Health Plans & PBMs
Make the best path to
medication visible.
Interra Health brings accurate cost, coverage and prior authorization information into the prescribing workflow and takes plan cost and pharmacy options straight to members. Providers choose with the plan in view. Members see their real cost and the easiest way to fill. Plans manage spend and utilization with less administrative burden.
Put your benefit where
decisions are made
Prescribers and patients make medication decisions quickly, often without a plan’s cost, coverage and prior authorization information in front of them. Interra Health brings it into the workflow, without adding another step for the prescriber, so more patients start the medication they need at a cost they can afford, with less rework and better-managed spend for the plan.
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Help providers see the coverage picture behind a patient’s medication access, even when details are missing.
- Insurance Discovery to find coverage when the payer or member ID is unknown
- Real-time benefit verification: eligibility, coverage status and patient out-of-pocket cost
- Direct PBM and payer connections that keep plan information current
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Show prescribers patient-specific cost and coverage inside the EMR-integrated prescribing workflow, while the prescription can still change
- Patient out-of-pocket cost and coverage status at the moment a medication is selected
- Prior authorization requirements flagged before the prescription is sent
- Formulary-preferred and lower-cost alternatives surfaced where clinically appropriate, shaped with your team
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Power accurate information for providers and fast review for your organization, preventing delays and rework.
- In-workflow electronic prior authorization intelligence and automation
- Determinations automated using data already in the EHR
- Prior authorization status, regardless of where the request was initiated
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The member-facing layer: Bring actual plan cost and in-network pharmacy options to members before they reach the counter, through compliant SMS messaging.
- In-network pharmacy options based on location or mail-order capabilities
- Actual plan cost as part of the pharmacy choice, with PBM-granted consumer permissions
- Clear next steps for filling the prescription, with the option to opt out at any time
Your benefit at every step
of the prescription journey
A prescription moves through the prescriber, the patient, the pharmacy and the plan. Interra Health brings cost, coverage and prior authorization information into each step, so decisions are made with the full picture and fewer prescriptions stall.
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Give providers the insights they need to select an on-formulary, clinically appropriate medication.
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Give prescribers patient-specific out-of-pocket cost and coverage inside the EMR workflow, while the choice is still open.
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Providers see a prior auth flag on the selected medication and initiate in workflow. Select plans can expedite further, with question sets automatically populated and submitted.
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Members can view coverage and preferred pharmacy details before fill.
Frequently Asked Questions
Questions? We have answers
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Through an EMR-integrated, real-time experience, Interra Health can show prescribers patient-specific out-of-pocket cost and coverage, prior authorization requirements and pharmacy options, so they can act on what applies to the patient before the prescription is sent. Health plans and PBMs can also work with Interra Health to surface the plan-specific guidance they want prescribers to see, such as formulary-preferred and lower-cost alternatives.
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Prior authorization requirements are flagged while the prescription is being written, and electronic prior authorization moves the request forward in the same workflow, so fewer prescriptions stall and therapy can start sooner.
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Patient Connect takes plan cost and pharmacy options straight to members, so they can see what their medication may cost under their coverage and the easiest way to fill it.
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Interra Health connects directly with PBMs and payers to keep plan information current, and brings it to prescribers inside the EMR workflow they already use, without adding another step for the prescriber.
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Interra Health works with plans and PBMs to see how fully providers use the information surfaced, and its impact on speed to therapy, adherence and cost for plans and members.