Whether your job is to request prior authorizations, submit clinical content for review or make final determinations, your organization needs the right tools and intelligence at your fingertips and within your workflow. By streamlining prior authorizations, Surescripts can help you work more efficiently and ensure patients get the right medication, covered under their prescription benefit plan, without unnecessary delays.
of active work time eliminated from the average prior authorization 1
of prior authorization wait time saved for patients 1
to return the average approval 2
A closer lookChoose your organization type to see how Electronic Prior Authorization can help you streamline your team’s processes and improve medication-related decision-making.
Make your prior authorization workflows more efficient than ever. Alleviate delays and frustration with a fully integrated solution that lets users proactively initiate requests and receive quick responses.
Make it easier to proactively submit clinical information to pharmacy benefit plans for efficient determinations and quickly respond to pharmacies.
Surface prior authorization responses within the workflow so prescriptions can be processed sooner.
Create routing rules for prior authorization tasks so others can assist prescribers in managing requests, submitting clinical information and following up on denials and approvals.
Ensure prescriptions are ready for patients when they go to the pharmacy. One health system improved its pickup rate by six percentage points using Surescripts. 1
Eligibility and formulary data is provided in the E-Prescribing workflow, including prior authorization requirements.
The request triggers the benefit plan to send the appropriate question set to your electronic health record (EHR).
Users complete only the required information, without leaving your EHR. Benefit plans respond within the same workflow.
Fast approval increases speed to therapy to support adherence.
Enable faster prior authorization decisions by securely delivering plan-specific question sets, decisions and responses to provider workflows. Eliminate the inefficiencies and administrative burden of manual processes.
Automatically send questions, receive answers and attachments, send responses and initiate renewals.
Transmit plan- and drug-specific questions sets directly to provider workflows. Eliminate communication barriers and inefficiencies.
Determine whether a prescription is covered sooner. In an AHIP study, the median time to a decision decreased 69% compared with manual prior authorization. 3
Improve time to therapy and get better, faster information from prescribers. Average wait time dropped by more than two days for one health system using Electronic Prior Authorization. 1
Surescripts transmits a dynamic electronic question set tailored to the medication from the benefit plan to the EHR.
Staff are guided through entering the required clinical details and, if necessary, submitting attachments.
Quickly send approvals, denials or requests for more information based on the information submitted.
Surescripts lets you or your pharmacy benefit manager (PBM) proactively prompt prescribers to initiate renewals.
With the Prior Authorization Portal, call centers can ease the process even for those without an integrated solution.
Make your prior authorization workflows more efficient than ever. Alleviate delays and frustration with a fully integrated solution that lets your team proactively initiate requests and receive quick responses within the EHR.
Make it easier to proactively submit clinical information to pharmacy benefit plans for efficient determinations and quickly respond to pharmacies.
Get responses sooner so patients spend less time waiting for their prescriptions.
Create routing rules for prior authorization tasks so others can assist prescribers in managing requests, submitting clinical information and following up on denials and approvals.
Ensure prescriptions are ready for patients when they go to the pharmacy. One health system improved its pickup rate by six percentage points using Surescripts. 1
Eligibility and formulary data is provided in the E-Prescribing workflow, including prior authorization requirements.
A prior authorization request automatically triggers the PBM or health plan to deliver the appropriate question set.
Staff complete only the required information, without leaving the EHR. Benefit plans respond within the same workflow.
Fast approval increases speed to therapy to support adherence.
Quickly understand when prior authorization is required and expedite the process on behalf of the prescribers and patients you serve.
Connect directly with the pharmacy benefit manager or health plan to initiate and complete prior authorization requests.
Jump-start the prior authorization process, leveraging your services expertise and the electronic workflow to help reduce a common barrier to timely treatment.
Leverage insights from eligibility information and drug-specific questions sets to help patients maximize their coverage.
The request is automatically delivered to the pharmacy benefit plan.
Surescripts displays only the patient and treatment questions that are truly needed for a decision.
Once the PBM receives the data and makes a determination, approvals typically arrive within minutes.
Work with the plan if you receive denials or requests for more information.
