Prior authorization is one of the most disliked workflows in medicine and for good reason. According to the 2024 AMA Prior Authorization Physician Survey, the average physician and their staff spend 13 hours per week completing approximately 39 prior authorization requests, and 93% say those PAs delay patient care. If your practice runs on athenaOne, you already know the platform offers several built-in and third-party tools to handle PAs. But not all options are created equal, and the right choice depends heavily on your practice's size, specialty, and patient mix.

This guide breaks down the five most common ways to manage prior authorizations inside athenahealth: from the tools built directly into athenaOne to third-party integrations like CoverMyMeds, Surescripts and newer AI-native platforms like Develop Health; so you can compare them side-by-side and choose the approach that fits your workflow.

Why Prior Authorization Is Still a Crisis in 2026

The 2024 AMA survey found that 82% of patients commonly abandon their recommended course of treatment due to PA delays, and 29% of physicians reported that a PA directly caused a serious adverse event for a patient in their care. These are not administrative inconveniences, they are clinical outcomes.

The administrative cost is equally staggering. The AMA estimates that a typical practice spends the equivalent of more than one full-time staff member per physician just managing prior authorizations. More than 40% of physicians have hired staff whose sole job is completing PAs. For a specialty practice managing GLP-1s, biologics, or oncology therapies, a single disease state can require four full-time employees dedicated to PA alone.

The Pharmacy Benefit Problem Athena Users Know Well

Most discussions of prior authorization in an EHR context focus on medical-benefit PAs, the kind submitted through X12 278 transactions for procedures, imaging or durable medical equipment. But in primary care, internal medicine and specialty practices using athenaOne for prescription management, pharmacy-benefit PAs are the volume driver. These are the PAs required by PBMs like Express Scripts, OptumRx, and CVS Caremark before they will cover a specialty medication.

The challenge is that pharmacy-benefit PAs involve a different data layer than medical-benefit PAs. They require payer-specific clinical criteria, real-time PBM connectivity, and increasingly, documentation from the patient's EHR chart to support medical necessity. Most providers are familiar with the frustrating cycle: prescribe a medication, wait for a rejection from the pharmacy, call the insurer, submit a PA form via fax and then chase a determination for days or weeks.

The average cycle time from prescription to approval for pharmacy-benefit PAs historically runs 1-2 weeks when managed manually.

Your Essential Prior Authorization Toolkit in athenahealth

Before comparing the five approaches, it helps to understand the basic layers of the PA workflow. Every PA, regardless of which tool you use, moves through roughly the same pipeline:

1. Benefit verification: Is the medication covered? Does it require PA?
   
   

2. Form identification and completion: What specific questions does this payer require?
   
   

3. Submission: Getting the completed form to the PBM or payer.
   
   

4. Follow-up and status tracking: Where is the request in the review process?
   
   

5. Denial management: If denied, what are the appeal options?

The five tools below differ primarily in how many of these steps they automate, and who is responsible for the ones they don't.

What "Integrated" Actually Means in athenaOne

athenaOne is an open, network-based EHR that allows multiple third-party integrations alongside its own native solutions. When a vendor says its PA tool is "integrated with athena" that can mean anything from a basic single sign-on to a deep, bidirectional workflow embedded in the prescribing and task queue experience. As you evaluate options below, pay attention to whether the integration means a provider must leave athenaOne to complete a step, or whether tasks surface and resolve within the native workflow.

The 5 Ways to Do Prior Authorizations in athenahealth

Option 1: athenaOne Authorization Management (Fully Managed Service)

athenaOne Authorization Management is athenahealth's own fully managed PA service. It is not a self-service tool, rather, it is a delegated service where athenahealth's specialist team takes on most of the authorization work on your behalf.

Here is how it works: when a provider submits an eligible order in athenaOne, the platform's Authorization Rules Engine automatically checks whether PA is required based on continuously updated payer requirements. If authorization is needed, the system initiates the process and athena's specialists handle clinical documentation submission, payer follow-up, and status tracking on your behalf. Providers retain full visibility via the Authorization Tracker within their existing workflow.

Key performance benchmarks (per athenahealth):

• Same-day authorizations are initiated within 2 hours of receipt
  
  

• 94% of urgent authorizations are completed within 48 hours
  
  

• Practices using the service report a greater than 98% success rate in managing authorizations
  
  

• South Texas Spinal Clinic reduced what was once a 6–8 week process to as little as five days

Best for: 

• Practices that want to fully offload PA management. 

