SamaCare is a tool that practices use to streamline the submission, tracking, and management of prior authorizations (PAs) for medical benefit drugs. SamaCare:
As a result, SamaCare practices often report spending up to half or even a quarter as much time working on PAs while also getting better visibility into the status of PAs across their practice.
Every practice that uses SamaCare has a dedicated account manager. Additionally practices can reach out to SamaCare via a live Support chat that is monitored Monday through Friday from 9am ET - 8pm ET.
SamaCare does not create prior authorizations on behalf of practices. SamaCare can help automate certain forms of data entry (e.g., patient demographics, prescriber information, practice information) and get the request to the payer, but practices still must fill out the PA request themselves.
Instead of replacing the PA process, SamaCare provides practices with a tool to improve the PA process.
There is no cost to practices to use the SamaCare system.
It depends on how quickly each practice can provide SamaCare with information needed; some implementations have taken as little as two weeks, though others take longer.
At the start of each implementation and as new users come onboard, SamaCare offers a live video-conferencing training session.
Supported Drugs are ones where SamaCare is working directly with the drug company to reduce the administrative issues that can result in delays and denials. SamaCare applies unique proactive and reactive measures to ensure that Supported Drug authorizations have the best odds possible of reaching patients who need them as soon as possible.
Practices can use SamaCare for prior authorizations for medical benefit drugs — as long as the drug has been on the market for at least 18-24 months. Beyond this, drug companies are beginning to partner with SamaCare to help further support PAs; in these instances, these drugs are considered “Supported Drugs”, which means that SamaCare has access to additional levers to help streamline the PA process.
SamaCare applies proactive and reactive measures to keep authorizations on track. These include:
Yes absolutely, practices can use SamaCare for all drugs, Supported or not. Most practices have found that even without this additional support, SamaCare vastly streamlines their PA process.
For drugs that are added as Supported Drugs, you will see the aforementioned features and support. For all other drugs, this will not impact your experience with SamaCare.
We work hard to help prevent prior authorizations from receiving avoidable administrative denials. That said, Supported Drug PAs may still be denied, for example for clinical or other unavoidable reasons.
No — SamaCare does not promote the use of any pharmaceutical product or particular treatment plan. All medication therapy and clinical decision-making shall be exclusively determined by the licensed prescriber.
All drug companies have the opportunity to work with SamaCare. SamaCare is actively working to partner with as many drug companies as possible to ensure that no patient has their treatment experience impacted because of a difficult prior authorization.