The complete medication access reference for clinicians.
The complete point-of-care reference for prior authorization, appeals, step therapy, formulary exceptions, drug shortages, and EHR-ready SmartPhrases — licensed once for your entire site instead of purchased seat-by-seat.
Individual license — $299 / provider / year
Purchase directly. Email [email protected] to get started.
Site license — from $99 / provider / year
Volume pricing for practices and health systems. Minimum 5 providers. Email with your provider count for a formal quote.
Your team is losing ground to a system built to say no.
Prior authorization denials, drug shortages, formulary restrictions, and step therapy requirements consume clinical time and delay patient care. Most teams lack the documentation language, legal grounding, and workflow infrastructure to push back effectively — and payers know it.
One reference. Every barrier. Ready to use at the point of care.
The Clinical Operations Package gives your team the frameworks, legal citations, SmartPhrases, and drug-specific playbooks to navigate every medication access barrier — without starting from scratch each time.
Prior authorization without a system
Submissions fail because documentation is vague, prior therapy history is incomplete, or the clinical rationale doesn't match what the payer's criteria actually require.
Denials that never get appealed
82% of filed appeals succeed — but fewer than 1 in 9 denied requests are ever appealed. The gap isn't clinical; it's workflow and language.
Legal rights that go unused
Gold card laws, step therapy reform statutes, ACA §2719, and CMS-0057-F create enforceable rights for patients and prescribers — but only when the team knows how to invoke them.
No EHR-ready language at the point of care
Clinicians write PA documentation from scratch, every time, in whatever words come to mind. The result is inconsistent, often insufficient, and never optimized for the payer's criteria.
Clinical Decision Support Statement. SmartPhrase text and template letters in this package are clinical decision support tools. Every template requires review and individualization by the treating prescriber before use. No template, framework, or phone script in this package substitutes for independent clinical judgment based on the individual patient's circumstances, current clinical guidelines, and applicable laws.
19 sections. Every barrier covered.
The complete point-of-care reference for prior authorization, appeals, step therapy, formulary exceptions, drug shortages, and EHR-ready SmartPhrases — licensed once for your entire site instead of purchased seat-by-seat.
19 sections covering the complete medication access workflow
PA, appeals, peer-to-peer, step therapy, formulary exceptions, external appeal, drug shortage, rare disease, pharmacy deserts, and bridge planning — all in one reference.
Full state-by-state legal citation library
CMS-0057-F, ACA §2719, ERISA §503, gold card and step therapy reform laws — with citations organized by state and payer type so your team can invoke them correctly.
EHR-ready SmartPhrases across 7 platforms
Epic®, Oracle Health/Cerner®, athenahealth®, eClinicalWorks®, NextGen™, Tebra™, and Veradigm® — copy-paste ready, formatted for each platform's SmartPhrase syntax.
Specialty and primary care drug-specific playbooks
22 named drugs across oncology, rheumatology, dermatology, neurology, cardiometabolic, and primary care — with drug-specific PA language, step therapy grounds, and appeal frameworks.
Inpatient and cross-setting access guidance, including discharge bridging
So access doesn't break down at the transition from inpatient to outpatient care.
Semi-annual legal and regulatory updates for the life of the license
Content stays current as CMS, IRA, and PBM rules change. Your team is never working from outdated guidance.
License once for your entire site.
Annual license, priced per provider covered — not a one-time purchase, so content stays current as law changes. Minimum 5 providers for a site license.
Individual (non-site) license: $299 / provider / year, purchased directly. Minimum site license: 5 providers.
Pricing proposals delivered within 4–5 business days. Email [email protected] with your provider count and organization name.
Request a site license quoteAnnual. Per-provider. Always current.
Annual license, priced per provider covered
Not a one-time purchase — so content stays current as law changes. Renew annually to maintain access to semi-annual updates.
One editable master file
Distributed and administered by your practice or health system for use by licensed providers only.
Semi-annual content updates delivered automatically
For the life of the license. CMS, IRA, and PBM rules change — your reference keeps pace.
Not for resale or redistribution
Not for resale, redistribution outside the licensed site, or use by providers not covered under the agreement.
Ready to license for your site?
Email [email protected] with your provider count and organization name for a formal quote and license agreement.