Health IT, Startups

5 companies that want to take the time suck out of prior authorization requests

With PriorAuthNow’s fundraise to make a dent in the ginormous time-suck of prior authorization requests, here are four other companies trying to make a difference in this health IT subsector.

The prior authorization process is a frequent, time-consuming process for physicians. A survey of 1,000 physicians revealed they made prior authorization requests 37 times per week on average, according to data from the American Medical Association. About one-fifth of the survey participants said it takes 20 hours to do these requests each week. It’s no wonder small and large health IT vendors see opportunities to use technology to create a more efficient workflow.

One of the best and most recent examples for the opportunity health IT vendors see in this market is the huge acquisition of CoverMyMeds earlier this year.

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A Deep-dive Into Specialty Pharma

A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.

PriorAuthNow closed a $3.6 million round this week to add to its staff and roll out its prior authorization tool to health systems. The Columbus-based company even hails from Ohio, the same state as CoverMyMeds. Its focus is speeding up the process of connecting hospitals with health insurers to check whether procedures and certain drugs are covered by patients’ insurance plans. Prior Auth Now’s product is designed to work within electronic health records, according to a news release. NCT Ventures led the funding round with involvement from Detroit Venture Partners.

Another health IT startup with a product that includes prior authorization in its wheelhouse is Klara. The clinical messaging platform, which raised $3 million in seed stage funding last year, is intended to improve communication between patients, their physicians, and insurers. In an interview last year, cofounder and managing director Dr. Simon Lorenz said it wanted to connect everyone who has a role in taking care of a patient, including primary care physicians, specialists, clinical and office staff, insurance companies, care coordinators and patients.

“The better the prior authorization, the more likely prescriptions will be filled,” Lorenz said.

Klara has integrated with health IT vendors, most notably Epic Systems, and is in the process of integrating with others to allow authorized users to read and share clinical notes, schedules and patient-specific information through the platform.

ZappRx, which focuses on specialty drugs, is also trying to improve the prior authorization process. Its initial focus is pulmonary arterial hypertension but it also plans to expand into drugs for rheumatology, neurology, oncology, and gastroenterology.

CenterX is another business that has prior authorization as part of its product offer but with a medication adherence component. It gives doctors out-of-pocket cost information so patients are armed with accurate information for their prescription therapy plan. It is also designed to work easily with electronic health records by using data from EHRs to alert patients when electronic prior authorization is needed. It also is intended to eliminate prior authorization requests with missing data that are required.

Although it’s not prior authorization per se, InteliSys Health wants to make drug prices more transparent so physicians and patients can have meaningful conversations about choosing a medication that is within patients’ budget range. The idea is that if patients know they can afford the drug they will be more likely to pick it up from the pharmacy and that can offer a meaningful way at reducing one of the many reasons for poor medication adherence.