It saves a ton of time for pharmacists, doctors and even the insurance plans to help get prior authorizations process quickly, efficiently and my personal favorite electronically.

I reached out to the company and asked if I could share their story with you.  Here is their answers to my burning questions.

What is CoverMyMeds?

CoverMyMeds is a health care IT company operated in Cleveland and Columbus, Ohio and one of the fastest growing health care technology companies in the U.S., integrating directly within prescriber and pharmacists’ existing workflow. We help patients get the drugs they need to live healthy lives by automating the medication prior authorization (PA) process, saving health care professionals valuable time and reducing prescription abandonment.

A prior authorization is essentially a permission slip from a patient’s health plan to go ahead and fill a specific medication prescribed by their doctor. Health plans use prior authorization to manage both care and cost.

Unfortunately, the process of prior authorization can be very time-consuming, requiring a lot of manual paper work and back-and-forth between the health care provider, pharmacy and health plan. That is where CoverMyMeds comes in. We provide a streamlined, electronic solution that connects the various stakeholders that participate in the process: pharmacists, prescribers, health plans. With the CoverMyMeds solution, it’s possible to receive real-time determinations and get patients out the door of the pharmacy with their medication in hand on their first trip. More transparency on behalf of the patient equals better medication adherence.

Who does CoverMyMeds work with?

• Pharmacies: The majority of prior authorization requests are still initiated in the pharmacy, so CoverMyMeds has integrated electronic prior authorization (ePA) functionality into nearly 47,000 pharmacies, giving pharmacists the ability to create a request with just the click of a button, as soon as they learn a PA is needed. Additionally, they can auto-fill important patient demographic information and send it directly to the prescriber for completion. This functionality significantly decreases administrative time for pharmacists, ensures more accurate data and most importantly gives them time back to spend with their customers.
• Prescribers/EHRs:  Doctors, nurses and their staff can use CoverMyMeds to continue a PA after it has been sent by the pharmacy. They also have the option of creating and submitting a new PA in the CoverMyMeds web portal or at the point of prescribing in their electronic health record system (EHR). If submitting through an EHR system, the prescriber will be alerted that the medication they are prescribing is going to require PA, and they can fill it out and often receive a real-time response. As with pharmacists, this reduces the administrative burden for prescribers, keeps them away from the phone and fax machines, and gives time back for patients. Providers using our solution successfully process more than 1.6 million PA requests every month.
• Health Plans:  Health plan integration of ePA functionality ensures all PA requests, regardless of how they are submitted (pharmacy, web portal or EHR), will be reviewed electronically. Plans can ensure the prescriber is being asked the appropriate questions for the respective patient/drug and eliminate the phone and fax back-and-forth. By establishing specific clinical criteria, they can auto-determine the outcome of a submission and provide prescribers with an answer in real-time.

How/why was it founded?

After frequently hearing the question, “Why won’t my insurance company cover my meds?” co-founders Sam Rajan and Matt Scantland (a clinical pharmacist and owner of a software company, respectively) sat down to brainstorm a better solution to the PA problem. They had both witnessed the problem of prior authorization, and the complexities it created for all stakeholders; mainly how terrible it could be for a patient waiting on their much-needed medication. Hence, they set out to create a “one stop shop,” so providers could standardize on CoverMyMeds for all their PA requests, regardless of plan or drug. Thus, CoverMyMeds was founded in 2008. CoverMyMeds became (and remains) the first all drug, all payer prior authorization platform.

Is it software or one on one help?

We are a software solution. By accessing CoverMyMeds through their pharmacy system vendor or using the free CoverMyMeds web portal, pharmacists and techs can initiate a PA request upon a PA-related claim rejection for any medication and for all plans, including commercial, Medicaid and Medicare Part D. Providers can access and complete the request through their own CoverMyMeds account. CoverMyMeds is also increasingly available within EHR system vendors, giving prescribers the option to submit a request at the point of prescribing, resolving the PA requirement before the patient reaches the pharmacy. If any issues arise, we have a dedicated support team of “PA Experts” available by phone or chat to provide one-on-one assistance.

How does it help the independent community pharmacy owner?

Community pharmacies likely are tight on time and resources and don’t have extra of either to spend on the phone, searching online for a specific form, faxing forms to the prescriber, etc. By using CoverMyMeds, the pharmacist and their technicians have access to our dashboard and the PA request is done in a couple clicks of the mouse with all forms needed at their fingertips..

Why is workflow efficiency important to community pharmacy?

Beyond the sensitivity to budget and manpower, maintaining their credibility and relationship with their customers is likely just as important. An improved workflow for PA ensures they receive the medication they need to be healthy, and that they understand why they may not immediately be getting the medication they were prescribed.

Do you have a training program to help maximize feature use?

CoverMyMeds offers regular webinars and individual demos whenever needed, and we have a team of dedicated support staff and account managers available to answer any questions a pharmacy may have about our solution.

What makes it different/better than the DIY approach?

Circling back to the administrative burden that PA causes in general. The archaic process of PA is finding a form online, printing it off, filling it out by hand, faxing it to a prescriber, faxing it to the plan, waiting for a response (and potentially having to fill out MORE information to get a favorable response), faxing back to the pharmacy and then finally filling the prescription. By using CoverMyMeds, everything is done electronically, the correct questions are asked immediately and a real-time response is often at hand.  It also increases transparency in the process and improves communication between the pharmacist, provider and health plan as the PA request status can be monitored throughout the process.

Why is promoting entrepreneurship in pharmacy important?

CoverMyMeds works with all sizes of pharmacies, from small, family owned businesses to large nationwide chains. We understand that the success of independent pharmacies is highly personal and the relationships between them and their patients are crucial, not to mention the importance of implementing processes that will maximize their bottom line. CoverMyMeds specializes in assisting pharmacies implement their PA solution whether through their pharmacy system vendor or directly with CoverMyMeds and offers free technical services to help them navigate through the process.

I want to thank CoverMyMeds for being on the blog today and for all they are doing to help advance the profession of pharmacy.

This new blog series focuses on tools that help community pharmacy implement and integrate enhanced patient services. 

The series is called the Community Pharmacy Toolkit…

Click here for past articles featuring Prescribe Wellness, Simplify My Meds, iMedicare and 340B Consulting.

Some of these tools focus on streamlining workflow, integrating new services,  improving interoperability, making for easier documentation or even just some services that I think are really cool.

If you’d like to stay up to date and be notified of each new article in this series, join our weekly Pharmapreneur Community Newsletter.