Seamless Solutions for Prior Authorization
Transforming prior authorization from a barrier into a seamless process. paPAyaRx™ delivers automated solutions that eliminate paperwork, reduce delays, and align the interests of patients, medical staff, and health plans—all without disrupting existing workflows.
We do this with No New Screens, and no changes for your operations team except less inbound work.
challenges of prior authorization
The Prior Authorization Crisis: Papercuts That Add Up
Every patient is unique, and so is each Prior Authorization (PA). It only takes one detail to trip a PA rejection code, creating cascading work for pharmacy teams, payer operations, and medical staff. These PA "papercuts" frustrate your team members and steal time away from higher-value work and patient care.
Despite electronic prior authorization (ePA) solutions being readily available, pharmacists report spending extra time on 40-50 PAs per day—leaving patients waiting and prescriptions abandoned. This increases the likelihood of additional work for medical staff and drives up costs for health plans unnecessarily.
One small error, one missing detail, one misaligned data field—and the entire process grinds to a halt. The result? Delays in patient access to critical medications and mounting frustration across the healthcare ecosystem.
94%
Employer Concern
Large self-insured employers rank high-cost pharmacy and medical claims as their top healthcare threat
55%
Specialty Spending
Specialty medicines now account for over half of net spending, up from just 28% in 2011
$4M+
Treatment Costs
Some specialty therapies now cost over $4 million per treatment course
The rapid rise in drug prices threatens both the financial viability of employer-sponsored healthcare and patient access to essential medications. Organizations need smarter solutions that balance cost management with timely care delivery.
Our Solution
paPAyaRx™: Making PA Papercuts Disappear
paPAyaRx™ streamlines pharmacy–payer interactions by eliminating delays, manual work, and guesswork. Our patent-pending solution automates the administration of the Gold Card framework using pre-approved prior authorizations (paPA✦), automatically granting Gold Card status to providers with proven track records.
We eliminate entire workflows by leveraging existing NCPDP data standards. paPAyaRx™ works invisibly in the background—your team doesn't need to learn a new process, look at a new screen, or change how they work. The system simply makes the problems disappear.
Most importantly, paPAyaRx™ helps realign the interests of patients, medical staff, and health plans, creating a win-win-win scenario across the healthcare ecosystem.
No New Workflows
Clinicians continue using their existing systems and processes. Nothing new to learn, nothing to change. Our automation works behind the scenes.
No New Portals
Stop juggling multiple platforms and logins. paPAyaRx™ integrates seamlessly with the tools your team already uses every day.
No Additional Data Entry
Eliminate redundant manual data entry. We leverage existing information flows to process authorizations automatically.
No Interruptions to Care
Providers stay focused on patient care. Our system handles administrative tasks silently and efficiently in the background.
The result is faster access to care, fewer administrative delays, and dramatically better experiences for everyone involved—patients, providers, pharmacists, and payers.
Potential Impact: Organization Goals
Organizations implementing paPAyaRx™ can see transformative results across their pharmacy operations. By eliminating manual prior authorization work, health plans can redirect staff time to higher-value activities like medication therapy management and member outreach.
Pharmacy teams expect significant reductions in calls to physician offices, abandoned prescriptions, and frustrated patients. Medical offices experience fewer interruptions from PA requests, allowing clinicians to focus on direct patient care rather than administrative tasks.
paPAyaRx™ is in its early days. As clients continue to realize results, we will develop new metrics and case studies.
Reduction in Manual PA Work
Staff time freed for patient-focused activities and clinical interventions
Faster Time to Therapy
Patients start critical medications sooner, improving health outcomes and satisfaction
Member Satisfaction
Patients feel their insurance working for them, quickly getting them access to the right medications
Provider Satisfaction
Physicians and pharmacists report dramatically improved workflow efficiency
True cost savings go beyond just administrative efficiency. When patients access medications promptly, health plans avoid costly complications, emergency visits, and disease progression. The downstream savings from improved adherence and outcomes often exceed the direct administrative cost reductions.