Epic gives you more native prior authorization tooling than most other EHR systems: electronic PA at the point of prescribing, AI-drafted answers to payer question sets, Payer Platform for connected health plans, and the workqueues that organize everything else. 

Yet 88% of prior authorizations nationally are still completed partially or entirely by hand, and the 2025 AMA Prior Authorization Physician Survey puts the cost at roughly 13 hours of physician and staff time per week. The gap between what Epic can automate and what most organizations actually automate is significant.

This guide breaks down the five ways organizations on Epic get medication PAs done in practice: what each covers, where each stops, and how to combine them.

Medication PAs vs. Medical-Benefit PAs in Epic: Know Which Problem You Have

Epic runs two separate PA pipelines.

Pharmacy-benefit PAs cover prescriptions billed to the patient's drug plan: GLP-1s, biologics, ADHD medications, specialty therapies. In Epic, these move through the e-prescribing infrastructure: Surescripts pulls each patient's prescription benefit data into the chart nightly, and ePA transactions flow between Epic and the PBM using the NCPDP standard.

Medical-benefit PAs cover procedures, imaging, referrals, and physician-administered drugs billed to medical insurance. These run through X12 278 transactions, Payer Platform, and the Auth/Cert workqueues.

This article focuses primarily on the pharmacy-benefit side, the volume driver for most ambulatory and specialty practices.

The 5 Ways to Do Prior Authorizations in Epic

Option 1: Epic's Native Medication ePA, With AI Answer Suggestions

Epic's electronic prior authorization has been embedded in the prescribing workflow since its Surescripts CompletEPA integration. When a prescription triggers a PA requirement for a connected PBM, Epic can initiate the request at the point of prescribing (prospective PA) or when the pharmacy hits a rejection (retrospective PA), pre-populated with patient, prescriber, and benefit data.

For organizations that have fully enabled it, the results are real. Advocate Aurora Health moved from a four-day manual process to completing over 80% of medication PAs automatically, with a centralized team handling the remainder.

The newest layer is generative AI. Epic's prior auth answer suggestions draft responses to payer question sets by scanning the patient's chart, pulling in the references it used so staff can review, edit, and verify rather than dig through records manually. Epic reports health systems using the feature have seen a 12.8% decrease in time spent answering PA questions and 13% faster turnaround for AI-assisted PAs versus those worked manually. 

The strongest published numbers come from Penny, Epic's revenue-cycle AI: Summit Health cut medication PA submission time by 42%, with 92% of AI-generated responses accepted without edits. At Advocate, AI-drafted responses to payer information requests cut staff time from up to 25 minutes to about 5 minutes per authorization.

Best for: Every Epic organization. If prospective ePA and the AI answer suggestions aren't enabled and adopted, fix that before evaluating any vendor.

Where it stops: Coverage depends entirely on PBM connectivity, and the automated share of your volume depends on your payer mix. PAs for non-connected payers, complex specialty drugs with off-form evidence requirements, denials, and appeals all fall outside the automated path. The AI suggestions assist a human working the queue rather than removing the queue. Most PA volume still requires manual work somewhere in the cycle.

Option 2: Epic Payer Platform (Medical-Benefit PAs)

Payer Platform is Epic's direct data-exchange layer with health plans. For participating payers, clinical documentation moves between the provider's Epic and the payer's system automatically. Ochsner Health and Humana completed 53% of prior authorizations instantly through this connection, and Mayo Clinic and a statewide health plan cut ADR denials by up to 75%.

Best for: Health systems with significant procedure, imaging, and infusion auth volume whose major payers participate. If a large regional payer is on Payer Platform, this is the highest-leverage medical-benefit move available.

Where it stops: It is payer-by-payer, and it is not a pharmacy-benefit tool. Industry-wide, the 2025 CAQH Index found only 40% of medical PA transactions are fully electronic, so even organizations with strong Payer Platform participation carry substantial portal-and-fax volume for everyone else. There is also no decision for a practice to make here beyond advocacy: either your payers participate or they don't.

Option 3: Workqueue and Operational Redesign

The top-performing PA operations on Epic aren't always the ones with the most software. Mayo Clinic cut medication PA denial rates by 70% and lifted staff productivity 39% by replacing one centralized PA workqueue with eleven specialty-specific queues, training staff on the payer criteria for their specialty's drugs, and creating a dedicated denial governance team to own appeals.

PA quality is a specialization problem. A staff member who works only endocrinology PAs learns every payer's GLP-1 criteria by heart; a generalist queue guarantees everyone is perpetually re-learning. Denials drop when the person completing the form has seen that exact payer-drug combination fifty times.

Best for: Health systems and large groups with existing PA staff who see high denial rates or long submission lags despite having ePA enabled. It's also the correct precursor to automation, because automating a badly designed workflow just produces more chaos.

Where it stops: Redesign reduces errors and denials, but the work is still manual. Mayo's staff still answer every question set; they just answer them correctly more often. Headcount scales linearly with volume.

Option 4: ePA Network Tools (CoverMyMeds and Surescripts Touchless PA)

The ePA rails under Epic are operated by Surescripts and CoverMyMeds, and both offer capabilities beyond the basic in-workflow transaction.

