Beyond Prior Auth: Unlocking Medication Access and Affordability

Beyond prior authorization hurdles, patients often face a variety of barriers when trying to access essential medications. Learn how CoverMyMeds is helping to break down medication access and affordability barriers through our comprehensive suite of solutions.

Clay Courville
Clay CourvilleChief Product Officer
March 15th, 2024
Concentric circles in CoverMyMeds brand colors of orange, magenta and blue
CoverMyMeds is breaking down medication access and affordability barriers through our comprehensive suite of solutions.

With over 20,000 medications approved for marketing, the processes for delivering them to patients have grown even more complex.U.S. Food & Drug Administration, FDA at a Glance. Accessed Feb. 14, 2024. Prior authorization is just one stage of that complicated process we support, and the continuum includes coordination among many parties: payers, providers, pharma, pharmacies and, of course, patients.

We’re best known for revolutionizing the prior authorization process. Beyond simplifying this cumbersome process, CoverMyMeds has built an expansive suite of tech-enabled solutions drawing from our decades of experience to help solve the most common medication access and affordability challenges brands face.

Breaking down barriers

Medication affordability is one of the top barriers to patients getting the medicine they need – and staying on their prescribed treatment. A CoverMyMeds patient survey revealed that 60% of patients discovered their prescription cost more than expected, causing 1 in 4 patients to abandon their medication.CoverMyMeds, Patient Survey, 2022 We want to change that, and our solutions are tailored to make access and affordability options a seamless part of the process.

65% of patients have experienced at least a 24-hour delay to pick up their medication and 11% have waited a week or longer.

CoverMyMeds, Patient Survey, 2022

Whether the patient needs access to a common antibiotic or a complex chemotherapy medication, timing is vital in assuring patients have access to affordability resources that ensure an uninterrupted flow from prescribed to filled to secured. In fact, 65% of patients have experienced at least a 24-hour delay to pick up their medication and 11% have waited a week or longer.CoverMyMeds, Patient Survey, 2022

CoverMyMeds is dedicated to helping break down these access and affordability barriers throughout the patient journey. Ultimately, reducing time to therapy and helping to prevent prescription abandonment – whether due to cost or delay – means better outcomes for everyone, from the patient taking the drug to the developers bringing it to market.

We partner with pharma customers and brands of all sizes – and in all stages of a medication's life cycle – to help overcome challenges beyond the initial prior authorization requirement.

Bridging the affordability gaps

Even when prior authorization requests are approved, we know that many patients continue to face affordability challenges that prevent them from starting – or staying on – the therapy or medication they need.

Whether patients struggle to afford the high out-of-pocket costs associated with high-deductible health plans or can’t sustain the ongoing expense of vital medication for themselves or a loved one, we’re committed to help bridge those gaps, so patients stay on their treatment path.

Once the prior authorization request receives an approved determination, our suite of affordability solutions kick in. Whether it’s an automatic copay coupon card that’s seamlessly embedded into a network of 50,000 retail pharmacies or an enrollment-based copay card program with an at-will network and owned engagement platform, our affordability offerings can help patients afford the medications they need to live healthier lives.

We also understand that many patients rely on caregivers to pick up their prescriptions. With that in mind, CoverMyMeds works behind the scenes to help prevent caregivers from getting stuck in a funnel of approvals and appeals. This is particularly important when a time-sensitive, lifesaving treatment needs to be filled.

Simplifying and expanding hub services

Hub services are designed to centralize the myriad of aspects that complicate patients' access to their specialty therapies. But even then, these well-intentioned resources can be challenging to navigate for both patients and their providers. This represents yet another obstacle to accessible, affordable treatments – and is another part of our expanded, intuitive solutions.

Through our expansive industry connections, progressive technology solutions and human guidance provided in real-time by knowledgeable professionals, CoverMyMeds is better positioned to make hub navigation easier for providers.

On the patient side, complex therapies may require more than seamless automation and technology touchpoints. For those receiving specialty treatments and who are enrolled in our hub services, we offer valuable high-touch support services delivered by experienced, empathetic and skilled case managers who engage with providers and other care team members.

These interactions are critical components of a patient's treatment path and provide an understanding of the ongoing impact of complex therapies on a patient's quality of life – be it physical, emotional or financial.

Expanded access and affordability solutions

Drawing from our deep industry knowledge and experience, we also offer a broad scope of advanced patient support services and solutions:

  • Case management
  • Copay savings programs
  • Field-based reimbursement and access teams
  • Patient assistance programs (PAP) and support
  • Non-commercial pharmacy, direct-to-patient dispensing
  • Peer-to-peer clinical education through provider nurse educators
  • Virtual and in-home clinical services, nursing and education to support patient success

The results speak volumes: providers who utilize our solutions to enroll patients in hub services had 48% more return engagement than their peers.CoverMyMeds, data on file, 2022

Personalizing solutions for brands of all sizes

The endless spectrum of solutions and processes – tied to interfaces and interactions from all parties involved – is what makes healthcare access so complex.

Because pharma companies may manage various brands that vary in classification – from blockbuster retail to breakthrough emerging medications – our suite is built on the flexibility necessary to support the most common challenges they face regardless of the complexity of the brand’s patient journey.

Whether a patient is being prescribed an oral oncolytic medication or is immunocompromised and waiting to pick up an antibiotic they're not sure they can afford, we consider each milestone of the patient's journey. We approach those milestones focused on the goals of access and affordability, so your treatments are matched to patients without interruption or delay.

The takeaways

Over a decade ago, CoverMyMeds transformed the prior authorization process, replacing the time-consuming manual methods with a modern electronic version that has become the go-to solution for over 950,000 providers. But our journey didn’t end there.

We’re continuing to combine our industry-driven insights, advanced technology and human expertise to break down even more barriers for patients to help uncover the best possible outcomes.

Learn how our suite of medication access and affordability solutions can support pharma brands of all sizes.

Clay Courville
Clay CourvilleChief Product Officer

Clay Courville is the Chief Product Officer at CoverMyMeds.

  1. 1. U.S. Food & Drug Administration, FDA at a Glance. Accessed Feb. 14, 2024.
  2. 2. CoverMyMeds, Patient Survey, 2022
  3. 3. CoverMyMeds, data on file, 2022

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