CoverMyMeds Prior Authorization

CoverMyMeds Prior Authorization is an electronic prior authorization (ePA) platform designed to streamline the process for prescription medications. It connects prescribers, pharmacies, health plans, and pharmacy benefit managers (PBMs) to facilitate electronic submission and resolution of prior authorization requests.

This tool is primarily for healthcare providers and pharmacies across various specialties and care settings who prescribe or dispense medications requiring prior authorization. It is widely used by over 950,000 providers and integrates with more than 350 EHR systems and 50,000 pharmacies. CoverMyMeds handles prior authorizations for drugs covered under the pharmacy benefit, including specialty medications, and works with all health plans and PBMs, including Medicare Part D and Medicaid.

Within a clinical or practice workflow, CoverMyMeds allows healthcare teams to initiate and submit ePA requests directly from their EHR or the CoverMyMeds portal. Pharmacists can also initiate requests at the point of claim rejection. The platform routes requests to the appropriate plan or PBM, receives clinical questions, and returns decisions electronically, replacing traditional fax and phone methods. Notable capabilities include:

• Automated Requirement Checks: The system can validate procedure code and payer requirements within the EHR workflow.
• Electronic Submission: It automates the submission of PA requests using APIs and AI-based technology.
• Real-time Status Monitoring: Provides notifications and updates on authorization status.
• Connected Workflows: Integrates with Real-Time Prescription Benefit and Enrollment Services.
• Automated Documentation: Saves coverage eligibility, cost estimates, and authorization documents into the EMR/PM system.
• Support for All Drugs and Plans: Handles prior authorizations for all medications, including specialty drugs, and all health plans.

Reviewed by Pouyan Golshani, MD — Interventional Radiologist