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Integrated ePA functionality for EHRs

CoverMyMeds’ ePA Now product integrates with EHR systems to power electronic prior authorization (ePA) functionality at the point of prescribing. It is the best way to add an NCPDP-compliant ePA solution to your E-Prescribing experience.


Pharmacy Integrations

While it won’t be the case forever, today nearly all PA requests begin following a claim rejection at the pharmacy. Our network of more than 49,000 pharmacies turns these claim rejections into PA requests in your workflow, rather than phone calls and faxes to your customers.

Works With All Plans

CoverMyMeds is the leader in ePA integration with payers, and our Universal Last Mile ensures that your ePA solution works for all plans, not just those that support ePA.

Best Financial Model

With the right partner, ePA is a significant revenue opportunity for EHRs. CoverMyMeds’ financial model makes the service free to providers, and pays the EHR a significant setup and per-PA transaction fee.


Are you a developer? View our ePA API »


Compare us to the competition

We will update with any information competitors can provide.
Functionality CoverMyMeds Competition
Free for providers and their staff Yes No
Universal compatibility with all plans Yes No
ePA connections Yes, Caremark, Prime, Humana, Aetna, US Script, HCSC, OptumRx, Express Scripts Yes, Caremark
Connects retrospective PAs from pharmacy to EHR Yes, more than 49,000 pharmacies No
Proven experience Yes, 7+ years, 20M+ PA requests, and only ePA solution operating at scale No
Open API Yes, REST and NCPDP messaging APIs, published and available to use right now No
Available integration for payers and EHRs Yes, 2-6 months Yes, 12-24 months
Positive financial model for EHRs Yes, implementation incentive and significant per-PA transaction fee paid to EHR No, Certification cost for EHR

Resources

Learn more about the successes and innovations of CoverMyMeds technology.

BLOG: Electronic Prescribing And Electronic Prior Authorization – Key Differences You Need To Understand Read More »
BLOG: WRS Health Partners Releases CoverMyMeds’ Electronic Prior Authorization Functionality To EHR Customers Read More »
BLOG: 2016 Proving Excellent Year For Industry Legislation Read More »


Integrated EHRs
CoverMyMeds integrates with the following companies to bring electronic Prior Authorization to more than 500 EHRs.
DrFirst-Oneliner-Navy DrFirst-Oneliner-Navy
ipatientcareEpic SystemsModernizing Medicine

Top FAQs for EHR Vendors


EHRs and E-Prescribing systems can integrate with CoverMyMeds to support both the “prospective” ePA process at the point-of-prescribing and the “retrospective” ePA process that occurs after a pharmacy claim rejection.

Integration is accomplished using the NCPDP ePA four-part XML standard, or our open REST API. Both integration methods:

  • Support the NCPDP ePA standard
  • Work for all plans, not just those that support ePA
  • Turn PA faxes and phone calls from more than 80% of US pharmacies into a task list in your system

Our ePA Now program provides extensive developer and operational support and a meaningful financial incentive for participating EHR vendors.

If you’re a prescriber looking to request an integration between CoverMyMeds and your EHR, we can help. Visit our EHR request page to submit information.

  • CoverMyMeds supports all plans, even those that don’t yet do ePA. This is important because providers want an all-payer solution.
  • Our pharmacy network takes claim rejections in the pharmacy and turns them into ePA transactions in the EHR workflow. This saves a massive amount of phone calls and faxes your provider customers will otherwise receive.
  • CoverMyMeds provides the ePA service for free to users, and pays the EHR a very significant revenue share. Most EHR vendors are surprised how much revenue they can earn by supporting ePA through CoverMyMeds.

See the full comparison chart on this page, or contact us to get a revenue share estimate for your system.


Fixing PA is an opportunity to reduce a big source of administrative waste and suboptimal health outcomes:

  • PA is responsible for prescription abandonment rates between 40 and 70% (Hansen et al, JMCP, September 2009; Belazi, AJMC, June, 2013).
  • An average of 8 hours-per-week is spent per-physician dealing with PA requests (Health Affairs, Vol. 28 No 4, August 2009).
  • 91% of physicians say that “PAs are frustrating” (National Council for Prescription Drug Programs (NCPDP) ePA Task Group, 2011).

Beyond solving for administrative waste and improving health outcomes, ePA legislation is requiring some prescribers to access an electronic solution. In states where ePA is required, prescribers will look to their EHR to facilitate the process.

To confirm that PA is a big deal for your customers, CoverMyMeds can conduct an “overlap analysis” with our customers to let you know how many of them are already using CoverMyMeds to automate their PA process.


That depends entirely upon your organization, but two to six months is typical. While we support the raw NCPDP messaging formats, the fastest way to connect is to use our REST API. This allows you to control the entire user interface without needing to handle as much work.

We encourage potential partners to have their developers check out the API and see what they think it takes to complete the integration. Because this is an open API, you may actually begin developing against it without talking with us. Most organizations find it to be much faster than they expected.


We integrate electronically with plans that represent 80% of U.S. prescription volume and support the rest through our Universal Last Mile service. This service allows us to connect to any plan using their drug-specific paper PA forms while maintaining an electronic experience for the provider and pharmacy.

When we connect in a two-way communication with the plan, the plan lets you know when your PA is approved right inside the workflow, sometimes in real-time. So far, we are seeing real-time approvals approximately 30 percent of the time; however, this rate is increasing rapidly and should eventually approach the overall approval rate for all PAs (60-90%).

We connect to plans that represent 80 percent of U.S. prescription volume. You can see our full ePA payer list.


Pharmaceutical manufacturers are interested in ensuring patient access for their medications. These organizations work with CoverMyMeds to reduce the chance that a prescription is abandoned after a claim rejection in the pharmacy, and to educate doctors and their staff about the opportunity to make their PA process more efficient.

Importantly, CoverMyMeds makes its service available for all drugs (not just those of sponsoring manufacturers), does not influence the prescribing decision of the provider, and does not share any Protected Health Information (PHI) with the manufacturer.

Much like the way we work with payers, the involvement of pharmaceutical manufacturers helps make it possible for CoverMyMeds to offer our service for free to pharmacies, physicians and their staff, and to pay transaction fees to vendor participants.