Prior authorization has been a required but often annoying step in getting some prescriptions. It means getting approval from a patient’s insurance before certain medicines can be given or paid for. Before, this process used paper forms or phone calls, which slowed things down, wasted staff time, and made patients wait longer for their medicine.
Electronic Prior Authorization solves these problems by adding the approval steps directly inside Electronic Health Records (EHRs). This lets healthcare providers start, follow, and finish prior authorization requests on their computer without leaving their usual software. The process becomes faster and easier to fit into daily medical work.
Use of ePA technology has grown fast in recent years. By 2022, 84% of prescribers in the United States use EHRs that have ePA tools. That shows many see its value. Electronic prior authorizations went up 44% that year alone, meaning many healthcare systems are adopting it quickly.
Several causes help this growth:
One big advantage of ePA is that it cuts down the time needed for prior authorization. Studies show ePA saves about 10 minutes of work per authorization. Even better, it cuts patient wait times for medicine approvals by over two days on average.
For example, Candace Minter, a Pharmacy Operations Manager, said her team can do 10 electronic prior authorizations in the time it takes to do one or two the old way. Jennifer Kohlbeck, a Clinic Operations Supervisor, said ePA can save up to 45 minutes per medication approval sometimes. This saved time lets staff spend more time caring for patients instead of doing paperwork.
A study from American Health Insurance Plans (AHIP) found that the middle value for time to get a prior authorization decision drops by 69% with ePA compared to manual methods. Faster approvals help clinics work better and help patients get their medicines sooner.
Quick prior authorization decisions help patients get their medicine faster. When approvals happen before patients go to the pharmacy, they have fewer delays and less chance of stopping their treatment. One health system noticed prescription pickups rose by six percentage points after starting electronic prior authorizations. This means timely approvals help patients take their medicines as prescribed.
Delays in prior authorization often make patients give up on getting their medicine or break their treatment. Electronic systems cut these problems and help patients start and keep their treatments, which leads to better health.
Electronic prior authorization systems also have ways to help track expiring approvals. Surescripts, a big ePA provider, sends alerts to healthcare providers when prior authorizations are about to expire. These automated reminders encourage staff to renew approvals on time and avoid breaks in medicine therapy.
Manually tracking when authorizations expire can cause renewals to be missed, leading to openings in treatment that hurt patient health. Automated alerts lower these risks by adding expiration checks into normal work routines. This helps keep care steady and makes managing complex medicine schedules easier for medical staff.
One reason ePA works well is because it fits smoothly into current EHR systems. Providers can start prior authorization requests, answer needed questions, and see approval results all in the software they already use. This stops the problems of having to switch between different programs or hard-to-use outside portals.
Dynamic question sets are part of ePA. They replace paper forms with electronic forms that change based on the medicine, insurance, and patient details. These forms only show questions that matter. This speeds up data entry and lowers mistakes. Often, clinical and patient information is automatically filled in from the EHR, which means less work for staff.
Even providers who do not have EHRs can still use ePA through portals like the Surescripts Prior Authorization Portal. This portal connects with pharmacy benefit managers and insurers electronically. This option helps small or rural clinics that don’t have advanced EHR systems to also use ePA.
Artificial intelligence (AI) and automation have become important for making prior authorization workflows better. By doing routine tasks automatically, AI lowers manual work and lets staff focus more on patient care than paperwork.
AI-powered workflow automation offers these benefits:
These automatic features help cut errors and speed up decisions. For example, Aurora Health Care said using electronic prior authorization lowered clinic staff overtime by more than half, largely due to automated tasks and better efficiency.
AI tracking can also watch authorization statuses and send reminders when renewals are due. This keeps medicine coverage from stopping without staff having to watch every case themselves.
Switching to electronic prior authorization supported by AI and automation can lessen administrative work in medical offices. Healthcare administrators often deal with staff burnout, too much paperwork, and complicated workflows. ePA cuts time spent on authorization tasks by up to 10 times compared to manual ways.
Those who use these technologies see:
These results lead to saving money on operations and being able to serve more patients well. This is very important in busy outpatient clinics and places with many providers.
By making prior authorization faster and improving prescription pickups, ePA helps keep patient care steady. Patients get medicines on time, have fewer breaks in their treatments, and experience better teamwork between providers and pharmacies.
These changes help both health results and quality measures in healthcare. They also support bigger goals in the U.S. health system, like cutting treatment barriers, increasing medication use as directed, and using resources well.
Overall, more use of electronic prior authorization systems—as shown by the growing number of EHR users adding these tools—is an important step toward updating healthcare. Medical leaders and IT managers should think about starting or improving ePA tools to keep up with these changes and better help patients and staff.
Electronic prior authorization combined with AI-driven automation offers real, practical benefits in handling prescription steps, keeping authorization rules, and supporting patient-focused care. By adding these tools to daily work, healthcare practices across the United States can work more smoothly and help the healthcare system deliver medicines quickly.
Yes. Electronic Prior Authorization is most efficient for prospective workflows that allow initiation and approval prior to pharmacy involvement. It can also handle retrospective prior authorizations triggered by pharmacies, enabling completion or continuation of requests electronically.
By integrating prior authorization within the EHR workflow and using dynamic question sets, Electronic Prior Authorization decreases median time to decision by 69% compared to manual processes, saving over two days in wait time and accelerating medication access and therapy initiation.
Question sets are customized, drug- and plan-specific electronic forms presented within the EHR. They replace static paper or PDF forms by only asking relevant clinical and demographic questions needed for the medication, pre-filling patient info, thus speeding submission and minimizing administrative burden.
It is embedded within the provider’s EHR system, allowing initiation, question answering, and receipt of determinations within a single workflow. This seamless integration reduces workflow disruptions and enables staff to manage requests efficiently without external systems.
Yes. Providers can use the Surescripts Prior Authorization Portal, a free, fully electronic platform that connects to pharmacy benefit managers, enabling electronic submission, tracking, and management of prior authorizations even without EHR integration.
Automation creates routing rules to delegate tasks such as submitting clinical info and managing follow-ups, reducing prescriber workload. Reports indicate up to a 45-minute time saving per authorization and significantly reduced staff overtime, increasing operational efficiency.
Prior authorization indicators are sent directly from PBMs or health plans, reflecting real-time benefit plan designs. This integration, paired with On-Demand Formulary and Real-Time Prescription Benefit inquiries, ensures prescribers get accurate, updated notifications about authorization needs.
By speeding approval so prescriptions are authorized before patients arrive at pharmacies, it reduces delays and enhances adherence. One health system increased pickup rates by six percentage points after implementing the solution, improving overall medication access.
Surescripts sends proactive alerts to providers when prior authorizations are nearing expiration, prompting timely renewals. This helps avoid therapy interruptions and supports continuous patient care without manual tracking.
Adoption is rapidly increasing. In 2022, there was a 44% rise in electronic prior authorizations processed, and 84% of prescribers now use EHRs equipped with Electronic Prior Authorization, demonstrating growing acceptance and integration into healthcare workflows.
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