Prescription Intelligence When and Where It’s Needed

When cost or coverage issues delay important care, it’s an unwelcome surprise for everyone involved.

Manual prior authorization processes can cause patients to lose valuable time. And sticker shock at the pharmacy can lead to anxiety, confusion and even treatment abandonment.

The 2024 West Health-Gallup Affordability Index found that only 55% of Americans could readily access and afford basic healthcare and prescribed medicines, a decline from 2022.

In a 2025 survey, 87% of pharmacists and 89% of prescribers said that prior authorization requirements negatively impact health outcomes, and 49% of prescribers said prior authorization requirements often prevent them from prescribing a medication their patients need.

To overcome cost and coverage barriers and improve time to therapy, clinicians, payers and even life sciences companies are increasingly using tools like Electronic Prior Authorization, Prior Authorization Automation and Real-Time Prescription Benefit to access accurate, up-to-date benefit intelligence and dramatically reduce prior authorization delays.

A sweeping new CMS proposed rule (CMS-0062-P) would amplify the value of these tools by expanding interoperability and prior authorization requirements across U.S. healthcare for payers, providers and healthcare clearinghouses. If finalized, this rule will establish nationwide requirements for interoperable, electronic prior authorization and real-time prescription benefit capabilities.

Data from our network shows the enormous impact that happens when the right information is leveraged at the right time—patients can start treatment sooner, without cost concerns or coverage surprises.

Real-Time Prescription Benefit lets prescribers see what a patient’s benefit plan covers at the point of care. Prescribers can see the amount a patient will pay at their chosen pharmacy and if prior authorization is required, then choose a therapeutic alternative in seconds.

In 2025, prescribers used Real-Time Prescription Benefit 1 billion times, saving patients an estimated $55.1 million dollars altogether. (Patients are on pace to exceed this in 2026: Real-Time Prescription Benefit has already saved patients more than $19.5 million from January through April.)

In addition to patient savings, benefit intelligence can also improve patient outcomes. A 2025 study of diabetes patients found that medication adherence was 3.4% higher for patients whose providers used a real-time prescription benefit tool.

Electronic Prior Authorization 

When automation isn’t an option, clinicians can still use Electronic Prior Authorization for a streamlined process.

It fast-tracks prior authorizations at the point of care by bringing payers’ question sets into prescribers’ workflows, where they can send information directly to the patient’s benefit plan and receive responses.

In 2025, Surescripts helped drive a network-wide transition to two updated NCPDP standards for sharing prescription benefit information: Real-Time Prescription Benefit Standard v13 and Formulary & Benefit Standard v60. This milestone advancement strengthened how benefit details are exchanged across the network, laying the foundation for faster, more consistent access to coverage information at the point of care.

Together, these updates make it easier to clearly communicate coverage status, coverage restrictions, refill eligibility dates and formulary placement—while eliminating redundant data and reducing confusion for prescribers.

The result is a more streamlined, trusted flow of benefit information that supports better prescribing decisions and smoother patient access to therapy.

To that end, Surescripts delivers a connected set of solutions designed to remove guesswork, reduce delays, and help patients start covered therapy faster:

• Electronic Benefit Verification: Help patients start their prescribed therapy sooner with benefit intelligence designed for life sciences companies’ patient access programs.
• Electronic Prior Authorization: Give providers the power to quickly submit prior authorization requests and get responses within their electronic workflow so patients can start on their medications sooner.
• Eligibility: Give clinicians easy access to prescription benefit coverage information at multiple points of the care journey so patients can get their medications sooner.
• Formulary: Provide healthcare providers with plan- and group-level formulary insights within care workflows so they can have more informed conversations with patients.
• Prior Authorization Automation: Reach clinically appropriate decisions as quickly as possible with intelligence that matches clinical data with determination criteria automatically at the time of prescribing.
• Real-Time Prescription Benefit: Supply cost and coverage information directly from the prescription benefit plan, including prior authorization flags, days’ supply options and up to five covered alternatives.

Real‑time insight, true automation and standards‑based connections are helping to transform prescribing into what it should be: clear, efficient and focused on getting patients started on therapy without delay.