Sam Rajan was working as a pharmacist for a pharmacy benefits manager (PBM) and frequently witnessed patients with major illnesses abandon their request for prescription therapy because they did not know how to complete prior authorization (PA). He spoke to patient support groups to understand the root cause. It was simple. They were frustrated because they thought that they did not have coverage. In response to their frustration, Sam co-founded CoverMyMeds in 2008, a pharmacy software company that streamlines the PA approval process.

Today, CoverMyMeds is the leader in electronic prior authorization (ePA), assisting physicians and pharmacists in completing PA requests for any medication and all health insurance plans online. Traditionally, this had been a laborious process involving phones and fax machines. Currently, the technology integrates with nearly 47,000 pharmacies, more than 500 electronic health record (EHR) systems and payers, which represent nearly 75% of U.S. prescription volume. With more than a million PA requests submitted through their portal monthly, CoverMyMeds is the only vendor using the ePA NCPDP SCRIPT Standard at scale.

Read the full story at PM360.