A new partnership with a company that bills itself as having the most broad-reaching healthcare communication network in the country could increase health IT startup CoverMyMeds‘ health insurance customer base.
Cleveland-area CoverMyMeds (CMM) has developed Web-based tools that speed up and automate the submission of prior authorization requests to health insurance plans. Insurers sometimes require these requests and other coverage determination forms to be submitted before approving a doctor’s order for a patient’s prescription.
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CMM recently entered a partnership with NaviNet, in which CMM’s prior authorizations software will plug in to NaviNet’s communications network, which conveys information between health insurers, health providers and pharmacies.
The result of the partnership is a multipayer platform that will allow health providers to respond to electronic prior authorization requests generated through most U.S. pharmacies. The platform’s multipayer nature will make it easier and more efficient for physicians to “advocate” for the prescriptions they believe their patients need, said Sam Rajan, principal and co-founder of CMM.
“NaviNet brings big payers into the prior authorizations space,” Rajan said. “This partnership brings significant scale for us, as well as a platform to talk to payers.”
Big health insurers on NaviNet’s network include Aetna, Cigna, UnitedHealthcare and many Blue Cross plans.
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CMM already had some health insurance customers, but most of its customers base is made of drug manufacturers, which have an interest in increasing their sales by expediting the prior authorization process. CMM clients’ drug reps help promote the prior authorization service to doctors and pharmacies.
In addition to expanding CMM’s potential revenue stream from insurers, the NaviNet deals helps the company add to its physician and pharmacy user base, Rajan said.
“We view this as a significant opportunity,” he said.
CMM has seen its physician-user base explode in recent months, to about 330,000 physician users completing prior authorization requests, up from about 130,000 in September.
