Dean Riggott Photography
Surescripts
At its best, prior authorization aims to protect patient safety and support cost-effective care. But widespread dissatisfaction with the process shows that it frequently falls short—even for the payers putting prior authorization requirements in place. While announcing a plan to simplify prior authorization, Mike Tuffin of the health insurance trade group AHIP recently commented, “The healthcare system remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike.”
Existing prior authorization statistics reveal the scale of that burden. Physicians in an American Medical Association survey reported completing an average of 39 prior authorization requests per week, requiring 13 hours of staff time. When healthcare resources are stretched thin, time spent on administrative work like prior authorization can come at the expense of time for patient care, quality improvement or clinician well-being.
Some research suggests that prior authorization issues are particularly common for medications. A KFF survey found that people taking prescription drugs were more than twice as likely to have experienced prior authorization problems as those who weren’t.
To better understand how we might solve medication prior authorization pain points across healthcare, Surescripts commissioned a survey of 503 prescribers (including physicians, physician assistants and nurse practitioners) and pharmacists. Their responses—along with on-the-ground feedback about emerging solutions—illuminate how we can transform the prior authorization workflow to benefit everyone involved.
The prior authorization process fuels clinician burnout
While prior authorization is just one administrative process among many required to deliver healthcare today, our survey shows that it’s a constant concern for providers. More than half of prescribers said prior authorization delays or denials for prescriptions are a major challenge in their day-to-day work. One in 5 selected a task related to prescription prior authorizations as the biggest daily challenge they face.
Even more clinicians agree that the prior authorization process for medications increases burnout. For 38% of pharmacists and 48% of prescribers, it’s a significant factor.
Some feel that the burden is increasing: 51% of prescribers and 47% of pharmacists said they’d seen denials increase in the past year.
A time- and resource-intensive workflow stokes frustration
What is it that makes prior authorization such a persistent problem? Our survey suggests that time to therapy is a key concern.
When asked how long it should take to get a patient started on a new therapy, 95% of prescribers said it should take no more than six days. In practice, however, 18% reported that it typically takes a week or more.
What’s behind this gap? According to 87% of pharmacists and 83% of prescribers, the biggest impediment to improving speed to therapy is obtaining prior authorization—no surprise considering that 88% of pharmacists and 70% of prescribers said the process often or always delays treatment.
For prescribers, the top two barriers to medication prior authorizations are getting responses from the benefit plan and a lack of staff resources to manage the process.
In addition to these challenges, pharmacists face another hurdle: 81% named the difficulty of getting a response from the prescriber as a key challenge. (Typically, the prescriber or their staff must complete prior authorization before a prescription can be filled.)
Patient impact is a critical concern
Apart from the time and effort of prior authorization, the clinicians we surveyed are intensely worried about its effect on their patients: 87% of pharmacists and 89% of prescribers said that prior authorization requirements negatively impact health outcomes. Nearly half of prescribers said prior authorization requirements often prevent them from prescribing a medication their patients need.
Even if the desired medication is prescribed, prior authorization problems can throw treatment off track. Nearly half of pharmacists and 4 in 10 prescribers said that the process often leads to treatment abandonment.
Worse still, 19% of both groups reported that the medication prior authorization process has led to a serious adverse event for a patient—and they perceive a host of other negative impacts.
Clinicians want prior authorization to happen in real time, at the point of care
These are serious problems—and yet mitigating some of them can be surprisingly straightforward. Technology now exists to address many prior authorization pain points:
- Real-time benefit tools can flag medications that require prior authorization and suggest alternatives.
- Electronic prior authorization allows prescribers to submit requests proactively at the point of care and receive responses in their workflow.
- Pharmacies can use the RxChange transaction to alert prescribers to prior authorization issues within their e-prescribing workflow.
- With recent prior authorization advances, requests can be submitted with no provider effort (using information automatically gathered from the electronic health record, or EHR) and approved almost instantly by the pharmacy benefit manager (PBM).
Our survey shows that prescribers are eager to use these innovations: 94% said that they and their teams would benefit from being able to obtain prior authorization for medications electronically in real time, at the point of care, and 91% said they were at least somewhat open to adopting this type of solution.
They also believe patients will benefit: 92% of prescribers said that being able to electronically process prior authorizations for prescriptions (whether automatically or just by using an EHR-integrated solution) would help their patient interactions.
27-second approvals with zero administrative work
Prior authorization doesn’t need to be a barrier to timely, clinically appropriate treatment. With Surescripts Touchless Prior Authorization, it’s now possible to automatically retrieve and send the patient information needed to approve many prior authorization requests almost instantaneously. When prior authorization criteria are met, the request can be approved without human intervention by the PBM in an average of 27 seconds.1
This type of innovation is only possible by leveraging interoperability, intelligence and collaboration from across healthcare. One partner in this work is Lauren Hackenberg, Senior Director of Provider Capabilities at Optum. In an interview at HIMSS25, she pointed out that Touchless Prior Authorization not only saves time but may improve accuracy: “We would actually argue that there's more clinical rigor when we're pulling that clinical information from the EHR—versus the manual entry that goes on with prior authorization today.”
The data support her argument. For prescriptions processed through Touchless Prior Authorization (now encompassing more than 50 medications in seven disease areas), results include:
- 88% fewer appeals
- 68% fewer denials due to lack of information
- 41% lower rates of abandoned requests
“The frustration comes with the administrative burden and the back-and-forth,” Hackenberg noted. Now, “we're getting it right the first time.”
Estimating an average of 20 minutes per prior authorization request, Touchless Prior Authorization has saved hundreds of hours for providers already.2
And for busy healthcare professionals, every hour saved is precious. When we asked clinicians what they would do with one extra hour per week, the most popular answer was direct patient care and education (chosen by 47% of prescribers and 40% of pharmacists). By dramatically reducing the time required for prior authorization, we can free up time for what matters most.
“We would actually argue that there's more clinical rigor when we're pulling that clinical information from the EHR—versus the manual entry that goes on with prior authorization today.”
Lauren Hackenberg
Senior Director of Provider Capabilities, OptumUNC Health delights providers by automating prior authorization requests
As System Executive Director at UNC Health, Angela Odham is constantly looking to “take the administrative stuff that providers are having to do and find ways to automate that,” she says. “How can we automate things to make it easier for them to see the patient and spend time with the patient?”
One way: becoming one of the first health systems to adopt Touchless Prior Authorization. Watch below to learn about her experience implementing this major step forward and the “over the moon” reaction she received from prescribers, nurses and other staff.
Surescripts partnered with APCO Insight to conduct an online survey of 250 pharmacists and 253 prescribers between May 28 and June 16, 2025.
Pharmacist requirements:
- Current role as a pharmacist at a retail pharmacy, hospital or health system
- 2–30 years of experience
- 25+ prescriptions filled each week
Prescriber requirements:
- Current role as a physician, physician assistant or nurse practitioner
- At least 50% of work time spent on patient care
- One or more prescriptions written each week
Recommended citation: Surescripts, “Data Brief: Healthcare Professionals Highlight Medication Prior Authorization Challenges & Solutions,” August 2025.
- Surescripts network data, April 2024 through May 2025.
- Surescripts network data. Surescripts estimates work time of 20 minutes per prior authorization request, totaling approximately 40,860 minutes/681 hours of care team time saved based on Touchless Prior Authorization transaction volume April 2024 through May 2025.