CoverMyMeds matters most for retrospective PAs: when a pharmacy hits a rejection, pharmacy-initiated PA requests route to the prescriber's dashboard for completion. Many Epic organizations, including academic health systems, run clinic-staff CoverMyMeds workflows alongside native ePA to catch what point-of-prescribing automation misses. It's free to providers, but it is a transmission and workflow layer, not an automation layer. Staff still complete, track, and chase every request.

Surescripts Touchless Prior Authorization goes further for a narrow slice: it retrieves required clinical data from the EHR and submits automatically, with approvals for qualifying drugs returning in as little as 18 seconds. As of late 2025 it had surpassed 76,000 prescribers and 70+ medications, with live deployments at systems including Cleveland Clinic and UNC Health. This is meaningful for high-volume, criteria-driven drugs, but it does not touch denials or appeals.

Best for: Rounding out native ePA coverage at no cost, and background automation for the specific medications Touchless PA supports.

Where it stops: Neither tool completes complex forms, gathers clinical evidence beyond structured data, manages denials, or generates appeals. The staffing burden doesn't disappear.

Option 5: AI-Native Automation (Develop Health)

Develop Health is an AI platform that automates the full pharmacy-benefit PA cycle: 

• real-time benefit verification

• payer form identification

• clinical evidence extraction from chart notes with citations

• submission

• determination follow-up

• denial analysis

• and AI-generated appeals.

Develop Health connects to Epic environments through its API REST endpoints for running benefit verifications and submitting prior authorizations, with webhooks pushing status changes back to your systems as they happen. That means your integration team (or middleware partner) wires prescription events from Epic into the API, and PA statuses flow back into whatever surface your staff already watch. Providers keep prescribing exactly as they do today.

What the platform automates that the options above don't:

• Benefit verification before the pharmacy rejection: direct eBV checks with full coverage, PA-requirement, and out-of-pocket visibility, replacing the reactive prescribe-wait-reject-scramble loop
  
  

• Evidence-backed form completion: AI extracts supporting clinicals from historical notes and labs, then fills payer question sets with cited documentation, the step that consumes most staff time and drives most denials
  
  

• 100% payer coverage via multi-channel submission: ePA where rails exist, AI phone calls and fax where they don't, with human fallback
  
  

• The other half of the process: determination chasing, denial-reason analysis, appeal letter generation and resubmission, which no native Epic tool or ePA network automates

The results we’re seeing from our customers are very positive: an 83% reduction in PA-related administrative work, a 14% lift in approval rates and prescription-to-approval cycle times cut from roughly 1.5 weeks to about 20 hours, at a scale of hundreds of thousands of patients per month. 

In one of our case studies, Arches Primary Care processed roughly 800 prior authorizations in six weeks, cutting turnaround from weeks to two days.

Best for: Organizations on Epic with high pharmacy-benefit volume in specialty medications: GLP-1s, biologics, specialty neurology. Also, it’s the only option on this list that automates appeals.

Where it stops: Pharmacy-benefit only. It is not a fit if your problem is procedure and imaging authorizations (that's options two and three).

Side-by-Side: PA Options in Epic

We’re Here to Help Automate the PAs that Epic Can't

Epic's native tools are very capable, and the right move for most organizations is to max them out first. But the PA work that actually burns staff hours (evidence gathering for complex specialty drugs, non-connected payers, denial chasing, appeals) sits outside what any native tool automates. If that's where your team's time goes, Develop Health automates the complete pharmacy-benefit cycle through an API that fits alongside your Epic environment, with no change to how providers prescribe. Book a demo to see how we can help.

Frequently Asked Questions

Does Epic have built-in prior authorization automation?

Yes, for part of the volume. Epic's medication ePA fires automatically for connected PBMs, and its AI answer suggestions draft responses to payer question sets from chart data. Epic reports 13% faster turnaround for AI-assisted PAs. Payer Platform automates medical-benefit auth exchange with participating payers. PAs for non-connected payers, denials, and appeals still require staff or a third-party layer.

What's the difference between Epic's ePA and Payer Platform?

ePA handles pharmacy-benefit PAs (prescriptions billed to a drug plan) over Surescripts/NCPDP rails between Epic and PBMs. Payer Platform handles medical-benefit authorizations (procedures, imaging, infusions) through direct data exchange between Epic and participating health plans' systems. They cover different request types and neither substitutes for the other.

How do third-party PA tools connect to Epic?

Through several paths: ePA network tools like CoverMyMeds use the existing e-prescribing rails; some vendors integrate via HL7/FHIR interfaces; and API-first platforms like Develop Health expose REST endpoints and webhooks that your integration team connects to prescription events. For hosted or Community Connect environments, integration paths depend on what the host system approves.

Is Epic's AI prior authorization feature available to all customers?

The prior auth answer suggestions are part of Epic's AI for revenue cycle and operations toolset, which organizations enable and configure individually. Availability depends on your version, licensing, and your organization's AI governance decisions. Check with your Epic representative; published results so far come from early-adopting health systems like Summit Health and Advocate.

How long does a medication PA take in Epic?

It ranges from seconds to weeks depending on the path. Connected-PBM ePAs can return determinations in minutes. Manually worked PAs for non-connected payers historically run 1-2 weeks. End-to-end automation platforms can cut the full prescription-to-approval cycle to roughly 20 hours.