Overview
Surescripts is the dominant US e-prescribing and medication-information network. Originally formed by the merger of RxHub and SureScripts, the company operates the pipes through which the vast majority of US electronic prescriptions travel — prescribers write in their EHR, Surescripts routes the order to the dispensing pharmacy, the pharmacy fills and dispenses, and dispensing events return back to the EHR for medication history. Surescripts also provides real-time prescription benefit check, prior-authorization-routing, medication-history lookup, and EPCS services for controlled substances.
The network's reach is effectively universal: approximately 1.2M prescribers, 100% of US pharmacies, and major PBMs and health plans participate. Annual transaction volume exceeds 20B across all services. For prescribers, Surescripts is typically invisible — the EHR's e-prescribing workflow routes through Surescripts without requiring provider interaction beyond medication selection and ordering.
Real-time Prescription Benefit (RTPB) is a key transformation in recent years. Rather than discovering copay and coverage issues at the pharmacy counter, Surescripts RTPB returns benefit information (member copay, coverage tier, step-therapy requirements, prior-authorization requirements) to the prescriber at the point of order selection. The information enables prescribers to select medications the patient can actually afford and that will not trigger PA friction, reducing downstream patient-access issues and medication abandonment.
EPCS (Electronic Prescribing of Controlled Substances) is Surescripts' compliance backbone for controlled-substance prescribing. EPCS requires two-factor authentication for the prescriber and a chain of identity-proofing requirements that have shaped the industry's implementation. Most states now require EPCS for all controlled-substance prescriptions; Medicare Part D also requires EPCS.
Medication-history lookup provides prescribers with a longitudinal view of a patient's medication history across pharmacies and payers. This is valuable at care transitions (hospital admission medication reconciliation, ED visits, new-patient establishment) where the patient's full medication history may not otherwise be accessible. The history is sourced from pharmacy fills and PBM data.
Prior-authorization routing through Surescripts connects EHR prior-authorization requests to payer/PBM systems for evaluation and determination. This functionality is growing and expected to expand under CMS-0057-F interoperability requirements.
For RCM and patient-financial workflows, Surescripts' real-time benefit information is increasingly feeding patient-cost conversations, financial-counseling workflows, and medication-access programs. The data quality has improved substantially over time though plan-specific gaps remain.
Mature RCM teams treat Surescripts as a lever rather than a report line. The practical move is to set a weekly delta target against the 90-day baseline and make Surescripts the headline metric a biller owner is accountable for, with pharmacy benefit manager and formulary as the second-tier drivers they report on beneath it. The trap worth naming is denominator drift — a change in payer mix, service line, or even calendar workdays can move Surescripts without any operational issue, so the monthly review should always include a volume-normalized cut alongside the raw number. Reviewers also recommend stratifying by top five payers, because a single payer's policy change will frequently distort an all-payer Surescripts reading.
Industry benchmark
Surescripts annual transaction volume: 20B+. E-prescribing market share: ~96% of US electronic prescriptions. EPCS adoption: ~99% of US pharmacies.
Worked example
A physician e-prescribes a diabetes medication during an office visit. The EHR queries Surescripts RTPB; the response indicates the patient's PBM requires step-therapy with a generic alternative before the branded medication would be covered. The physician switches to the generic alternative, avoiding pharmacy-counter friction and a likely PA denial.
Frequently asked questions — Surescripts
Is Surescripts a government agency?
No — Surescripts is a private company. It is effectively universal because of its market-leading network effect, not because of regulatory designation.
What is RTPB?
Real-time Prescription Benefit — returns coverage, copay, and PA-requirement information to the prescriber at medication selection. Enables informed medication choice before the patient reaches the pharmacy.
Does Surescripts handle prior authorization?
Increasingly yes — Surescripts provides PA routing connecting EHRs to payer/PBM systems. Expansion is expected under CMS-0057-F interoperability requirements.
Disclaimer
This glossary entry is operational reference for revenue-cycle and medical-billing professionals. It is not legal, clinical, or contractual advice. Industry benchmarks cite named public sources where available; always verify against the current guidance from the authority body before relying on a number in a contract, policy, or compliance filing.