How to Automate CoverMyMeds

CoverMyMeds is where a prescription waits while the plan decides

A prescription for a biologic or a continuous glucose monitor often stops at the pharmacy counter, because the plan wants a prior authorization first. CoverMyMeds, owned by McKesson since 2017, carries that request electronically between the pharmacy, the prescriber's office and the plan.

Most requests start at the pharmacy, according to the CoverMyMeds help center. The pharmacist opens the request with nearly all the patient and prescriber details filled in and faxes the office a Key, a six to eight character code for that one request. Staff open it on their dashboard with the Key and the patient's name and date of birth. An office can also start its own request, and in an EHR that is one of the more than 350 integrated with CoverMyMeds, the request can begin at e-prescribing.

It costs the office nothing: health plans, PBMs and drug manufacturers pay to keep it free for prescribers and their staff.

Keys arrive by fax and the answers live in the chart

A medical assistant's prior authorization work comes from three directions: a pharmacy fax with a Key on it, a patient calling to ask why the prescription still has not been filled, and a request on the dashboard waiting for its clinical questions.

The plan sends those questions back once the request is first sent: which diagnosis, which drugs the patient has already tried, what the latest labs show. The medical assistant answers them from the EHR in a second window, going through recent notes for an A1c or a count of headache days.

Then the determinations come in. An approval means booking the injection visit and telling the patient, a denial means pulling the chart again for an appeal, and a request stuck with a plan for a week means a phone call. When an approval period ends, the medication needs a new request.

CoverMyMeds

Requests prepared before they are needed Patients on next month's schedule without a current approval found in the EHR, with the CoverMyMeds request filled in from the chart and left for review.

A dashboard read every morning Requests waiting on the office, requests stuck with a plan and new determinations sorted into one short list for the team.

Renewals started a month ahead Approvals nearing their end date flagged a month ahead, with the renewal request drafted from the latest notes.

CoverMyMeds carries the request to the plan and back

New Request picks the right form from the drug and the plan details on the patient's insurance card, for any drug and all plans. After the office fills in the required fields and sends it, the plan returns its patient-specific clinical questions, and a second Send to Plan completes the request.

Every plan answers by fax, and integrated plans also answer on the CoverMyMeds website and by email, often within moments. The dashboard lists every request; once a plan has responded, staff archive the request as Approved, Denied, Not sent to plan or Don't know outcome, and everyone with access gets an email. The Renew feature copies a previous request's information onto a new one for the office to check and send, and PA experts answer questions by chat and phone.

An integrated EHR fills in the patient and prescriber details; the plan's clinical questions are answered by whoever reads the chart. The office itself spots the patients on next month's schedule who need a new approval before their injection. A determination, however it arrives, still leaves the injection visit for the scheduler to book.

Every request can arrive with the chart already read

In a neurology practice that gives Botox for chronic migraine, each of next month's injection patients without a current approval already has a request in CoverMyMeds, filled in with the diagnosis, the headache days and the preventive drugs tried, for the medical assistant to check and send.

The front office reads the CoverMyMeds dashboard as a Microsoft Teams message each morning, sorted with requests waiting on the office first, then those that have sat with a plan for more than a few days, then new determinations. The scheduler books the injection off each approval, and the doctor reviews each denial alongside the plan's reason and a draft appeal letter.

A diabetes clinic can run its glucose monitor renewals the same way, and so can a GI practice with hepatitis antivirals or an osteoporosis clinic with biologics. A month before an approval ends, the medical assistant checks a renewal already started through Renew and updated with the notes written since the last request.

Nothing goes to a plan without a clinician's say-so

The medical assistant's share of every request above is reading the EHR and typing the answers into CoverMyMeds. WebRun is an AI agent that works a real Chrome browser, signed in as you. A CoverMyMeds user and an EHR login cover the reading, and the practice's own users decide which User Group that CoverMyMeds user joins, and so which shared requests it can open.

The agent leaves Send to Plan to the office: each prepared request waits on the CoverMyMeds dashboard until a clinician or medical assistant checks it and sends it. Appeal letters reach the doctor as drafts, and messages to patients stay with the front office.

The workflows that follow pair CoverMyMeds with specialty systems such as Glooko, gGastro and ModuleMD.