Advocate Health's AI-drafted prior authorizations cut pharmacy staff time from up to 25 minutes to about 5

What the agent does

Prior authorization means getting a payer's approval before a prescription is covered. Payers send questionnaires. Before, Advocate Health pharmacy staff wrote the answers by hand, often over phone and fax.

Now an AI tool inside Epic, the health record system, pulls clinical facts from the patient's record and drafts answers that match the payer's questions. Pharmacy staff review the draft and submit it.

What happened

Advocate piloted the tool in some areas, then expanded it to specialty, outpatient and centralized retail pharmacy. As reported, the time per request fell from up to 25 minutes to about 5, and requests reach payers about one day sooner on average.

What to copy

• Start with forms that ask for facts already in your records.
• Let the AI draft, and keep a person as the one who submits.
• Pilot in one area, then expand.

Starter prompt

Written by us, not by Advocate Health or Epic. Use only with approved, compliant tools for patient data.

Payer questionnaire: {questions}
Patient record excerpts: {record_excerpts}

For each question, draft an answer using only the record.
Quote the record line you used, with its date.
If the record does not answer a question, write "NOT FOUND - staff to complete".
Do not guess clinical facts.