Failure to take prescription medications as prescribed or discontinuing prescription medications that are otherwise still needed is both dangerous and expensive. It’s dangerous – as patients put themselves at risk of serious complications related to their conditions. And it’s expensive because the cost of treating such patients down the road due to hospitalizations and additional disease complications runs in the billions of dollars according to some estimates.
But another significant concern with respect to patient adherence is the issue of prescription abandonment. This happens when a patient brings his/her prescription to the pharmacy and the claim is denied by the insurance due to either a Prior Authorization or Step Therapy requirement. At this point many things might happen. The patient might be instructed to contact their physician and/or insurance company. The pharmacy might try contacting the physician and/or insurance company. The claim might just sit in some sort of “rejected” status in the pharmacy claim system for days, weeks…or just simply get cancelled and placed on “hold.” The patient may just give up and not bother trying to pursue it. All these scenarios and many more, may lead to “prescription abandonment.”
CoverMyMeds.com is an effort to solve this problem of prescription abandonment. It was an honor to chat with co-founder Matt Scantland about their resource which is available for FREE to pharmacies and physicians looking to help improve patient adherence by getting rejected claims approved. I’m happy to introduce this service to my readers here at The Honest Apothecary.
1) Thank you for taking the time to talk with us here at The Honest Apothecary. So can you just explain to my readers what CoverMyMeds does?
Thanks so much for having me on THA!
CoverMyMeds helps physicians, pharmacists and their staff streamline the Prior Authorization for any drug and any health plan. We do this through our integrations with most pharmacy systems, and EHR systems at our website CoverMyMeds.com. Our service is 100% free for all providers.
2) How did the idea of CoverMyMeds come about? How long has the site been operating?
Back in the early years of Medicare Part D, my partner (Sam Rajan, a pharmacist) and I built the prior authorization system for a major plan. During this collaboration, we learned that the prior authorization process was causing prescription abandonment —a big problem for the health of the patients we all care about. We thought we should try to do something about it, and we did.
3) Can any pharmacy join and use this service, and what is the process like?
Any pharmacy can use the system, and it’s 100% free. The process is very similar to submitting a “coordination of benefits” claim — once you get a rejection, you just use your pharmacy system to resubmit the claim to us, and we start the process with the prescriber by electronically sharing the prior authorization so it can be completed and sent to the plan.
To get started, go to our website and click “Create an Account” from our homepage. If you need help, we have a great live support team.
4) As a pharmacist, I know the frustration of a claim that needs approval but sort of gets “lost in limbo” so to speak. The patient and pharmacy often don’t know where the request is at in the process. Does CoverMyMeds help solve that problem?
You’re right—it is this “lost in limbo” problem that causes pharmacies to lose these prescriptions, and patients to go untreated. CoverMyMeds provides a simple “PA dashboard” so our pharmacies can easily see where each PA is in the process.
5) Many pharmacies just call or FAX a physician when a PA is needed. How is the CoverMyMeds process better than that?
Calling or faxing can work for some pharmacies, but already, more than 30,000 (about half of all pharmacies in this country) have found our process to be much faster and more effective.
Just as the successful pharmacy has systematized their claims processing, they recognize that an automated prior authorization workflow allows them to save time while offering better service to patients and prescribers.
With e-prescribing, doctors have a bigger influence than ever on where the patient gets their prescriptions filled, and many of them actually send their patients exclusively to CoverMyMeds’ pharmacies so that the prior authorization process will work better.
6) Can either the pharmacy or physician initiate a PA request through CoverMyMeds?
Yes, that’s right. We allow the process to start in the pharmacy (after a claim rejection), or before the claim rejection by letting the prescribing physician’s office initiate the request. The doctor’s office can initiate the request from our website or in their e-prescribing / EHR system.
7) Time is a critical issue in many retail pharmacies. Some pharmacists may be wondering how much extra time it will take to utilize this service to initiate a PA. Could you comment on that?
We save pharmacists and staff an average of 3-6 hours a week per pharmacy. That’s time you’re not sitting on the phone, on hold, or sending/resending faxes, so you can concentrate on all of the other things you need to do to take care of your business and your patients.
8) Your website says that this service is free to pharmacies and physicians. Can you explain how CoverMyMeds generates income to be able to offer this valuable service?
We earn money from both health plans (PBMs) and pharmaceutical manufacturers. These companies are increasingly recognizing how damaging prescription abandonment is for their patients and their bottom line. It is hard to believe, but that is one of the things everyone can agree on when it comes to prior authorization.
Remember that our service works for all drugs and all plans-these organizations have recognized that a “universal” solution is needed to solve the problem and we have stepped into that position.
And we don’t ever share or sell patient data.
9) Are there any other things about CoverMyMeds which you would like our readers to know?
I just wanted to say thanks to all of the folks in the pharmacies and doctor’s offices that use our service. You’ve helped us build a great business and are doing a wonderful thing for patients.
The PA process is going to continue to get better—one major innovation we’re working on with the PBMs is a nationwide electronic standard for prior authorization called ‘ePA’, which allows PA requests to receive real-time approvals instead of waiting up to 72 hours for a response. We already have this live with Caremark and more are on the way.
10) Where can people go online to find out more about CoverMyMeds?
Check out our website at www.covermymeds.com.
Matt, I want to personally thank you for answering these questions about www.CoverMyMeds.com. For my readers who are pharmacists or technicians, I would recommend suggesting this free service to your pharmacies. And for my physician friends, I believe this system allows for a more transparent and traceable approach to following the approval process for your prescriptions.
©Jason Poquette and The Honest Apothecary. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Jason Poquette and The Honest Apothecary with appropriate and specific direction to the original content.
Last modified: April 17, 2023