Supported Drugs FAQs

TABLE OF CONTENTS

• What does it mean for a drug to be a supported Drug on the SamaCare system?
• Why are certain drugs on the SamaCare system considered "Supported Drugs" while others are not?
• What specifically changes for the Supported Drugs?
• How does Supported Drug status affect PA delays?
• Can I use SamaCare for drugs that are not "Supported Drugs"?
• If I've been using SamaCare already, how will "Supported Drugs" affect my experience?
• Does SamaCare eliminate denials for Supported Drug PA requests?
• Does SamaCare try to push prescribers to use any particular drugs?
• How does SamaCare determine which drugs are Supported Drugs?

Want to learn more about  SamaCare's Supported Drugs? See our frequently asked questions below! 

What does it mean for a drug to be a supported Drug on the SamaCare system?

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.

Why are certain drugs on the SamaCare system considered "Supported Drugs" while others are not?

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. 

What specifically changes for the Supported Drugs?

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. 

How does Supported Drug status affect PA delays?

• 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. 

Can I use SamaCare for drugs that are not "Supported Drugs"?

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. 

If I've been using SamaCare already, how will "Supported Drugs" affect my experience?

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. 

Does SamaCare eliminate denials for Supported Drug PA requests?

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.

Does SamaCare try to push prescribers to use any particular drugs?

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.

How does SamaCare determine which drugs are Supported Drugs?

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. 

We're here to guide you through your prior authorization quest!