• Particularly strong for medical-benefit PAs (procedures, imaging, referrals). 

• Less differentiated for high-volume pharmacy-benefit PA workflows.

Limitations to consider:

• This is a paid add-on service, not a free feature of athenaOne
  
  

• The managed service model means you are dependent on athena's specialist throughput for complex cases
  
  

• It focuses primarily on medical-benefit prior authorizations

Option 2: Express Authorizations (Self-Service in athenaOne)

Express Authorizations is athenahealth's self-service PA tool for practices that want to manage authorizations in-house. It surfaces an automated Authorization Determination Engine inside the athenaOne workflow, giving staff the ability to obtain payer approvals without leaving the platform.

The tool integrates directly with payer systems via electronic connections, allowing practices to obtain prior authorization approval without leaving athenaOne. Per athenahealth, 70% of prior authorizations processed through the network are now auto-approved. The AI-powered workflow also uses machine learning to pull relevant information from the patient's chart and auto-populate clinical forms, a feature that has helped reduce claim holds by 35% and insurance-related denials by 10.6% for practices using it.

Key capabilities:

• Authorization Determination Engine checks real-time payer requirements
  
  

• AI-enhanced chart analysis to auto-populate clinical forms at submission
  
  

• Authorization Tracker for monitoring status across all open requests
  
  

• Native to athenaOne: no separate login or portal required

Best for: 

• Mid-size to large practices with dedicated staff who want in-workflow efficiency but prefer to maintain internal control of the PA process.
  
  

• Strong for medical-benefit PAs; pharmacy-benefit coverage depends on payer connectivity.

Limitations to consider:

• Still requires staff time to review and manage exceptions and denials
  
  

• Payer connectivity varies; not all PBMs are directly integrated

Pro Tip: Express Authorizations pairs well with athenahealth's AI-powered Authorization Prediction tool, which can flag whether a PA is likely needed before the order is placed, saving time spent on unnecessary submissions.

Option 3: CoverMyMeds (ePA Transmission Network)

CoverMyMeds, part of McKesson, is the most widely adopted electronic prior authorization platform in the United States. It has been integrated with athenaClinicals since 2017, and its presence in athenaOne allows providers to electronically initiate PA requests at the point of prescribing.

When CoverMyMeds is active in athenaClinicals, prescribers can initiate an ePA request for a medication during the prescribing workflow. The tool auto-populates patient, prescriber, and medication details, then routes the request to the appropriate health plan. Real-time determinations are available for partnered health plans. Early adopters of ePA on athenaClinicals cut average PA determination time from nine days to three, while reducing administrative data entry by half.

CoverMyMeds is also free to providers and is accessible to all practices on athenaClinicals. It is integrated with 50,000+ pharmacies nationwide, and pharmacies can initiate PA requests that automatically surface in the provider's dashboard for completion.

Key capabilities:

• Free to providers; no subscription required
  
  

• Electronic transmission of PA requests to health plans and PBMs
  
  

• Auto-population of patient and prescription data from athenaClinicals
  
  

• Pharmacy-initiated PA requests appear in provider workflow
  
  

• Real-time determinations from participating health plans
  
  

• Supports Medicare Part D and Medicaid PAs

Best for: 

• Practices that want a free, low-friction electronic submission tool to replace fax and phone PAs.
  
  

• Widely used for pharmacy-benefit PAs across most specialties.
  
  

• CoverMyMeds covers more than 950,000 providers and connects to virtually every health plan.

The critical distinction to understand: CoverMyMeds is fundamentally a transmission network. It enables electronic submission of PA forms, which is a major improvement over fax, but it does not complete the PA on your behalf. Your staff still needs to review, fill in clinical details, manage denials, and follow up on outstanding requests. The platform is as efficient as the staff using it.

Option 4: Surescripts Electronic Prior Authorization (ePA Network)

Surescripts is one of the dominant e-prescribing health information networks, connecting over 2.2 million prescribers, virtually every pharmacy, and the major PBMs. Surescripts' CompletEPA (now branded as Prior Authorization Automation) has been integrated into athenaOne as part of the platform's e-prescribing infrastructure for years.

