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Payer Solutions 

Helping payers move therapies more efficiently

At CoverMeds, we understand that access and affordability can create seemingly insurmountable barriers to therapy for patients. Our solutions help payers reduce labor inefficiencies, operational costs and accelerate therapy starts.

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The challenge

Payers face multiple challenges in managing healthcare delivery. They are tasked with optimizing patient outcomes and controlling costs, while navigating complex regulations to maintain compliance. The data and analytics they have access to are often fragmented, limiting their ability to make well-informed decisions quickly and effectively.

Reduce time spent on prior authorization requests

CoverMyMeds' suite of electronic prior authorization (ePA) solutions helps payers expedite the medication PA process, resulting in operational cost savings and faster time-to-therapy.

  • Enhanced operational efficiencies

    Our technology-based solutions help empower payer staff to more easily and effectively process claims.

  • Support formulary compliance 

    We can assist payers with getting their members on compliant therapy seamlessly through real-time pharmacy benefit solutions.

  • Empower providers

    Our solutions support the delivery of payer-provided therapeutic alternatives along with their costs and alerts to assist providers and patients with prescription decisions.

  • A smoother appeals process

    Optimize the appeals process with operational efficiencies that relieve payer teams of manual processes, ultimately reducing delay-driven prescription abandonment.

  • Improved member satisfaction​

    Intelligent workflows help payers deliver faster, clearer decisions— relieving manual processes and driving better member experiences.

  • Better member experience

    Our solutions provide notifications at the point of prescribing, allowing providers to select the most cost-effective drug or one that doesn’t need a prior authorization.

A streamlined, integrated PA process for stakeholders

See the start-to-finish PA process from CoverMyMeds.

Illustration of a blue prescription with a magenta check mark overlaid
Provider and pharmacy-led PA initiations are accepted

Our technology supports requests across most health plans and PBMs; specific payer connectivity may vary.

    An illustration that depicts three blue circles in a horizontal line connecting to one pink arrow
    Automated workflows streamline once-manual tasks with transparency

    Provider-led:

    • Provider anticipates PA need
    • Provider starts PA on CoverMyMeds portal
    • Provider picks PA form
    • Provider submits PA

    Pharmacy-led:

    • Pharmacy runs claim, gets rejection
    • Pharmacy creates PA
    • Pharmacy sends initial PA request to provider
    • Provider receieves pharmacy-led PA request and submits
      Illustration of a blue gear surrounded by a magenta arrow
      Continued workflow automation leads to determination, or instructions sent to payer for follow up
      • Provider submits prescriber, drug and patient info
      • Provider receives question set(s) from payer
      • Provider submits responses to clinical questions
      • PA determination
      • PA sent to payer via e-fax: requires manual payer responses
        Illustration of a blue bell
        PA outcome is one of three results

        PAs are approved, denied or sent to payer for more information. Extends electronic processing to PA renewals and even denials, streamlining the entire lifecycle of a PA.

          Illustration of a blue prescription with a magenta check mark overlaid
          Provider and pharmacy-led PA initiations are accepted

          Our technology supports requests across most health plans and PBMs; specific payer connectivity may vary.

            An illustration that depicts three blue circles in a horizontal line connecting to one pink arrow
            Automated workflows streamline once-manual tasks with transparency

            Provider-led:

            • Provider anticipates PA need
            • Provider starts PA on CoverMyMeds portal
            • Provider picks PA form
            • Provider submits PA

            Pharmacy-led:

            • Pharmacy runs claim, gets rejection
            • Pharmacy creates PA
            • Pharmacy sends initial PA request to provider
            • Provider receieves pharmacy-led PA request and submits
              Illustration of a blue gear surrounded by a magenta arrow
              Continued workflow automation leads to determination, or instructions sent to payer for follow up
              • Provider submits prescriber, drug and patient info
              • Provider receives question set(s) from payer
              • Provider submits responses to clinical questions
              • PA determination
              • PA sent to payer via e-fax: requires manual payer responses
                Illustration of a blue bell
                PA outcome is one of three results

                PAs are approved, denied or sent to payer for more information. Extends electronic processing to PA renewals and even denials, streamlining the entire lifecycle of a PA.

                  Drive a lower cost of ownership

                  Our payer solutions start with a focus on prior auth requests, but we’re always working to develop solutions that keep pace with the ever-evolving healthcare policies and processes that can impact a patient's experience.

                  It makes sense to prioritize prior authorization

                  With technology on your side, you can stay on top of managing costs with fewer prior auth hassles.

                  • 60%

                    of prior auth requests

                    More than 60% of prior auth requests can be processed in less than two hours by leveraging automation technologies.

                    Illustration: More than 60% of prior auth requests can be processed in less
than two hours by leveraging automation technologies.
                  • 50%

                    of manual prior auth tasks

                  • 80%

                    of prior auth claims

                  Join the payers representing 96% of prescription volume with CoverMyMeds today. 

                  Contact our payer team

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