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Surescripts
Approved before patients know it
Prior authorization for medication is intended to protect patient safety and support cost-effective care. But cumbersome manual processes undercut these goals, triggering delays and frustration.
Prior Authorization Automation matches clinical data with determination criteria to help reach a clinically appropriate decision as quickly as possible. It automatically retrieves required information from the patient’s electronic health record and sends it to the pharmacy benefit manager (PBM).
When prior authorization requirements are met, the request can often be approved without human intervention. That means patients can get started on appropriate medications quickly and seamlessly.
18 seconds
median approval time
17% lower
rate of appeals
11% lower
rate of denials due to lack of information1
What can Prior Authorization Automation do for you?
Choose your organization type to see how Prior Authorization Automation can help you speed up prior authorization for medications.
Create a dramatically more efficient prior authorization experience
Vanquish a major source of frustration with Prior Authorization Automation. Surescripts draws on data that’s already in your EHR and automatically sends it to the PBM for approval—with little or no provider action required.
Handle prior authorizations in workflow
Make prior authorization a seamless part of the e-prescribing experience that's handled without leaving your platform.
Improve patient experience
Reduce delays and set the stage for better medication adherence by helping patients get approved medications right away.
Gain speed with built-in intelligence
Prior Authorization Automation doesn’t rely on manual work behind the scenes. It genuinely automates the process of preparing and delivering the information payers require.
How it works for EHR vendors
The prescriber or EHR initiates prior authorization for a qualifying prescription.
Then, if Prior Authorization Automation is available for the patient and medication, the process begins instantly.
Surescripts retrieves clinical data from your EHR to complete the question set.
Partnerships with PBMs make it possible to determine the precise clinical values required for prior authorization.
If all criteria are met, the payer sends an automated approval.
If the request can’t be instantly approved, the prescriber is prompted to complete the request through your EHR.
The prescriber receives the approval and the patient can start their medication promptly.
Your EHR receives a message confirming that the prescription has been authorized.
Minimize treatment delays for better patient care
Vanquish a major source of frustration with Prior Authorization Automation. Surescripts draws on existing clinical documentation and automatically sends payers the data they need for approval—with little or no provider action required.
Get prior authorization decisions faster
When prior authorization criteria are met, approvals can be delivered in seconds or minutes. When more information is needed, providers are prompted to complete additional steps.
Improve time to therapy
About 40% of prescriptions delayed by the manual prior authorization process are abandoned.2 Support greater adherence by helping patients get approved medications right away.
Gain speed with built-in intelligence
Prior Authorization Automation doesn’t rely on manual work behind the scenes. It genuinely automates the process of preparing and delivering the information payers require.
How it works for health systems
A prescriber writes an e-prescription that may qualify for automated approval.
If Prior Authorization Automation is available for the medication, Surescripts empowers your EHR to start the process.
Surescripts retrieves clinical data from the EHR to complete the question set.
Partnerships with PBMs, health plans and your EHR make it possible to collect the exact information required.
If all criteria are met, the payer sends an automated approval.
If the request can’t be instantly approved, the prescriber is prompted to complete the request through your EHR.
The prescriber receives the approval and the patient can start their medication promptly.
Your EHR receives a message confirming that the prescription has been authorized.
Reduce operational costs without compromising clinical rigor
Deliver clinically appropriate prior authorization decisions faster. Prior Authorization Automation brings you the patient data and automation needed to reach approval with minimal manual intervention.
Get the precise clinical values you need
Prior Authorization Automation gathers required clinical information straight from the patient’s EHR, reducing the risk of receiving incorrect or incomplete data.
Make decisions at the time of prescribing
Reduce the need for follow-up calls and create a vastly more efficient prior authorization experience for patients.
Pave the way for medication adherence
About 40% of prescriptions delayed by the manual prior authorization process are abandoned.2 Support greater adherence by helping patients get appropriate medications right away.
Gain efficiency with built-in intelligence
Prior Authorization Automation doesn’t rely on manual work behind the scenes. It genuinely automates the process of preparing and delivering the information you need.
How it works for PBMs
Select medications and question sets that are a good fit for Prior Authorization Automation.
We’ll align on automated question sets that can be answered with clinical values retrieved from the EHR.
Prior Authorization Automation is initiated within the e-prescribing workflow.
If Prior Authorization Automation is available for this medication, Surescripts retrieves the clinical data you need.
You receive and analyze the completed question set.
If the prior authorization criteria are met, you can send an automated approval.
The provider receives an approval message in their EHR.
With little or no manual intervention, the prescription is authorized and your member can start their medication.
Get more automation with NewRx-initiated requests
When enabled, Surescripts will proactively check whether a new prescription requires prior authorization and if it’s eligible for Prior Authorization Automation. If so, we will automatically initiate the process.
Real-time detection of new prescriptions
Surescripts automatically uses the latest data from the EHR, meaning there’s no delay between a prescription being written and the confirmation of whether it is eligible for Prior Authorization Automation.
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Integrates with provider systems and PBMs
Because Prior Authorization Automation is triggered by the EHR before the prescription is sent, this feature seamlessly works with existing workflows.
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No action or effort needed
We will automatically initiate the Prior Authorization Automation process without waiting for the provider or their EHR to take action.
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Find out more about Prior Authorization Automation
With Prior Authorization Automation, are all prior authorization decisions automated?
No, PBMs can only automate approvals through Prior Authorization Automation. Denials are never made automatically. If the request cannot be approved based on the clinical information submitted, the provider will be prompted to complete a prior authorization request. This can happen via Electronic Prior Authorization or another method, depending on implementation.
How much can Prior Authorization Automation speed up medication prior authorization?
Since approvals can be delivered almost instantly, time savings can be significant. One analysis found that prior authorization approvals for in-scope medications previously took an average of over 71 minutes. Now, Prior Authorization Automation delivers approvals in a median time of just 18 seconds.
What other results are being seen with Prior Authorization Automation?
In addition to faster approval times, pilot participants have seen significant reductions in appeals, denials due to lack of information, and abandoned prior authorization requests. Read the case study “Leveraging Innovative Technology to Streamline Medication Prior Authorizations” for more details.
How can we be sure that the clinical data used for Prior Authorization Automation is accurate?
Prior Authorization Automation collects actual clinical values from the patient's EHR and transmits them to the PBM alongside metadata verifying the source of the information, creating an audit trail that can be reviewed by the PBM at any point.
Keep pace with healthcare innovation
- Surescripts, “Annual Impact Report 2025,” March 2026, p. 18.
- Gulzar Virk and Tony Schueth, "Electronic Prior Authorization: Leveraging the Latest Technologies to Improve Care Delivery and Determine Optimal Benefit Coverage," 2016.
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