More recently, in early 2025, Surescripts launched a significant new capability: Touchless Prior Authorization. This technology represents a meaningful step beyond traditional ePA. Rather than simply routing a PA form electronically, Touchless PA automatically retrieves required clinical information from the patient's EHR and sends it to the PBM, enabling approvals without any manual intervention when PA requirements are met. In a 2024 pilot with Fairview Health Services, appeals and denials caused by lack of clinical information were reduced by 88% and 68% respectively, with many approvals completed in under 30 seconds.

By October 2025, Touchless PA had reached more than 76,000 prescribers and supported 70+ medications. Surescripts' 2025 Annual Impact Report notes that some Touchless PA approvals now return in as little as 18 seconds.

Key capabilities:

• Embedded in athenaOne e-prescribing workflow; no additional login
  
  

• Standard CompletEPA routes PA requests electronically to PBMs using NCPDP SCRIPT standard
  
  

• Touchless PA automatically retrieves clinical data from the EHR and submits without provider action
  
  

• Free to providers as part of Surescripts network participation
  
  

• Covers approximately 85% of PBMs via the Surescripts network
  
  

• Real-time Prescription Benefit (RTPB) checks for coverage and out-of-pocket cost at point of prescribing

Best for: 

• Health systems and large practices with high prescription volumes who want background PA automation for qualifying medications.
  
  

• The Touchless PA feature is particularly valuable for medications with well-defined, criteria-based PA requirements (e.g., GLP-1s, ADHD medications, biologics with established step therapy requirements).

Limitations to consider:

• Touchless PA currently covers a limited drug list (~70 medications as of late 2025) — complex or niche specialty drugs may not qualify
  
  

• The platform does not handle denials or appeals automation
  
  

• Requires payer/PBM adoption of the standard to function in Touchless mode

Key insight: Surescripts and CoverMyMeds are complementary infrastructure layers, not direct competitors. Surescripts owns the e-prescribing network itself; CoverMyMeds operates as a PA middleware atop that and other networks. In practice, athenaOne uses both to achieve broad payer coverage for electronic PA submission.

Option 5: Develop Health (AI-Native End-to-End PA Automation)

Develop Health is an AI-powered benefit verification and prior authorization automation platform that launched its native integration with athenaOne in December 2025. Unlike the four options above, Develop Health is designed to automate the entire PA cycle, from real-time benefit verification through submission, follow-up, denial analysis, and appeal generation, without requiring any change to how providers prescribe.

The integration works as follows: clinicians prescribe as usual in athenaOne. In the background, Develop Health automatically runs benefit verification across relevant medications, identifies whether PA is required, sources the correct payer form, extracts relevant clinical evidence from the patient's EHR chart across all historical visits and lab results, completes the form, and submits it. Status updates return directly into the athenaOne workflow. Providers can review before submission, but they are not required to take any additional steps.

Per the December 2025 press release, the platform eliminates "hours of manual work per provider" and has been shown to reduce PA handling time by 83% for customers, while boosting approval rates by 14% across the customer portfolio.

Key capabilities:

• Benefit verification: Real-time checks through direct eBV connections with full view of coverage, PA requirements, and out-of-pocket cost, including applicable manufacturer copay programs
  
  

• PA form completion: AI automatically extracts clinical evidence from EHR notes and lab data, then fills payer forms with cited documentation
  
  

• Multi-channel submission: ePA, AI-powered phone calls, and fax, with human fallback for 100% coverage of payer connectivity
  
  

• Denial management: AI analysis of denial reasons, automated appeal letter generation, and resubmission
  
  

• HCP front door: A lightweight portal for providers to review submissions and provide context without leaving their workflow
  
  

• Analytics: Real-time dashboards with approval rates, denial patterns, and payer-level insights
  
  

• Free to providers: Cost is borne by pharma sponsors or covered under the platform's venture-backed model, no charge to the practice

Performance benchmarks:

• Reduced prescription-to-approval cycle time from 1.5 weeks to approximately 20 hours (customer-reported)
  
  

• 83% reduction in PA handling time
  
  

• 14% improvement in approval rates across the customer portfolio
  
  

• Serving more than 300,000 patients per month as of early 2025

Best for: 

• Practices with high pharmacy-benefit PA volumes, especially those managing specialty medications like GLP-1s, biologics, or ADHD drugs.
  
