Solutions

Medication claim rejection

Helping patients leave the pharmacy with their therapy in hand, despite medication claim rejections.

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Pharmacist hands medication to their patient at the pharmacy counter.

The challenge

Prescription claim rejection barriers at the pharmacy, due to prior auth requirements or lack of formulary coverage, can lead to medication switching or patients abandoning their therapy. Without claim rejection solutions in place, pharmacies may not be able to dispense necessary medications and a patient’s originally prescribed therapy may be left at the pharmacy counter.

  • 80%

    of providers[0]American Medical Association, 2022 AMA prior authorization physician survey, Feb 2023

    80% of providers said issues related to prior authorization led to patient therapy abandonment.

    Illustration: 82% of Providers Said Prior Auth issues Led to Therapy Abandonment
  • 1 in 4

    Patients[0]CoverMyMeds Patient Survey, 2020

  • ~50%

    of patients[0]IQVIA Medicine Spending and Affordability in the U.S., 2020

Medication claim rejection solution benefits

With an optimized mix of technology-based access solutions that integrate directly into pharmacy and provider workflows, patients can get on therapies quickly and reduce abandonment.

  • Improved patient acquisition

    In-workflow solutions help enable patients to leave the pharmacy with their therapy in hand at an affordable cost following a claim rejection.

  • Fewer provider callbacks

    Auto-starting a prior auth request or auto-converting a denied claim to paid at the pharmacy helps eliminate back-and-forth between providers and pharmacies to determine next steps.

  • Prior auth support

    Integrated ePA solutions can send the provider a medication-specific, payer-specific prior auth request at the point of claim rejection to reduce delays and help establish patients with insurance complexities on their therapies.

  • Flexible & adjustable program design

    Claim rejection solutions are strategically designed based on common rejection codes to bolster patient support.

Care team members collaborating at a workstation reviewing an EHR dashboard.

Solution spotlight: Electronic prior authorization (ePA)

Our ePA solutions plug seamlessly into pharmacy and provider workflows to streamline the prior auth process and help patients start their originally prescribed therapy.

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  • 950,000+ providers, with 350+ EHRs integrated
  • 50,000+ pharmacies, inclusive of top 10 chains
  • 650+ brands across 95% of therapeutic areas Connect with our team to see how CoverMyMeds can help deliver comprehensive solutions to improve patient access, affordability and adherence.
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