Tech Cuts Prescription Red Tape, Slashing Wait Times and Costs

ARLINGTON, Va. – May 20, 2026 – For millions of Americans, the journey from a doctor’s prescription to holding medication in their hands is fraught with frustrating delays and sticker shock at the pharmacy counter. A bureaucratic process known as prior authorization, designed by insurers to manage costs, has become a significant barrier to care. But a wave of automation is beginning to dismantle this hurdle, with new data showing technology can shrink approval times from days or weeks to mere seconds.

Surescripts, a leading health intelligence network, recently announced a major expansion of its automated systems, which are now used by 50% more prescribers than just six months ago. The company's latest report highlights the growing impact of its Prior Authorization Automation and Real-Time Prescription Benefit tools, which are now in the hands of 68,000 prescribers across 42 health systems. The results are striking: median approval times of just 18 seconds and millions of dollars in patient savings.

"When patients no longer need to make decisions about their treatment due to cost concerns or prior authorization delays, we have made an impact on improving their care,” said Frank Harvey, Chief Executive Officer for Surescripts, in a statement accompanying the release.

The High Cost of Waiting

The problem Surescripts and its competitors are tackling is one of the most persistent pain points in American healthcare. Prior authorization requires physicians to get pre-approval from a patient's health plan before a specific medication or treatment will be covered. While intended as a cost-control measure, the process has ballooned into a major administrative burden and a direct threat to patient health.

According to recent surveys by the American Medical Association (AMA), the impact is severe. An overwhelming 94% of physicians report that prior authorization processes delay access to necessary care. More alarmingly, nearly a third of physicians say these delays have led to a serious adverse event for a patient, such as hospitalization, permanent impairment, or worse. The friction is so significant that studies show nearly 80% of patients have abandoned a prescribed treatment altogether after encountering a prior authorization roadblock.

This administrative quagmire consumes immense resources. Physician practices report spending an average of 13 hours per week—the equivalent of nearly two full workdays for one staff member—just navigating prior authorization paperwork and phone calls. This not only drives up administrative costs, estimated at $35 billion annually across the U.S. healthcare system, but also contributes significantly to physician burnout.

Automation as the Antidote

Technology firms are positioning automation as the antidote to this bureaucratic poison. Surescripts' solution works by integrating directly into a physician's electronic health record (EHR) workflow. When a doctor prescribes one of the 104 medications currently supported, the system automatically pulls the necessary clinical data from the patient's chart and matches it against the insurer's criteria. This information is sent directly to the pharmacy benefit manager (PBM), often resulting in an automated approval in seconds.

The company reports a 34% automated approval rate for in-scope medications, a figure that promises to grow as more health systems and payers come online. An additional 119,000 prescribers are expected to be enabled with the technology later in 2026.

Beyond just speeding up approvals, a parallel technology is tackling the second major hurdle: cost. The Real-Time Prescription Benefit tool gives prescribers an immediate, point-of-care view of what a patient’s insurance covers and, crucially, what their out-of-pocket cost will be at their chosen pharmacy. If the cost is too high or a prior authorization is required, the doctor can see and select a clinically appropriate, more affordable alternative on the spot.

The financial impact is substantial. Between January and April 2026 alone, the tool saved patients $19.7 million. In 2025, when prescribers used the feature to find a lower-cost drug, patients saved an average of $77 per prescription. For expensive specialty drugs, the average savings soared to $817 per prescription. Savings were particularly high for critical medication classes, including antipsychotics ($194 average savings) and diabetic therapies ($101 average savings).

"As affordability pressures intensify for patients—particularly for specialty, diabetes and obesity medications—the need to meaningfully remove obstacles at the point of care has never been more critical," noted Kat Thorp, Vice President, Product Innovation, Medication Access for Surescripts.

A Shifting Regulatory Landscape

While companies like Surescripts, CoverMyMeds, and Availity have been developing these solutions for years, a powerful new tailwind is accelerating their adoption: federal regulation. In January 2024, the Centers for Medicare & Medicaid Services (CMS) finalized its Interoperability and Prior Authorization Final Rule, a sweeping regulation set to fundamentally reshape the process.

Beginning in 2026, the rule mandates that Medicare Advantage plans and other federally regulated payers must provide prior authorization decisions within 72 hours for urgent requests and seven calendar days for standard requests—slashing the previous 14-day standard in half.

More importantly, by 2027, these payers will be required to implement a standardized electronic Prior Authorization API (Application Programming Interface). This will create a secure, digital pathway for provider software to automatically submit requests and receive decisions, effectively mandating the very electronic infrastructure that companies in this space have been building. The rule also demands greater transparency, requiring payers to provide specific reasons for any denials.

This regulatory push is expected to create a tipping point, moving the industry away from faxes and phone calls and toward the integrated, automated workflows that can deliver the 18-second approvals Surescripts is reporting. The convergence of market-driven innovation and federal mandates offers a promising path toward alleviating one of healthcare’s most profound administrative burdens, ultimately making it easier and more affordable for patients to get the medicine they need.