Innovation Spotlight

CoverMyMeds has a prescription for success

By
From the June 2014 issue of Columbus CEO

At CoverMyMeds, motivation often comes in the form of emails and calls from healthcare professionals who are grateful for the company’s service.

“We receive dozens of kudos from office staff weekly,” says Matt Scantland, co-founder of the technology startup that automated a paper-based system used for drug prior authorization. “We’ve heard stuff like, ‘This helps get the patients on the medications that they needed’ and ‘We just weren’t able to help these patients before.’ That’s really the most rewarding thing about the company.”

Scantland and fellow CoverMyMeds co-founder Sam Rajan sought to streamline the prior authorization process after discovering that the complexities of the traditional system led some patients to “abandon” or never take drugs that had been prescribed.

Drug prior authorizations historically required paperwork, faxes and phone calls—an inefficient and often frustrating process for physicians, pharmacists and patients. CoverMyMeds’ software offers a modernized system with a single, electronic workflow. The system provides medical offices and pharmacies access to thousands of prior authorization forms that can be completed online and quickly submitted to patient healthcare plans.

CoverMyMeds launched its beta program in 2009. Today, the Columbus firm’s software is used by most pharmacies in the U.S. and is gaining popularity in hospitals and medical offices, Scantland says.

“Just like the technology you use to pay your bills online or to book an airline reservation saves time on the phone, we do the same thing for prior authorization,” he says. “We’re turning what used to be a 20-minute process for the provider into a two-minute process.”

The service is free to physicians, pharmacists and patients; health plans and pharmaceutical companies each pay to support the service, Scantland says.

But it’s the patients who ultimately benefit because they’re going to obtain their medications faster, says Michael Bukach, media contact at CoverMyMeds.

“Let’s say you go to the doctor and she prescribes you a medication,” Bukach says. “You go to the pharmacy, you hand in your prescription. Nine times out of 10, you walk out with your prescription.”

Sometimes, however, prior authorizations are required beforehand. To a patient battling cancer, recovering from an organ transplant or undergoing treatment for HIV, for example, being off their prescribed medication is detrimental to their health, Bukach says.

“The process of the PA, sometimes it can take you an hour to get something back from them, sometimes it can take a week,” Bukach says. “They need those meds now.”

CoverMyMeds initially evolved from Scantland’s software consulting company, Innova Partners, which develops custom software for health insurance companies.

Scantland said his focus now is on CoverMyMeds.

“After building the consulting practice, we knew that we wanted to become more of a software product company,” Scantland says. “Consulting companies tend to turn into ‘staffing’ companies in order to grow, and we were more interested in having a tight-knit team. So we have been incredibly fortunate that our customers have helped us turn into a software product company.”

CoverMyMeds recently celebrated helping its nine millionth patient obtain prior authorization. The startup has surpassed 100 employees and is growing at a rate of more than 125 percent per year. Revenue is projected at roughly $50 million this year.

Last year, the company was ranked No. 96 on the Inc. 5000’s list of the 5,000 fastest growing private companies in the U.S. and was named the 8th fastest-growing healthcare company in the country.

“It's young, it’s vibrant and you can tell it’s a group of people who love what they do,” says Dave Scaglione, product manager for physician connectivity at Prime Therapeutics, a pharmacy benefit manager based in Minneapolis, Minn. “And, because they’re happy, their work shows that.”

Prime recently contracted with CoverMyMeds to launch an electronic prior authorization solution.

“I think all of us had been saying for many years, ‘We'd really like to make this paperwork process easier,’ ” Scaglione says.

CoverMyMeds’ one-stop system does exactly that.

“I come from an IT background—I'm a product manager by trade,” Scaglione says. “I've never really worked with a company that got something done so quickly and got it right.”