- Who We Serve
- /Payer
- /Medical Benefit Prior Auth for Health Plans and PBMs
The fastest path to scalable medical prior auth (PA) connectivity
Fragmented systems. Manual processes. Growing pressure to modernize medical PA workflows. CoverMyMeds unifies medical and pharmacy PA in one workflow — with the provider network already embedded in the systems your care teams use every day.[0][0] One connection for policy-mapped submissions that are measurable from day one. Built to fit your ecosystem, not replace it.
Validated medical PA outcomes with minimal IT lift
These are the results health plans see when clean, policy-mapped medical PA submissions arrive through CoverMyMeds.[0] Not projections.
Approval rate[0]
Medical PA approval rate observed in a specific FastAuth dataset (USON, March 2026). Results vary by plan and therapy category — but this is what clean, policy mapped submissions make possible.
Same-day outcomes[0]
Share of Medical PAs reaching a same day determination in the same FastAuth dataset — reducing back-and-forth and accelerating time to care for your members
Decided in 7 days[0]
Medical PA outcomes within seven days — the standard turnaround target under the CMS-0057-F rule taking effect January 1, 2027
Built for the people who own medical PA
See how CoverMyMeds supports the teams responsible for a successful implementation.
Cleaner intake. Fewer touches. Consistent, defensible decisioning.
Your reviewers waste time chasing missing info. CoverMyMeds fixes the top of the funnel: submissions arrive mapped to your policy with coverage rules, PA requirements, formulary, step therapy and needed documentation surfaced before submission.[0] Fewer denials, fewer appeals, faster decisions and audit‑ready submissions aligned to CMS‑0057‑F.[0][0]
Reduce operational drag and free your team for the work only they can do
Manual medical PA costs $3.41 and 24 minutes per case — time you can’t recover.[0][0] CoverMyMeds reduces intake burden with complete, validated first‑submission documentation and fewer status calls.[0][0] Providers save 13 hours weekly, and automated PAs save 14 minutes each.[0][0]Your team shifts from admin exceptions to high‑value clinical work while compliance readiness comes built in.
One integration. FHIR-ready structure. No rip-and-replace.
You don’t need another point solution. CoverMyMeds plugs into your ePA API, submits structured PA requests mapped to your policy, and keeps your vendors and teams in place.[0] Submissions are FHIR‑compatible for CMS‑0057‑F.[0] We’re SOC 2/HITRUST‑aligned with minimal IT lift.[0] One connection reaches 1M+ prescribers across 350+ EHRs.[0] We support CRD, DTR, and PAS as they mature.[0]
A complement to your stack — not another vendor to manage.
CoverMyMeds fits into your existing PA ecosystem, integrating with current vendors through one connection.[0] Submissions flow cleanly into your decisioning workflow.[0] We’re the only partner supporting pharmacy + medical PA across the full access journey.[0] We complement aggregators and PBMs by extending provider reach, not competing.[0]
Cleaner intake. Fewer touches. Consistent, defensible decisioning.
Your reviewers waste time chasing missing info. CoverMyMeds fixes the top of the funnel: submissions arrive mapped to your policy with coverage rules, PA requirements, formulary, step therapy and needed documentation surfaced before submission.[0] Fewer denials, fewer appeals, faster decisions and audit‑ready submissions aligned to CMS‑0057‑F.[0][0]
Reduce operational drag and free your team for the work only they can do
Manual medical PA costs $3.41 and 24 minutes per case — time you can’t recover.[0][0] CoverMyMeds reduces intake burden with complete, validated first‑submission documentation and fewer status calls.[0][0] Providers save 13 hours weekly, and automated PAs save 14 minutes each.[0][0]Your team shifts from admin exceptions to high‑value clinical work while compliance readiness comes built in.
One integration. FHIR-ready structure. No rip-and-replace.
You don’t need another point solution. CoverMyMeds plugs into your ePA API, submits structured PA requests mapped to your policy, and keeps your vendors and teams in place.[0] Submissions are FHIR‑compatible for CMS‑0057‑F.[0] We’re SOC 2/HITRUST‑aligned with minimal IT lift.[0] One connection reaches 1M+ prescribers across 350+ EHRs.[0] We support CRD, DTR, and PAS as they mature.[0]
A complement to your stack — not another vendor to manage.
CoverMyMeds fits into your existing PA ecosystem, integrating with current vendors through one connection.[0] Submissions flow cleanly into your decisioning workflow.[0] We’re the only partner supporting pharmacy + medical PA across the full access journey.[0] We complement aggregators and PBMs by extending provider reach, not competing.[0]
Connectivity that fits your ecosystem
Four steps from signed agreement to structured, policy-mapped medical PA submissions arriving in your existing workflow. Your teams stay in charge of decisioning. We handle the provider-side complexity.[0]
Step 1: You share your medical policy and API access. We map your rules — coverage, PA requirements, documentation, routing.
Step 2: Activate connectivity through a provider network of 1M prescribers already embedded in existing clinical workflows, helping accelerate adoption.[0]
Step 3: Providers submit through the workflows they already use. Submissions arrive pre-validated and pre-mapped to your policy.[0]
Step 4: Your team decisions cleaner requests, faster. Real-time status flows back to providers, reducing inbound inquiries.[0]
Capabilities designed to support scalable medical PA operations
Here's what makes CoverMyMeds different — grounded in what matters most about scaling medical PA readiness.
Real-world proof from oncology
Oncology is a top-five category of payer spend – and the ideal place to prove medical PA impact. Through the US Oncology Network, structured PA is already flowing.[0]
Payer-ready oncology infrastructure
The US Oncology Network is the largest independent community-based oncology network wholly dedicated to quality cancer care. Through CoverMyMeds, oncology PAs flow through structured, electronic channels — no provider recruitment required on your side.[0]
2,700
600
Your oncology PAs can flow through structured, electronic channels from day one — no provider recruitment required on your side.ref
Payer insights
Your path to medical PA starts here — streamlined, connected, built for what plans need
Request a meeting to see how our solution fits into your existing ecosystem, and walk through real workflows tailored to your organization.