SamaCare Launches First-of-Its-Kind Benchmarks for Medical Benefit Prior Authorization Performance

Derived from real-world prior authorization activity across tens of thousands of specialty practices who use SamaCare, the benchmarks provide quarterly insights into approval rates and time to therapy for medical benefit drugs across specialties and disease areas.

While prior authorization plays a critical role in determining whether and when patients start treatment, historically, there has been limited transparency into the impact of these processes on patient access to care. SamaCare's benchmarks address this gap by aggregating and analyzing the largest real-world dataset of medical benefit prior authorizations in the United States.

"Prior authorization is one of the most important and least understood barriers to patient access," said Syam Palakurthy, CEO and Founder of SamaCare. "By making this data visible, we're giving the industry a clearer picture of where delays occur, how approval rates vary, and what it takes to improve access to therapy."

The benchmarks focus on two of the most critical metrics impacting patient access:

• Net Approval Rate: the percentage of prior authorizations that payers ultimately approve
• Mean Time to Resolution: the average time required to secure an authorization decision from payers

Both metrics can be explored across specialties and tracked quarter-over-quarter, offering a dynamic view of how access conditions evolve over time, and vary seasonally.

For life sciences organizations, any changes in approval rates or turnaround times can have a significant impact on therapy adoption, patient adherence, and overall brand performance. For providers, prior authorization management can be a significant drain on patient resources and have a direct impact on patient care and patient outcomes.

SamaCare's dataset reflects real-world workflows, capturing not only payer policy but also how those policies are applied in practice. This includes variability in documentation requirements, submission pathways, and operational delays that are often not visible through traditional claims or policy data alone.

"Understanding how to improve access to treatment requires visibility into what actually happens at the point of care," added Palakurthy. "These benchmarks are designed to help market access teams move beyond assumptions and make decisions based on real-world performance, and to help providers understand what to expect when it comes to medical benefit prior authorization."

In addition to the public benchmarks, SamaCare offers life sciences organizations the ability to generate a custom Access Snapshot for individual therapies, providing deeper insights into approval performance, time to therapy, and key drivers of access barriers.

The release comes at a time of increasing focus on prior authorization reform and transparency across the healthcare industry. As stakeholders seek to reduce administrative burden and improve patient outcomes, access to reliable, real-world data is becoming essential.

SamaCare's benchmarks are updated quarterly and will continue to expand over time to include additional metrics and segmentation.

To explore the benchmarks, visit:

https://www.samacare.com/market-access-benchmarks

About SamaCare
SamaCare is an AI-powered insights and interventions platform designed to accelerate patient access to specialty therapies by unifying and optimizing the prior authorization process for provider-administered medications. The platform aggregates and analyzes real-world data from millions of prior authorizations across a nationwide network of providers, delivering actionable insights and in-workflow support that reduce delays, denials, and therapy abandonment. SamaCare partners with pharmaceutical manufacturers, providers, and patient access teams to improve the script-to-therapy journey and help patients start and stay on treatment. For more information visit www.samacare.com

SOURCE SamaCare