Improving Utilization, Decreasing Paperwork
EnvoyHealth’s delegated prior authorization program reduces payors’ administrative burden with customizable utilization review for high-cost medications under any benefit design. A dedicated team of pharmacists in specialty develops drug-specific utilization criteria based on evidence-based guidelines and best practices. We provide clients with the program’s clinical criteria for approval and can request criteria modifications. We can also tailor the program to adhere to any existing formulary and rebate structures.
Our software platform ensures the availability of full audit trails of our interaction with each request. We can provide customized, detailed reports at intervals that fit clients’ needs.
Besides promoting appropriate clinical decisions, our delegated prior authorization service improves turnaround times and communication, strengthening payors’ relationship with patients and providers. We integrate seamlessly with health plans, working with medications covered under the pharmacy benefit and the medical benefit. EnvoyHealth acts as a gatekeeper—reducing waste, promoting cost-effective care, and improving data accuracy.