Our Prior Authorization platform is free for medical practices to use.
SamaCare earns revenue from drug companies by providing 1) premium services for contracted drugs and 2) data/insights.
First, we provide a set of premium services to the drug companies who contract with us directly. These include high-touch concierge prior authorization support for brands that work with us, as well as integrated benefit verification and denials assistance within the platform. When we partner with drug companies to offer these premium services for their brand, we’ve been able to demonstrate a 70% reduction in the time-to-approval as well as a 20% increase in Prior Authorization (PA) approval rates. This also has the positive (and free) effect of helping patients who need access to life-changing therapies, and helping the practices who serve those patients.
Second, we provide de-identified and aggregated data to drug companies, which they use to identify obstacles that hinder patient access to the drugs they manufacture.
This revenue stream allows SamaCare to keep investing in the platform and furthering our mission of eliminating the administrative hassles that harm the quality and timeliness of patient care.
We share data — stripped of patient and prescriber identifiers — that helps drug companies locate and alleviate insurance-related obstacles to patient care.
This data includes:
SamaCare does not share prescriber-level data with drug companies (or any other third parties).
We aggregate data at the practice level, so drug companies are not able to identify individual prescribers in our data. The one exception is for practices with a single prescriber.
Drug companies value this data because it helps them prioritize the best ways to make their drugs easier and more likely for patients to access.
To get new therapies to market, drug companies typically spend billions of dollars upfront on research, development, and marketing. When administrative barriers such as prior authorizations delay or ultimately prevent a patient from getting onto a drug prescribed by the physician, that results in significant lost revenue — and lost profit — for drug companies.
Using SamaCare’s data, drug companies are able to identify where payer policies or actions cause delays or denials to treatment. While drug companies receive other forms of prescription data elsewhere — SamaCare does not sell prescription data — they are often blind when it comes to prior authorization obstacles. For example, some payers may have one state policy for a drug prior authorization requirement, but adjudicate it differently in the real world. Other insurance companies may have a very low approval rate for a drug, or a very long time-to-approval. Drug companies can use SamaCare’s data to identify these obstacles and address them in at least two ways:
SamaCare’s data enables drug companies to serve as a counterweight to payer policies that restrict patient access and stymie provider reimbursement.
Any single practice, even one with a large regional presence, only covers a small part of each payer’s total insured population. As a result, few practices have the breadth of data or the national presence to convince the largest payers to change their policies. Drug companies, on the other hand, have a national presence with teams dedicated to working with payers, along with a depth of resources to push back against overly onerous utilization management. What they need — and what SamaCare provides them with — is the data to help them focus their people and resources on the most urgent obstacles to patient access. This ultimately benefits patients and providers by improving access to those drugs.
SamaCare does not sell data that sales reps can use to market to prescribers.
We provide aggregated data to drug companies for access-related purposes, not data that can be used by sales reps to market to prescribers. Our data is not made available at the granular level of individual prescribers. Additionally it is focused on access and reimbursement-related queries, such as average turnaround time, and only provides visibility into the drugs that require authorizations. The result is that a sales rep is not able to use the data to identify or sell against an individual prescriber’s drug utilization patterns.
While drug companies can sometimes obtain individual prescriber-level utilization data from other sources — e.g., CMS, data companies like IQVIA or Symphony Health, etc — SamaCare does not provide that kind of data.
The data SamaCare provides is valuable to drug companies because our PA platform structures and aggregates nationwide data in real-time.
Without a platform like SamaCare, it would be challenging to create data that is structured and granular enough to measure metrics such as average payer turnaround time or approval rate for a specific drug-plus-indication, or the means to provide this data in real-time. The use of SamaCare structures this very granular data and allows it to be reported out in real-time. SamaCare provides this data — structured, aggregated across thousands of physicians across the country, and in real-time — to drug companies so they can immediately take action to improve patient access to their drugs.
SamaCare does not charge medical practices to use a software platform that thousands of physicians find useful for streamlining a painful and financially-risky administrative process; in exchange, we retain a right to use de-identified data as described above.
SamaCare reports back practice-level data that practices use to improve internal operations as well as to identify and effectively respond to difficult payers.
SamaCare provides automated weekly reports showing practice-, physician-, location- and user-specific data. Practices have used this data to reduce turnaround times, measure performance of specific team members and locations, and identify areas for improvement. Some practices have also used this data to successfully push slow or challenging payers to improve their prior authorization adjudication processes.
In the near-future, SamaCare is adding blinded regional and national benchmarking data to these weekly reports. This will enable practices to gauge how they are performing against other practices in their specialty.
We use a method known as the HIPAA Safe Harbor Provision to de-identify data shared with drug companies. In fact, we are more restrictive than HIPAA allows, because we do not share prescriber-level data. To maintain HIPAA compliance, we utilize enterprise grade security measures, including encryption at-rest and in-transit, advanced intrusion detection, and many other strategies to ensure data security.