  

• Also a strong fit for digital health companies, specialty pharmacies and any practice that wants to eliminate PA-related staff overhead without replacing tools or changing how providers prescribe.

Limitations to consider:

• Develop Health focuses primarily on pharmacy-benefit PAs, it is not the right solution if your primary volume is medical-benefit authorization (procedures, imaging, referrals)
  
  

• As a newer integration (launched December 2025), the athenaOne deployment is still gaining scale in the athena ecosystem

Side-by-Side Comparison: PA Options in athenahealth

Common Prior Authorization Mistakes to Avoid in athenahealth

Mistake 1: Treating CoverMyMeds as a Full PA Solution

This is the most common misunderstanding in practice-level PA management. CoverMyMeds is an excellent electronic submission channel, it removes fax and phone from the equation, which alone is a substantial improvement. But it does not automatically complete PA forms, track outstanding requests, manage denials, or generate appeals. Practices that rely on CoverMyMeds alone without a robust internal workflow still end up spending significant staff time on PA. The platform is a starting point, not a finish line.

How to avoid it: Pair CoverMyMeds with a clear internal SOP for denial management and follow-up tracking, or layer in a more automated platform for high-volume specialty medications.

Mistake 2: Not Using Benefit Verification Before the PA Process

Many practices initiate a PA only after a pharmacy rejection, meaning the patient has already arrived at the pharmacy, found their medication isn't covered, and left without it. This reactive model delays therapy starts and creates avoidable rework. Real-time benefit verification, such as eBV through Develop Health, can flag PA requirements and out-of-pocket costs before the patient leaves the office.

How to avoid it: Enable benefit verification in your athenaOne e-prescribing workflow so coverage information surfaces at the point of prescribing, not at the point of dispensing.

Mistake 3: Using One Tool for Both Medical and Pharmacy Benefit PAs

Medical-benefit PAs (procedures, imaging, referrals) and pharmacy-benefit PAs involve different payer infrastructure, different form formats, and different determination workflows. CoverMyMeds and Develop Health are optimized for pharmacy-benefit PAs; athena's Authorization Management is stronger for medical-benefit PAs. Using a single tool to handle both often means one category gets handled well and the other gets managed manually.

How to avoid it: Audit your PA volume by type. If your practice has significant volume in both categories, consider a tiered approach: athena's native tools for medical-benefit PAs, and a pharmacy-benefit PA specialist platform for prescription authorizations.

Mistake 4: Not Tracking Denial Rates by Payer

Most practices know their overall PA approval rate. Few track denial rates broken down by payer, by drug, or by denial reason. This data is essential for understanding which payers are systematically denying certain medications, which clinical criteria are most commonly cited, and where appeal rates are high enough to justify building an appeal template library.

How to avoid it: Use whatever analytics are available in athena's built-in reporting or a dedicated platform like Develop Health, to track denial patterns over time. This intelligence compounds in value as your PA volume grows.

Pro Tip: If you are managing a high GLP-1 PA volume (Ozempic, Wegovy, Zepbound, Mounjaro), payer criteria for these medications change frequently. A platform, like DevelopHealth, that automatically updates to current payer requirements, rather than requiring manual rule updates, will save your staff hours per week in re-learning what each payer now requires.

How to Choose the Right PA Approach for Your Practice

This is where your specific situation determines everything.

Choose athena Authorization Management if:

• Your primary PA volume is medical-benefit (procedures, imaging, referrals)
  
  

• You want to fully offload PA management to specialists and do not need to handle it in-house
  
  

• You are a high-volume practice where the cost of the managed service is justified by staff savings

Choose Express Authorizations if:

• You want to keep PA management internal but need better tooling than manual fax/phone
  
  

• Your team already uses athenaOne and wants native in-workflow tools without adding a new vendor
  
  

• You have a mix of medical and pharmacy PAs and want a unified platform

Choose CoverMyMeds if:

• Your PA volume is manageable with existing staff and you just need to eliminate fax/phone

Choose Surescripts (Touchless PA) if:

• You have high volume in the specific medications Touchless PA supports (~70 as of late 2025)
  
  

• You want background automation that requires no action from providers or staff for qualifying approvals
  
  

• You are part of a health system with strong Surescripts network participation
  
  

• You don’t mind handling payers and drugs not covered by Touchless PA

Choose Develop Health if:

• Your practice has high pharmacy-benefit PA volume for specialty medications (GLP-1s, biologics, specialty neurology, etc.)
  
