The healthcare industry has seen massive growth in health information technology over the past decade. Two of the most widely adopted platforms are Surescripts for electronic prescribing and CoverMyMeds for electronic prior authorizations. But what exactly are these technologies, who uses them, and how do they compare?
This comprehensive guide takes a deep dive into Surescripts and CoverMyMeds to highlight the key features, pros and cons, and use cases of each platform.
A Brief Comparison Table
| Category | Surescripts | CoverMyMeds |
| Purpose | ePrescribing network | Prior authorization automation |
| Primary Users | Prescribers, pharmacists | Prescribers, pharmacists, health plans |
| Key Features | eRx, medication history, benefits check | ePA submission, real-time benefits check, ePA status |
| Data Flow | Clinician → PBM → Pharmacy | Clinician → Payer → Clinician/Pharmacy |
| Main Benefits | Improved safety, efficiency | Reduced delays, higher approval rates |
| EHR Integration | APIs for embedded workflow | APIs for embedded workflow |
| Network Reach | 1M clinicians, 68K pharmacies | 1.7M clinicians, 775K pharmacies |
| Limitations | Network outages, privacy risks | Learning curve, system fragmentation |
What Is Surescripts?
Surescripts operates the nation’s largest ePrescribing network, connecting prescribers to pharmacies and benefit managers. Surescripts allows doctors and other clinicians to electronically transmit prescriptions, check medication histories, and access benefit information when prescribing.
Some key features of Surescripts include:
- ePrescribing: Enables clinicians to send electronic prescriptions directly to the pharmacy. This eliminates illegible handwritten scripts.
- Medication History: Provides clinicians with a patient’s medication history from pharmacy benefit managers and payers to inform prescribing decisions.
- Benefit Check: Checks patient insurance, formulary, and medication history data to determine prescription coverage and costs.
- Pharmacy Directory: Provides access to a nationwide network of retail pharmacies. Clinicians can electronically send scripts to the patient’s pharmacy of choice.
- Integration with EHRs: Seamlessly integrates with electronic health records (EHRs) through APIs to allow ePrescribing workflow directly in the EHR.
Who Uses Surescripts?
The Surescripts network connects over 1 million healthcare professionals, 68,000 pharmacies, 700 electronic health record systems, and nearly all pharmacy benefit managers. This accounts for the vast majority of ePrescriptions in the US.
The major users of Surescripts include:
- Physicians: doctors use Surescripts integrated with their EHR to electronically prescribe, check formularies, and access medication history.
- Nurse Practitioners and PAs: can prescribe within their scope of practice using the ePrescribing workflow.
- Pharmacists: receive and process electronic prescriptions from the Surescripts network.
- Pharmacy Benefit Managers: provide patient medication history and insurance coverage data.
- EHR Vendors: integrate Surescripts into EHR products to enable ePrescribing capabilities.
Pros And Cons Of Surescripts
Pros
There are many benefits that Surescripts provides to both prescribers and pharmacies:
- Improved patient safety – Eliminates errors due to illegible handwritten prescriptions
- Reduced costs – Lowers overhead without paper scripts and faxes
- Enhanced workflow efficiency – Scripts are instantly sent electronically to pharmacy
- Better informed decisions – Access to medication history and insurance data
- Higher patient satisfaction – E-prescribing reduces trips to doctor’s office for paper scripts
- Interoperability – Integration with EHR improves data exchange across healthcare
Cons
Some potential downsides of Surescripts include:
- Startup costs – Expenses to integrate Surescripts into EHRs and pharmacy computer systems
- Learning curve – Clinicians need training to adopt ePrescribing workflow
- Network dependency – Temporary network outages can cause prescribing disruptions
- Privacy concerns – Transmission of patient prescription data across a network
- Limited rural access – Smaller pharmacies in remote areas may lack connectivity
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What Is Covermymeds?
CoverMyMeds is a health information technology company that provides electronic prior authorization (ePA) solutions to automate and simplify the PA process. The platform facilitates electronic transmission of PA requests from healthcare providers to health plans for review and approval.
Key features of CoverMyMeds include:
- Electronic PA submission: Submit electronic PA requests directly to health plans. Eliminates faxes and phone calls.
