CoverMyMeds is a company in a brilliant niche. ePA – Electronic Prior Authorizations.
Usually a doctor’s prescription reaches pharmacy, which informs patient when to pick it up. If the drug needs the insurance company’s authorization, it’s up to the Pharmacist to notice that and get authorization process started (includes paperwork, calls, faxes). Patient may not even find out till they arrive to pick up medication.
This messy cycle happens 200 million times a year in US, costing $20-30 Billions dollars annually. Cover My Meds offer APIs and widgets to digitize this workflow with all stakeholders.
For example, on payer side it can enable automated routing to staff queues acc. to rules, auto-determination for some, electronic notifications to prescribers, reporting, etc. For pharmacies it can alert pharmacists about PA need, kick off approval workflow digitally, etc. For patients it means less prescription abandonment.
Most fascinating aspect of Cover My Meds is its business model. It’s free for everyone who uses it. They make money by charging drug companies to pay for the service. Drug companies fund that from the revenue of what otherwise would have been unfilled prescriptions. That is a win-win all around… minimal barrier to adoption.
Cover My Meds started with a $250K seed in 2008. They were acquired by McKesson Corp. for $1.1B last month. A well-deserved unicorn exit in Health IT.