SamaCare is a tool that practices use to streamline the submission, tracking, and management of prior authorizations (PAs) for medical benefit drugs. SamaCare:

• Gives practices a single website to submit medical benefit PAs, regardless of the payer or drug.
• Replaces a manual process that relies on hundreds of different fax forms, multiple payer portals, and disparate spreadsheets with a digital process.
  

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.

• SamaCare does not change a payer’s process for responding to a drug authorization request — instead, we work to ensure the payer receives the request in exactly the form they’re expecting it, meaning they’ll process it the same way they would if you do not use SamaCare.
• However, digitizing the response and providing a clear cover sheet can sometimes help payers respond more quickly.
• Additionally, a unified dashboard for PAs can help practices identify and address delayed requests more quickly.
• Finally as noted below, SamaCare Supported Drugs are resolved more quickly on average.

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.

You can reach out to join@samacare.com to get more information, or schedule a demo through the SamaCare website.

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:

• Pings to the payer to ensure: a PA request was received; that the payer has the information needed to adjudicate the authorization; and that a payer response has been communicated back to the practice.
• Live status updates that the practice can easily track to see communications to the payers, requests for more information, and updates on the status of each authorization.
• The ability for practices to request, with a simple click, additional support on outstanding prior authorizations.

• To reduce the impact of PAs to patients for Supported Drugs, SamaCare focuses on what we call “wayward” PA requests — the 37% of requests that take much longer to get a final approval from the payer.
• By applying the tactics above, SamaCare has found that it can halve the time-to-approval for wayward requests, from an average of 9.5 days to 4.4 days, based on internal studies we’ve done.
• This overall reduction in time-to-approval (though not a guarantee) makes it more likely that patients will receive the best treatment in the timeliest manner, and that practices will experience the least disruption possible from PA burdens.

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.