- Real-time Benefit Check: Verify patient coverage and PA requirements before prescribing.
- Electronic PA Status: Get notifications when PA requests are approved or require additional info.
- Pharmacy PA Assistance: Helps patients get required medications by handling PA approval process.
- Integration with EHRs: Embed PA workflow directly in electronic health record systems.
Who Uses Covermymeds?
The CoverMyMeds network is used by over 1.7 million healthcare providers, 775,000 pharmacies, 700+ electronic health records, and 700+ health plans.
Major users include:
- Physicians: Obtain electronic approval for drugs requiring prior authorization during workflow.
- Hospitals & Health Systems: Check PA status and assist with approvals for medications after discharge.
- Pharmacists: Seamlessly integrate with PA approval process to reduce Rx abandonment.
- EHR Vendors: Incorporate CoverMyMeds API into EHR products for integrated PA workflow.
- Health Plans: Receive and process electronic PA requests instead of faxes and phone calls.
Pros And Cons Of Covermymeds
Pros
CoverMyMeds offers many benefits over manual prior authorization:
- Increased efficiency – Automates time-consuming paperwork and calls for providers
- Reduced delays – Real-time decisions enable patients to get meds faster
- Higher approval rates – Meds more consistently covered when appropriate docs provided
- Enhanced workflows – Integrates PA into EHR clinical and pharmacy workflows
- Improved transparency – Electronic tracking provides status visibility
- Greater eligibility accuracy – Integrates with benefits to verify exact PA requirements
Cons
Some of the potential limitations of CoverMyMeds include:
- Learning curve – Training required to adapt clinical workflows
- Startup costs – Expenses related to integration with health IT systems
- Network dependency – Platform relies on consistent internet connectivity
- Fragmentation – Many different payer platforms Vs. single centralized network
- Privacy risks – Transmission of patient data over networks
- Lacks prescriber authority – Cannot mandate payers to approve PAs that meet criteria
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Frequently Asked Questions (FAQ)
Surescripts operates the largest national network for electronic prescribing. It allows healthcare providers to electronically transmit prescriptions to pharmacies to improve safety, reduce costs, and enhance efficiency.
The major users of Surescripts are doctors, nurse practitioners, physician assistants, pharmacists, pharmacy benefit managers, EHR vendors, and other healthcare organizations. Over 1 million clinicians and 68,000 pharmacies use Surescripts for ePrescribing and medication history.
Yes, CoverMyMeds is a legitimate technology company focused on electronic prior authorization solutions. They partner with over 1.7 million healthcare providers, 775,000 pharmacies, 700+ EHRs, and 700+ health plans to automate and streamline the prior authorization workflow.
CoverMyMeds facilitates the electronic transmission and management of prior authorization requests between healthcare providers, pharmacies, and health plans. This eliminates paperwork, phone calls, and faxes traditionally required for the prior authorization process.
The Verdict
Both Surescripts and CoverMyMeds play important roles in streamlining healthcare processes through their respective e-prescribing and prior authorization platforms. Surescripts has a strong footing as the dominant e-prescribing network, connecting the majority of electronic health records and pharmacies in the U.S.
Its platform improves patient safety and reduces costs by enabling fully digital prescription writing and routing.
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However, it lacks robust prior authorization capabilities, which is where CoverMyMeds steps in. CoverMyMeds allows providers to electronically submit prior authorizations to payers and track their status, speeding up time-consuming medication approval processes.
While the two companies have differing core strengths, there is also some overlap in their offerings. Both provide access to drug formularies and prescription benefit information as well as medication history data.
Surescripts has made moves into the prior authorization space with Prior AuthHub while CoverMyMeds offers e-prescribing functionality integrated with its platform. This convergence shows the value of bringing together these interrelated capabilities within the prescription process.
Overall, Surescripts and CoverMyMeds are leaders in modernizing the prescription journey through technology. As healthcare organizations look to optimize efficiency, patient safety and cost savings, platforms like these will likely play an increasingly vital role.
The ideal scenario may be one in which e-prescribing and prior authorization are seamlessly integrated into provider workflows through a single system. While the two companies have taken steps in this direction, there is room for continued innovation and partnership to provide an end-to-end digital prescribing solution.