One of the biggest burdens that medical providers face when trying to get patients onto new therapies is a process called prior authorization, meaning the paperwork that insurance companies require doctors and patients to fill out in order to approve the use of a therapy.
Part of the problem, explained Syam Palakurthy, founder and CEO of SamaCare, a prior authorization platform for physician-administered medications, is that every insurance company requires a different process, which can include fax forms, online portals, or phone calls, leading to enormous administrative waste.
“Most importantly, it often leads to delays in care; or worse, to patients not getting on best possible therapy at all. No one, not the patients, the medical provider, the pharmaceutical manufacturers, not even the insurance company, likes prior authorization as it exists today,” he said.
“A prior authorization process that is both fast and universal across payers could save the system many billions of dollars and save lives in the process.”
This is an especially big problem when it comes to specialty drugs, Palakurthy explained, due to a lack of technological infrastructure, and more variation, among the different insurance companies. That means that, for many of these very expensive drugs, the medical provider will buy the drug, keep it in inventory, and then hope they get reimbursed by the insurance company after they’ve used it.
“A failure to get prior authorization for a single patient and drug can cause a medical provider to lose hundreds of thousands of dollars,” said Palakurthy.
SamaCare, which announced a $12 million Series A funding round on Wednesday, helps solve this problem by giving providers a portal that allows them to streamline this process, letting them to submit, track, and manage prior authorizations for specialty medications across all payers and drugs.
This saves them from having to cobble together solutions from disconnected spreadsheets, unstructured notes in the EMR, and different insurance company-specific portals.
Medical practices use the platform to submit, and automatically track, the status of each submitted prior authorization, so their staff doesn’t need to manually check if a patient is approved for a therapy, or if an insurance company needs more information. The practices also get regular prior authorization reporting, with metrics such as average resolution times, which can help practices avoid having to reschedule or delay starting treatment.
While the platform is free for medical practices, the company makes its money from pharmaceutical manufacturers who pay for add premium features. That includes region specific data, and the ability to enroll patients into other services offered by the pharmaceutical manufacturer, including nurse support, adherence programs, and financial assistance.
There are over 2,300 prescribers using the SamaCare platform currently, and the platform has been shown to reduce time spent on prior authorization by 43%, along with a 22% increase in administrative denials. For its pharmaceutical customers, the company has shown a 70% reduction in time-to-treatment and a 20% increase in prior authorization first-time approvals for their drugs.
SamaCare’s Series A round, which brings its total funding to $17.8 million, was led by Vive Collective, and included participation from existing investors NextView Ventures, South Park Commons, and Susa Capital.
the company says it plans to use the new funding to expand practice penetration across existing and new specialties, and to ramp up customer acquisition and support for pharmaceutical manufacturers. It will go toward bringing on executives to lead medical provider growth, customer success, operations, product, and engineering; that includes its recently hired Chief Commercial Officer, Anurag Rai, who will scale the company’s pharmaceutical contracts.
As part of the investment, Cheryl Cheng, Vive’s founder and CEO, will join the board of directors at SamaCare.
“Cheryl and her amazing team have an in-depth understanding of healthcare industry drivers, as well as an impressive network in the space. For us, it was vitally important to find an investor who knew the ins and outs of what it takes to make a healthcare tech business succeed, because the space operates like the funhouse-mirror version of most other industries,” said Palakurthy.
“In the short time we’ve worked together, Cheryl has already delivered that knowledge and network, including insights into product extensions and by plugging us in with experts who we would have struggled to reach otherwise.”
Ultimately, SamaCare’s goal is to create a world where patients get on therapy because of clinical considerations, and not due to administrative or financial considerations.
“Our role in this equation is to provide the technology and insights to medical providers and to pharmaceutical teams to be able to eliminate avoidable obstacles to care. We’ll know we’ve succeeded when prior authorizations are as simple and convenient as a credit card swipe, and patients always get timely access to therapy due to clinical considerations, not undue administrative or financial burdens.”