  

• You want to eliminate PA-related staff overhead without changing how providers prescribe
  
  

• You need real-time benefit verification with manufacturer copay program integration at the point of care
  
  

• You want end-to-end automation including denial analysis and AI-generated appeal letters

Frequently Asked Questions

What is the difference between medical-benefit and pharmacy-benefit prior authorization? 

Medical-benefit PAs cover procedures, imaging, referrals, and infused or physician-administered medications billed to a patient's medical insurance. Pharmacy-benefit PAs cover prescription medications dispensed at a pharmacy and billed to the patient's prescription drug plan (PBM). In athenahealth, medical-benefit PAs are primarily handled through athenaOne's Authorization Management tools; pharmacy-benefit PAs often require separate ePA platforms like CoverMyMeds, Surescripts, or Develop Health.

Is CoverMyMeds the same as Surescripts? 

No. CoverMyMeds (part of McKesson) and Surescripts are separate companies that serve related but distinct roles. Surescripts is the underlying e-prescribing network infrastructure connecting prescribers, pharmacies, and PBMs. CoverMyMeds operates as a PA workflow platform on top of that and other networks. In practice, athenaOne uses both: Surescripts for e-prescribing and its ePA / Touchless PA capabilities, and CoverMyMeds as an additional ePA transmission and workflow layer for pharmacy-benefit PAs. For most athena users, both are accessible as part of the platform.

How much does Develop Health cost for an athenaOne practice? 

Develop Health is free to providers and their practices. The platform operates on a model where pharmaceutical companies sponsor access for their branded drugs, or where Develop Health's venture-backed model covers the cost. Practices do not pay a subscription or per-transaction fee. To learn more or request access for your practice, visit develophealth.ai/athenahealth.

How long does PA approval typically take with these tools? 

It varies significantly. Manual fax/phone PAs historically take 1–2 weeks end to end. CoverMyMeds reduces this for participating health plans, with early athena adopters seeing approvals in approximately 3 days. Surescripts' Touchless PA can return approvals for qualifying drugs in under 30 seconds in some cases. Develop Health has reduced prescription-to-approval cycle time to approximately 20 hours for customers previously using hub services (down from 1.5 weeks). athena's Authorization Management handles urgent PAs within 48 hours for 94% of requests.

Does using an AI-powered PA tool create compliance or liability risks? 

This is an important and reasonable concern. Platforms operating in this space are required to comply with HIPAA and, for pharma-sponsored relationships, the Anti-Kickback Statute (AKS) personal services safe harbor. Develop Health, for example, operates under SOC 2 Type 2 certification (HITRUST underway), maintains audit-grade transparency with confidence thresholds that trigger human review for uncertain AI outputs, and has built-in controls including data firewalls that prevent field sales access to patient-level data. When evaluating any AI PA platform, ask specifically about their HIPAA BAA structure, AKS compliance model, and how they handle AI errors or low-confidence determinations.

Can I use more than one PA tool simultaneously in athenahealth? 

Yes, athenaOne is an open platform and does not restrict the use of multiple integrated tools. In fact, most practices end up using a combination: Express Authorizations or athena Authorization Management for medical-benefit PAs, and Develop Health for pharmacy-benefit PAs. The key is ensuring your staff understands which tool handles which request type so requests do not fall through the cracks between platforms.

Ready to Reduce Your PA Burden?

Prior authorization is not going away anytime soon, but the tools to manage it have improved dramatically. Whether your priority is eliminating fax-and-phone submissions with CoverMyMeds, achieving background automation for qualifying medications via Surescripts' Touchless PA, or implementing full end-to-end AI automation with Develop Health, athenaOne's open architecture means you are not locked into a single approach.

If your practice is managing high volumes of specialty pharmacy PAs, particularly GLP-1s, immunology, or specialty neurology, and you are spending more staff hours on PA than you should be, Develop Health's integration with athenaOne is worth evaluating. The platform requires no workflow change, is free to providers and automates from benefit verification through appeal; the complete cycle that no other option above fully covers on its own.