Requirement lookup
We check the patient's plan and confirm whether a medication requires prior authorization, step therapy, or quantity-limit review under the current formulary.
Medication Prior Authorization Support
Medication prior auths, off your team's desk.
PAuthNow handles the administrative paperwork behind medication prior authorizations for provider practices — payer requirement lookups, form completion, submission, status tracking, and appeal packet preparation — so your prescribers and staff can focus on patients.
- HIPAA-aligned workflows
- Business Associate Agreement offered
- U.S.-based support team
Experience with major payers and PBMs
CVS CaremarkExpress ScriptsOptumRx
Humana PharmacyCignaAetnaMedicare Part D
PAuthNow is an independent service and is not affiliated with, endorsed by, or partnered with the payers or PBMs listed above. Names are used descriptively only.
What we do
Administrative support for the medication prior authorization lifecycle.
Our specialists handle the forms and follow-up. We do not make clinical decisions, we do not decide medical necessity, and we do not guarantee approvals — those decisions belong to the prescriber and the plan. What we do is take the paperwork off your team.
Form intake & assembly
We collect the information the practice provides — chart notes, diagnosis, prior-medication history — and assemble the payer's PA form for the prescriber's review.
Submission
Requests are submitted through the payer or PBM's preferred channel — CoverMyMeds, Surescripts, portal, or fax — depending on the plan.
Status tracking
Every open request is monitored to a determination and your team gets a single, clear status view instead of chasing portals and hold music.
Patient & pharmacy updates
When a determination comes back, we notify the practice so the prescriber, patient, and pharmacy can move forward without another round of phone tag.
Appeal packet preparation
If a request is denied, we assemble the payer-specific appeal paperwork based on the denial reason and turn it back to the prescriber for review and signature.
How it works
A defined workflow — auditable at every step.
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01
Referral received
Your practice sends the prescription and available chart information through a secure channel we agree on — EHR task, secure upload, or fax under a HIPAA-compliant workflow.
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02
Coverage & requirement check
Our specialists verify the patient's pharmacy benefit and look up the payer or PBM's current PA requirements, including step therapy, quantity limits, and formulary tier.
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03
PA form assembled & submitted
We complete the payer's PA form using information the practice provided and submit it through the channel the payer prefers. The prescriber authorizes the request; we handle the paperwork.
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04
Tracked to determination
Every open case is monitored through approval, denial, or request-for-info. Your team sees one status view instead of chasing multiple portals.
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05
Appeal support, if needed
If denied, we prepare the payer's appeal paperwork based on the denial reason and hand it back to the prescriber for review, signature, and submission.
Compliance & security
Built to align with HIPAA and pharmacy-industry data standards.
Handling medication prior authorizations means handling protected health information (PHI). We take that seriously, and we structure our program around the frameworks health plans, PBMs, and provider organizations expect.
- Written policies and procedures aligned with the HIPAA Privacy, Security, and Breach Notification Rules.
- Business Associate Agreement (BAA) offered before any PHI is exchanged, consistent with HHS guidance.
- Role-based access, least-privilege permissions, encryption in transit (TLS 1.2+) and at rest (AES-256).
- Workforce training on HIPAA, PHI handling, and payer-specific submission requirements.
- Support for workflows consistent with the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) and NCPDP SCRIPT electronic prior authorization standards where payers have implemented them.
- Documented incident response plan and vendor risk review process.
SOC 2 Type II readiness is in progress. PAuthNow does not currently hold SOC 2 or HITRUST certification; we will not represent otherwise. A current status summary is available on request during procurement review.
Who we help
Prescribing practices with high medication PA volume.
Primary care & internal medicine
GLP-1s, diabetes therapies, weight-management, cardiometabolic medications.
Behavioral health
Psychiatric medications, ADHD stimulants, long-acting injectables.
Dermatology & rheumatology
Biologics, specialty injectables, and step-therapy heavy formularies.
Endocrinology & specialty clinics
Non-formulary and high-cost medications that need PA on nearly every fill.
Frequently asked
Questions procurement and compliance teams ask first.
Are the people doing the paperwork clinicians or pharmacists?
No. Our team is made up of trained administrative specialists — not licensed physicians, pharmacists, nurses, or other clinicians. We do not select therapy, counsel patients, or make clinical judgments. Every PA request is authorized and signed by the prescriber; we handle the forms and follow-up around it.
Are you a HIPAA business associate?
Yes. When we handle PHI on behalf of a covered entity, we act as a business associate under 45 CFR 160.103, and we sign a Business Associate Agreement before any PHI is exchanged.
Do you make clinical or medical necessity decisions?
No. Medical necessity determinations are made by the prescriber and, ultimately, by the health plan or PBM. Our role is strictly administrative.
Can you guarantee that a medication PA will be approved?
No responsible vendor can guarantee approvals. Approval depends on plan policy, formulary status, step therapy, and the clinical information the prescriber provides. We commit to a defined, auditable workflow — not to a specific outcome.
What types of prior authorizations do you handle?
We focus on medication (pharmacy benefit) prior authorizations. We do not handle surgical, procedural, imaging, DME, or other medical-benefit prior authorizations.
How do you handle PHI?
PHI is transmitted over TLS 1.2+ and stored encrypted at rest. Access is role-based, logged, and reviewed. Workforce members complete HIPAA training and sign confidentiality agreements. Our incident response plan is available on request.
Are you SOC 2 or HITRUST certified?
SOC 2 Type II readiness is in progress. We are not currently SOC 2 or HITRUST certified and will not represent otherwise. We will share a current program status summary during procurement review.
Do you integrate with our EHR?
We support several intake models: EHR task queues, secure file exchange, fax, and payer/PBM portals. Direct EHR integration is scoped case by case based on your system, IT security review, and payer mix.
Get started
Talk to us about your medication PA workload.
Tell us a bit about your practice and we'll set up a scoping conversation. We do not collect PHI through this form — please do not include patient information.
- Emailhello@pauthnow.com
- Procurement / securitysecurity@pauthnow.com
- Business hoursMon–Fri · 8am–6pm CT