OUR CAPABILITIES

A More Connected Approach to Patient Access

For patients, starting therapy isn’t just one step—it’s a series of moments that need to come together. When they don’t, progress can stall.

CareMetx orchestrates the patient journey end-to-end, carrying information forward to create a more efficient, transparent, and connected path to therapy for pharmacy, medical, and dual benefit products.

ACCESS

Start the Patient Journey on the Right Foundation

A missed step at intake ripples through everything that follows. CareMetx captures, validates, and activates patient information from the first interaction so every downstream step builds on accurate data, not assumptions.

Our capabilities are connected by design: coverage insights inform authorization, and missing information is flagged before, not after, delays occur.

Enrollment and Consent

Captured once across flexible channels (eRx, portals, direct submission), with automated validation to ensure complete data is immediately available across all services.

Benefit Verification (eBV)

Multi-source payer intelligence, automation, and AI-driven navigation deliver real-time coverage clarity and surface next steps early.

Prior Authorization (ePA)

Comprehensive PA support across both pharmacy and medical benefits, leveraging automation and payer connectivity to streamline submission, reduce provider burden, and minimize delays.

AFFORDABILITY

Guide Patients to the Right Financial Pathway from the Start

Affordability decisions made late, or made wrong, create unnecessary delays and drop-off. CareMetx applies real-time data and rules-based logic to determine the right financial pathway upfront, without the back-and-forth. 

Eligibility Verification

Income checks, LIS verification, insurance discovery, and coverage assessments are unified into a single decisioning engine

Copay and PAP Support

Automated eligibility and continuously updated plan logic move patients into copay or patient assistance programs (PAP) the moment they qualify, synchronized with BV and PA outcomes

Because affordability is integrated into the Access workflow, eligibility is continuously reassessed as new information arrives, so patients move forward with clarity, not delays.

PHARMACY SERVICES

Move Patients from Prescription to Therapy Without Gaps

Disconnected Access and dispensing creates friction patients feel. CareMetx brings these parts of the journey together within a single workflow. 

Rx Intake and Non-Dispensing Pharmacy (NDP)

As a HIPAA Covered Entity, CareMetx can initiate BV, PA, and affordability support the moment a prescription is received

COMING SOON

Non-Commercial Dispensing - QuickStart, bridge, and PAP programs are managed within the same system, so transitions are smooth and manual coordination is minimized

Commercial Dispensing (via central fill) - Prescriptions reach the right pharmacy the first time, reducing delays and back-and-forth 

Fewer handoffs. Better visibility. A more continuous experience for patients and providers.

ONBOARDING

A Simpler Start to Treatment

Once Access is approved, patients are ready to begin. The next steps should feel simple and coordinated.

CareMetx helps patients move forward:

Coordination Services

Patients are guided to the right care setting based on their needs, coverage, and provider requirements

Scheduling and Network Verification

Handled within the same workflow, reducing friction before treatment begins

End-to-End Coordination

Across providers, sites, and stakeholders, from access approval to treatment delivery

Patients know what's next, where to go, and how to move forward — with fewer delays from the very first day of therapy.

ADHERENCE

Personalized Engagement to Keep Patients on Track 

Starting therapy is a big step. Staying on therapy takes the right support, delivered at the right moment.

Adherence Communications

Omnichannel outreach supports patients through timely reminders, education, and personalized engagement to improve initiation and keep patients on therapy

Virtual Nurse Support

One-on-one video or phone guidance helps patients manage side effects, understand their medication, and stay confident in their care

Because these capabilities are connected to real-time patient signals, support arrives when it matters — resulting in more consistent engagement and fewer gaps in therapy.

A More Connected Approach to Patient Access

Start the Patient Journey on the Right Foundation

Enrollment and Consent

Benefit Verification (eBV)

Prior Authorization (ePA)

Guide Patients to the Right Financial Pathway from the Start

Eligibility Verification

Copay and PAP Support

Move Patients from Prescription to Therapy Without Gaps

Rx Intake and Non-Dispensing Pharmacy (NDP)

A Simpler Start to Treatment

Coordination Services

Scheduling and Network Verification

End-to-End Coordination

Personalized Engagement to Keep Patients on Track

Adherence Communications

Virtual Nurse Support

Ready to Transform Your Patient Support?

Personalized Engagement to Keep Patients on Track 