Enable faster prior authorization decisions by securely delivering plan-specific question sets, decisions and responses to provider workflows. Eliminate the inefficiencies and administrative burden of manual prior authorization.
Automatically send question sets, receive answers and attachments, send responses and initiate renewals.
Transmit plan- and drug-specific questions sets directly to provider workflows. Eliminate communication barriers and inefficiencies.
Determine whether a prescription is covered sooner. In an AHIP study, the median time to a decision decreased 69% compared with manual prior authorization. 3
Improve time to therapy and get better, faster information from prescribers. Average wait time dropped by more than two days for one health system using Electronic Prior Authorization. 1
Surescripts transmits a dynamic electronic question set tailored to the medication from the benefit plan to the EHR.
Staff are guided through entering the required clinical details and, if necessary, submitting attachments.
Quickly send approvals, denials or requests for more information based on the information submitted.
Surescripts lets you or your pharmacy benefit manager (PBM) proactively prompt prescribers to initiate renewals.
With the Prior Authorization Portal, call centers can ease the process even for those without an integrated solution.
Features In FocusWe collaborate across healthcare to bring more intelligence into prior authorization workflows—which means less administrative burden and better experiences for everyone.
Get the connections you need to all the providers, pharmacies and payers involved in medication prior authorizations by partnering with Surescripts.
We’re constantly innovating to further optimize the process with enhancements such as validating patient identity, NDC codes and provider credentials.
We are pioneers in bringing prior authorization into the familiar, efficient workflows care teams already use within their EHRs and other technology platforms.
“We are finishing 10 electronic prior authorizations in the time it takes to finish one or two manually during a day.”
Candace Minter, Pharm.D. Pharmacy Operations Manager, Sentara Medical Group“It saves a significant amount of time—up to 45 minutes per medication authorization in some cases.”
Jennifer Kohlbeck Supervisor of Clinic Operations, Advocate Aurora HealthYes. Organizations are gaining the most efficiency from the prospective prior authorization workflow, which lets them initiate the process and gain approval before the pharmacy has to take action. However, you can also use Electronic Prior Authorization to complete or continue retrospective prior authorizations that are triggered at the request of the pharmacy.
Yes. Prior authorization indicators are sent directly from the PBMs or health plan and reflect the prior authorization status based on the benefit plan design. We help payers supply that up-to-date information through On-Demand Formulary and through Real-Time Prescription Benefit inquiries. As a result, prescribers are presented with a more accurate reflection of the need for prior authorization.
Yes. Thousands of prescribers and their staff use the free Surescripts Prior Authorization Portal to gain a fully electronic connection to PBMs. The portal gives them easy tools to organize their workflow, manage requests and submissions, and access timely approvals or other determinations.
Question sets are dynamically generated based on the type of medication and the type of clinical information a payer may need for a given patient and medication. They will appear in the EHR or portal and ask for only the necessary demographic and clinical information about the patient and their treatment.
Unlike paper or PDF forms, questions sets will only display the questions that are appropriate and often will have the patient’s demographic information already filled in. This makes electronic prior authorizations much faster to complete.
Increasing. In 2022, we saw a 44% rise in prior authorizations processed electronically, and now 84% of prescribers use EHRs equipped with Surescripts Electronic Prior Authorization. 2
We encourage prescribers who use Electronic Prior Authorization within their EHR to start with their EHR vendor. In many cases, the answer to your question is just a support ticket away.
Prescribers using the Surescripts Prior Authorization Portal can contact our Surescripts support team directly.
We also have resources for health plans, PBMs and pharmacies that have teams working directly with prescribers and health systems. We work with many such partners to help educate their prescriber-facing teams or call centers to understand how prescribers are seeing prior authorization details and processing requests. If your teams could benefit from a better understanding of how Electronic Prior Authorization comes to life for prescribers, please contact us below or reach out to your Surescripts account team.
Surescripts is always expanding its partnerships for medication-related prior authorizations. We guide EHRs, health plans and other organizations throughout proven certification process step by step.
To get the conversation started, click the “Get in touch” button below.