CVS Caremark advances prior authorization to get specialty medications to patients faster

WOONSOCKET, R.I. — CVS Caremark is deploying innovative new processes and technology to simplify the prior authorization process for medications and make it faster for members and providers while upholding rigorous clinical integrity and quality. As part of this effort, CVS Caremark is expanding use of Surescripts Touchless Prior Authorization. Touchless Prior Authorization is an industry-leading technology that anticipates what clinical information will be needed to complete a prior authorization, connects directly to a patient’s electronic health record to retrieve that information, and shares that information back to CVS Caremark.

When prior authorization requirements are met, CVS Caremark can immediately approve the medication. The process of automatically matching clinical data with determination criteria at the time of prescribing enables CVS Caremark to reach approvals as quickly as possible, often in as little as 22 seconds*.

CVS Caremark is using this approach for select specialty medications. Specialty medications are essential for patients managing chronic, rare, or serious conditions, but the prior authorization process for these drugs can sometimes be complex. The first specialty medications added — Vivitrol and Epidiolex, used to treat substance use disorder and epilepsy, respectively — represent high impact therapies for which complex approval requirements are needed.

“CVS Caremark and Surescripts share a commitment to transform the prior authorization approval process through innovation,” said Dr. Michelle Gourdine, Senior Vice President, CVS Health; Chief Medical Officer, CVS Caremark. “By helping to make prior authorization instant and seamless, we reduce administrative burden while maintaining clinical integrity, helping to ensure the people we serve receive the medications they need more quickly.”

The expansion of Touchless Prior Authorization is one part of CVS Caremark’s broader commitment to enhancing the prior authorization experience by leveraging technology and optimizing process across a multitude of initiatives. Last year, these combined efforts reduced the median time to process a prior authorization to 34 minutes, down from 2-3 hours in 2024, with nearly 4 million prior authorizations approved automatically through use of responsible technology.

A faster, easier prior authorization experience ensures providers and colleagues can focus on their patients, and that members get their medications quickly.

The adoption and expansion of Touchless Prior Authorization is another step in CVS Health’s commitment to reduce administrative obstacles, resulting in less friction for providers, and expediting care and improved health outcomes for patients.