Electronic Prior Authorization is a way to make the process of getting approval for medicines faster and easier. Instead of using paper forms and phone calls, ePA works inside the electronic health records (EHR) system that doctors already use. This lets healthcare workers send and get approval for prescriptions all in one system.
More doctors and clinics in the U.S. are now using ePA. In 2022, about 84% of prescribers had EHR systems with ePA features. That year, the number of prior authorizations done electronically grew by 44%. This shows that many healthcare providers trust technology to handle these tasks better than doing them by hand.
This change helps medical staff work more smoothly and provides better care for patients.
One big benefit of ePA is how much time it saves. Usually, doing prior authorization by hand takes about 10 extra minutes for each request. With ePA, that time is cut down or removed. This gives clinic staff more time for other important work. Candace Minter from Sentara Medical Group said that their staff can now do 10 electronic prior authorizations in the time it used to take to do one or two by hand.
Jennifer Kohlbeck at Advocate Aurora Health also said ePA could save up to 45 minutes per authorization in some cases. Since many clinics handle many requests every day, these savings add up and reduce costs and delays.
Another aim of changing prior authorization is to help patients get medicines faster. ePA speeds up approvals. With ePA inside EHRs, the average approval time is less than four minutes. Manual methods can take days.
A study by AHIP found that ePA cut the average decision time by 69% compared to doing it by hand. In some health systems, patients waited over two days less for their medicines. This helps stop breaks in treatment and lets patients start their medicines sooner, which can improve health.
ePA also helps more patients pick up their prescriptions. When the approval is done before patients get to the pharmacy, the medicine is ready quickly. One health system saw prescription pickups go up by six percentage points after using ePA.
When patients get their medicines on time, they manage their diseases better and their overall health improves. This also helps clinics by lowering missed follow-up visits and increasing patient happiness.
Many clinics struggle with staff working too many hours because of paperwork. ePA has helped lower staff overtime by more than half in places like Aurora Health Care. This lets staff spend more time helping patients and less time on paperwork.
One strong point of ePA is that it fits right into the technology clinics already have. Since it works inside EHRs, staff don’t need to use different systems or enter the same information twice. The system shows specific questions for each medicine and insurance plan, reducing mistakes and making data entry easier.
ePA replaces old paper forms with real-time digital submissions. It also fills in patient information automatically from the EHR, cutting down on repeated typing and errors.
For places without EHR integration, the Surescripts Prior Authorization Portal offers a free, fully electronic option to send and track authorizations, working directly with pharmacy benefit managers.
Artificial intelligence (AI) and automation help make ePA even better. AI routes requests and medical information to the right staff without delay or manual work.
Automation also sends reminders before authorizations expire. These alerts stop gaps in medication by telling providers to act early. AI keeps authorization rules updated with changes from insurers and pharmacy plans, helping avoid mistakes or rejections.
With AI, providers get exact authorization steps for each plan. This lowers errors, speeds approvals, and stops treatment delays. Clinic managers see fewer disruptions and more predictable approval times.
Some health systems report that automated ePA lets staff finish authorizations ten times faster than manual methods. This helps cut overtime and lets staff do other important tasks.
More U.S. healthcare providers are using ePA as part of a larger shift toward digital healthcare. The rise in prescribers using ePA with EHRs shows that electronic communication with insurers and pharmacy managers is becoming normal.
The 44% increase in electronically processed prior authorizations in 2022 reflects efforts to make medication management quicker and less wasteful. As ePA grows, more health systems should see fewer breaks in therapy, better patient medicine use, and more manageable staff workloads.
Electronic Prior Authorization helps medical practices in the U.S. work more efficiently and care for patients faster. It combines digital workflows inside EHRs, real-time question sets, and AI-based automation. This cuts approval times from days down to minutes, lowers staff work hours, and raises prescription pickup rates. For healthcare managers and IT staff, using ePA means better control of operations and improved patient treatment results, important goals for today’s healthcare.
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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