Prior authorization remains one of the most administratively burdensome processes in healthcare and one of the most consequential.
Delays in getting medications approved mean delayed therapy, patient abandonment and clinicians spending hours on paperwork instead of care. For pharmacy leaders, AI-enabled prior authorization has emerged as one of the clearest opportunities to demonstrate measurable return on investment (ROI) while directly improving patient outcomes.
During a featured session at Becker’s Spring Chief Pharmacy Officer Summit in April, sponsored by Latent, three pharmacy executives shared how they secured organizational buy-in, implemented AI-enabled prior authorization and quantified the results.
All three health systems built their medication access programs in partnership with Latent. Below are four takeaways from their conversation.
1. AI as care infrastructure
For Joshua Weber, PharmD and senior director of ambulatory, retail and specialty pharmacy services at St. Luke’s Health System in Boise, Idaho, the pivotal moment in securing organizational approval came down to how the investment was framed.
His IT team was tasked with cutting operational expenses and his approach positioned Latent not as a point solution but as care transformation infrastructure tied to what St. Luke’s called “smart growth.”
“It’s not just an operational expense, it’s more of a care transformation infrastructure investment — and that’s how we pitched it,” Dr. Weber said. Mark Sullivan, PharmD and senior vice president and chief pharmacy officer at Vanderbilt University Medical Center in Nashville, Tenn. took a similar approach at Vanderbilt, presenting directly to the CEO, COO, CFO and revenue cycle lead with data showing labor savings and turnaround improvements.
To him, pharmacy could take on the prior authorization burden for the entire system, freeing clinicians to focus on patient care. Ryan Mezinger, RPh, senior vice president and chief pharmacy officer at MetroHealth in Cleveland, the ROI argument extended beyond financials to physician satisfaction and the data made the case.
Prior authorization had been the top-ranked service in MetroHealth’s prescriber surveys for three consecutive years. “My CEO is a doctor. She was a family practice doctor, and she absolutely loves it,” he said.
2. Clear results
All three panelists reported results that met or surpassed what they had projected to leadership. MetroHealth reduced average prior authorization turnaround time from one to two months down to two weeks, with submission time dropping from 25 to 30 minutes to under four minutes.
The organization has since reported zero denials attributable to missing or incorrect information. At St. Luke’s, Dr. Weber reported that the prior authorization queue dropped from roughly 2,400 cases to 600 in five months, a 72% efficiency gain. The team unlocked approximately $300,000 in annualized labor cost avoidance and generated what he described as close to a multi-million dollar net new revenue impact by routing more specialty fills back to St. Luke’s pharmacies.
Sullivan said Vanderbilt met its ROI targets from the start, with a recent bolus of 70 prior authorizations cleared in under an hour.
“The nice thing about this process is that they focus on figuring these problems out,” Dr. Sullivan said. “They come in and learn and understand your processes and understand the problems you’re trying to solve, really get you to that value quicker because of that focus.”
3. Redirecting capacity
A consistent theme across all three organizations was that AI doesn’t automatically create value — it creates capacity, and leadership decisions determine whether that capacity translates to ROI.
At MetroHealth, the prior authorization team expanded its scope to cover financial assistance, specialty infusions and oncology infusions. The system has provided $50 million in copay assistance and achieved a specialty fill capture rate above 85%, up from a team that previously had little direct patient contact. At St. Luke’s, Dr. Weber restructured roles so staff previously focused on transactional prior authorization work were redeployed to direct patient engagement and connecting them with their pharmacies.
“It’s magical because people are used to waiting 14 days or longer,” he said. “They never get the therapy their doctor wrote. Now we can tell them we can get this done in three days.”
Mezinger emphasized that the goal was never to eliminate jobs but to eliminate vacancies. “Anything I do with AI, I’m not looking to replace FTEs. I’m looking to replace the openings we’ve had for three months that we cannot find.”
4. ROI is multidimensional
Panelists agreed that organizations evaluating AI should not reduce AI ROI to a single financial metric. Mezinger cited A1C reductions in patients on GLP-1 medications and outcomes data that helped MetroHealth fall below CMS benchmarks for the first time. Dr. Weber tracked net promoter score alongside financials, seeing a 6 percentage point jump since implementation.
He also described plans to surface prior authorization data to flag individual clinic first-pass approval rates, which have already improved by 7 percentage points. For health systems that carry payer risk, Dr. Weber noted that adherent patients generate lower total cost of care on a per-member per-month basis, a metric that strengthens payer negotiations and specialty pharmacy access.
“If we can show that pharma spend might increase but total overall care drops, that’s been successful for us,” he said. Dr. Sullivan also emphasized that pharmacy-led prior authorization creates a standard level of care across the system and reduces cognitive burden for clinicians.
All three panelists emphasized expanding beyond prior authorization to include appeals, status checks and payer communications—ultimately moving toward autonomous submission. As Dr. Weber described it, the goal is a fully orchestrated medication access workflow, from reducing manual steps at prescribing to closing the loop with automated notifications, with human input reserved for complex cases.
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