a visit. Surescripts validates their pharmacy benefit coverage.
Surescripts Eligibility and our Master Patient Index identify the patient and their pharmacy benefit plan.
The prescriber initiates a prescription and enters the patient’s preferred pharmacy.
Benefit and coverage details are based on the prescriber’s choice of medication and the patient’s choice of pharmacy.
The prescriber sees pricing for the chosen medication, as well as lower-cost alternatives.
Get patient-specific pricing information (not estimates) directly from the plan, including up to five drug alternatives.
The prescriber also sees prior authorization requirements and alternatives that avoid it.
Accurate prior authorization information allows prescribers to change options to avoid the process when possible.
The prescriber selects the best medication and sends the prescription to the pharmacy.
Equip prescribers to consider clinical and financial factors when discussing medication options with patients.
Get plan-based benefit insights to providers when it matters most
Inform prescribers and pharmacies of your benefit-plan drug pricing, clinical alternatives and coverage details to help them assist your members with the best medication treatment options. Provide these insights right within their workflow so they can proactively improve adherence for better outcomes and member satisfaction.
Optimize plan compliance
Give clinicians accurate, member-specific information on costs, coverage and medication alternatives—helping them choose treatments that cost less and avoid prior authorization.
Drive medication adherence
Empower prescribers and pharmacies to discuss options with your members that they can afford and are more likely to pick up and keep taking as prescribed.
Improve member satisfaction
Help your plans and their members experience the best medication pricing the benefit plan offers.
Empower providers
Equip providers—both prescribers and pharmacies—with clinical alternatives and pricing options that help them make the best prescribing decisions at the point of care.
How it works for PBMs
Connect your PBM and associated plans with Surescripts Real-Time Prescription Benefit.
Expand data sharing to include pricing and alternatives.
Providers see your benefit plan insights within the EHR or pharmacy management system.
Inform providers about member-specific pricing and benefit options within existing prescribing and pharmacy workflows.
Providers pick the medication that is best clinically and aligns with plan design.
By supplying up-to-date information on coverage requirements, you help improve speed to therapy.
Optionally, the prescriber can use Electronic Prior Authorization in the same workflow.
Add Surescripts Electronic Prior Authorization to speed determinations. Learn more about Electronic Prior Authorization.
Bring patient-specific pricing and alternatives to pharmacy teams
Increase visibility into medication pricing options from your patients’ pharmacy benefit plans—with no need for pharmacists to leave their workflow (or run and reverse mock adjudications).
Accurate (not estimated) cost data
Get patient-specific medication costs, therapeutic alternatives and prior authorization requirements directly from the benefit plan.
See alternatives and pricing
For each medication, view up to five lower-cost alternatives suggested by the benefit plan along with prior authorization and step therapy requirements.
Avoid prior authorizations
View alternatives that may not have the same prior authorization requirements as the originally prescribed medication. Use RxChange to easily request the change with prescribers.
Drive adherence and satisfaction
Create better staff and customer experiences with more effective ways to find the best prescription options while reducing restocking, delays or lapses in treatment.
How it works for pharmacies
Get benefit information in your workflow.
The pharmacist can look up patient coverage information in your pharmacy management system instead of making calls.
The pharmacist views patient- and plan-specific pricing for the current medication.
Real-Time Prescription Benefit provides benefits-based pricing without the need to adjudicate and reverse a claim.
The pharmacist identifies an alternative that costs less or avoids prior authorization.
Using RxChange, the pharmacist can easily recommend an alternative to the prescriber.
The prescriber sends an updated, optimized prescription or renewal for quick fulfillment.
When your team can quickly address cost and coverage barriers, you reduce surprises, abandonment and costly restocking.
Features In Focus
Innovations for better pricing visibility
When clinicians have greater insight into pricing, lower-cost alternatives and ways to streamline operations, all stakeholders win.
Real-time insights
Get accurate medication pricing, alternatives and benefit insights directly from the source of truth—PBMs and the plans they represent.
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Prior authorization flags
View up-to-date prior authorization and step therapy requirements for each drug covered under a benefit plan, along with possible alterative drugs that may not require a prior authorization.
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Driven by patient needs and preferences
Improve medication treatment planning and adherence by informing patients of their prescription options tailored to their pharmacy of choice.
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Success Stories
Real-world results
FAQs
Find out more about Real-Time Prescription Benefit
Who can use Real-Time Prescription Benefit?
Real-Time Prescription Benefit is available for prescribers, pharmacists and their staff. In all cases, users access real-time benefit information within their electronic workflow.
What is the source of the pricing information? Is it ever estimated?
Unlike other options, our pricing information is not inferred or estimated.
For patients with a pharmacy benefit plan, the pricing shown in Real-Time Prescription Benefit through Surescripts comes directly from the PBM and/or the associated health plan.
For patients that do not have benefit coverage or are no longer eligible, the pricing shown is from a validated drug discount program.
What variables are used to determine the medication prices and alternatives?
In order for prescribers and pharmacists to see pricing information for a prescription, the important variables include the drug, dosage, days’ supply and patient’s preferred pharmacy.
How often would an EHR or a prescriber need to update the real-time pricing information?
Updates are made automatically thanks to a real-time transaction that retrieves benefit information at the time of writing or reviewing a prescription.
How is it possible to avoid prior authorizations using Real-Time Prescription Benefit?
During the Real-Time Prescription Benefit inquiry, the requirement for a prior authorization is double-checked with the PBM. The PBM sends back that information along with pricing information for the selected medication as well as lower-cost alternatives. Each of the lower-cost alternatives should also have a prior authorization indicator.
Many times, a therapeutic alternative will not need a prior authorization. Therefore, the prescriber can quickly make a change to prescribe an alternative that can reduce patient costs, avoid the prior authorization and save everyone time.
How can my organization sign up to share or receive data through Surescripts Real-Time Prescription Benefit?
No matter what type of organization you’re with, we’ll help guide you through each step of the process.
We work with PBMs and their associated health plans to expand the data they share beyond eligibility and formulary information to include real-time, patient-specific benefit details as well.
We work with EHRs and health systems to quickly integrate the technology with their workflows and help with programs to drive adoption and best practices for their prescribers.
We work with pharmacies and pharmacy technology solutions to embed real-time benefit information into their pharmacy system workflows.
Click the “Get in touch” button below to get the conversation started today.
Insights
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Footnotes
- Surescripts, “2022 National Progress Report,” March 2023.
- Shiven Bhardwaj et al., "Impact of Real-Time Benefit Tools on Patients’ Access to Medications: A Retrospective Cohort Study," The American Journal of Medicine 135, no. 11 (November 2022): 1315-131.
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