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.
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.
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 »
|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|
Learn more about the successes and innovations of CoverMyMeds technology.
Integration is accomplished using the NCPDP ePA four-part XML standard, or our open REST API. Both integration methods:
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.
See the full comparison chart on this page, or contact us to get a revenue share estimate for your system.
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.
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.
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.
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.