Ask a pharmacy team what makes prior authorizations painful and you will usually get an answer about forms. Too many of them, all different, always asking for something the prescriber’s office has to supply.
The forms are annoying. They are not the expensive part.
The expensive part is that a prior authorization is a case that lives for days across at least three organisations, and almost nothing in a pharmacy is built to hold a case. It is held in a person’s head, a sticky note, a will-call bag and a text thread. That is statelessness, and it costs money in three specific ways.
Nobody owns it
A rejection comes back at the counter. A technician starts something: a call to the prescriber, a fax, a note in the patient’s profile. Then the queue moves and the shift ends.
The next person to touch that patient has no way to know what stage the case is at, whether the office was already called, who they spoke to, or what was asked for. So the work is either redone or dropped, and the pharmacy cannot tell which without doing it again. The patient calls on day four and the honest answer is that nobody knows.
Nobody sees the clock
Every payer has turnaround expectations, and appeal windows close. A case that is legitimately waiting on the plan looks exactly like a case that was forgotten on day one. There is no dashboard where a pending authorization ages visibly, so nothing escalates until the patient escalates it.
The measurable result is abandonment. The prescription sits, the patient goes without, and eventually the fill is reversed. That loss is recorded, if it is recorded at all, as an unrelated reversal rather than as a prior authorization that timed out.
Nothing is learned
This is the quietest of the three and the one with the most compounding value.
The same plan asks for the same clinical evidence on the same drug class, over and over. Step therapy documentation. A recorded trial and failure. A specific lab value. A pharmacy that ran two hundred authorizations last year is sitting on a detailed map of what each payer actually wants on the first submission, and almost none of that map is written down anywhere. The two hundredth case is fought exactly as hard as the first.
What good looks like
Use the electronic rails, properly. Electronic prior authorization is a genuine improvement over fax, and the infrastructure already exists. Surescripts operates an electronic prior authorization service built to “streamline the prescription authorization process” and help patients get medication “without unnecessary delays”, and CoverMyMeds is the other name a prescriber’s office is most likely to already have open. If a request can go electronically, it should, and any tool that quietly reverts to fax is adding a day for no reason.
Give the case an owner and a state. Not a note. A record with a status, an assignee and a last action, visible to whoever is standing at the counter when the patient walks in. The single highest-value change most pharmacies can make here costs nothing in software: decide that one named person reviews every open authorization every morning.
Make the clock visible. Age every open case in days. Sort descending. Anything past the payer’s stated turnaround gets a follow-up that day, and anything approaching an appeal deadline gets escalated before the window closes rather than after.
Write down what each payer wanted. A one-line note per resolved case, keyed to plan and drug class, becomes the most valuable internal document in the pharmacy within a year. It converts a repeated argument into a checklist you complete before the first submission.
Close the loop on outcome. Approved, denied, appealed, abandoned, and if abandoned, at what stage. Without that, you cannot tell whether your authorization process is improving, and you cannot tell which payers are worth pushing on.
None of this is a criticism of the ePA networks, which are the useful half of the problem being solved by people who solved it well. The other half is the pharmacy’s own: an authorization is a small, slow, multi-party workflow, and it needs to be run like one rather than filed like paperwork.