CoverMyMeds

Supergood | CoverMyMeds API

Alex Klarfeld

Alex Klarfeld

— 7 min read
Supergood | CoverMyMeds API

Programmatically access electronic prior authorization (ePA), prescription benefit verification, formulary alternatives, and specialty enrollment workflows in CoverMyMeds with a stable REST API. Supergood builds and operates production‑grade, unofficial CoverMyMeds integrations so your team can automate critical medication access and billing pipelines without heavy custom engineering.

Plain English: CoverMyMeds helps providers and pharmacies get patients on therapy faster by streamlining prior authorizations, verifying pharmacy benefits, surfacing formulary alternatives, and coordinating specialty medication enrollments. With an unofficial API, you could create and track prior auth requests, attach clinical documentation, run real‑time benefit checks with estimated copay, identify plan‑preferred alternatives, and submit specialty enrollments—end to end.

From the perspective of a healthcare tech startup focused on billing, practice management, or provider services, integrating your stack with CoverMyMeds means fewer denials, faster time‑to‑fill, and more complete audit trails. You’d pull PA statuses, benefit coverage details, and determination reasons directly into your RCM dashboards; push new PA requests and required documentation from your EHR; and build authorization‑aware scheduling, prescription routing, and appeals workflows that keep claims clean and reimbursable.

If you’re a clinic, provider group, or revenue cycle team, integrating your tech stack with CoverMyMeds unlocks concrete data flows and features:

  • Pull: Patient profiles, prescription details (NDC, directions, quantity), payer/plan info, PA questionnaires and statuses, determination results (approved/denied, reasons), benefit verification summaries (tier, copay estimate, UM flags), specialty enrollment statuses
  • Push: New/updated patients and prescribers, prior authorization submissions with attachments, questionnaire responses, benefit verification requests, specialty enrollment packets and consent documents
  • Build: Authorization‑aware prescribing, real‑time benefit transparency, formulary substitution prompts, denial‑prevention and appeals workflows, audit‑ready documentation for RCM

What is CoverMyMeds?

CoverMyMeds provides medication access solutions used by prescribers, clinics, pharmacies, payers, and manufacturers to streamline electronic prior authorization (ePA), verify pharmacy benefits, surface formulary alternatives, and coordinate specialty medication enrollments and patient assistance. Their network connects provider systems, payer portals, and pharmacy benefit managers to reduce delays, improve adherence, and minimize claim denials.

Core product areas include:

  • Electronic Prior Authorization (ePA) with payer‑specific questionnaires
  • Prescription benefit verification (coverage, copay, tier, utilization management requirements)
  • Formulary alternatives and substitution management
  • Specialty medication enrollment and hub coordination
  • Attachments and documentation management for PA and appeals
  • Notifications, tasks, and determination tracking

Common data entities:

  • Patients (demographics, eligibility)
  • Prescribers and care team
  • Payers/Plans and PBMs
  • Prescriptions (drug NDC, strength, directions, quantity, days supply)
  • Prior Authorizations (questions, attachments, status, determination)
  • Benefit Verifications (coverage, tier, copay estimate, UM flags)
  • Formulary Alternatives (preferred products, prior auth or step therapy requirements)
  • Specialty Enrollments (programs, consent, labs, documentation)

The CoverMyMeds Integration Challenge

Organizations rely on CoverMyMeds daily, but turning portal‑based medication access workflows into automated pipelines is hard:

  • Payer‑specific question sets: Each plan may require different PA forms, clinical questions, and documentation standards
  • Strong enterprise security: SSO/MFA and network controls complicate headless automation
  • Portal‑first delivery: Key PA, determination, and specialty coordination workflows often live behind web apps rather than unified public APIs
  • Attachments and audit trails: Clinical notes, lab reports, and consent forms must be captured with compliant metadata
  • Timing windows and notifications: Acknowledgements, pending information requests, and determination updates arrive asynchronously
  • Denial prevention nuances: Benefit checks, formulary tiers, and utilization management flags must be evaluated before prescribing

How Supergood Creates CoverMyMeds APIs

Supergood reverse‑engineers authenticated browser flows, batch interfaces, and network interactions to deliver a resilient API endpoint layer.

  • Handles username/password, SSO/OAuth, and MFA (SMS, email, TOTP) securely
  • Maintains session continuity with automated refresh and change detection
  • Normalizes PA, benefit, and specialty enrollment objects so you can integrate once across payers/plans
  • Aligns with customer entitlements and licensing constraints to ensure compliant access
  • Bridges portal uploads and document handling with signed URL retrieval and delivery

Use Cases

EHR‑to‑PA Synchronization

  • Push patient and prescriber details from your EHR into CoverMyMeds
  • Create prior authorizations automatically when a prescription is ordered
  • Track PA statuses and determination reasons back in your clinical and billing systems

Real‑Time Benefit & Pricing Transparency

  • Run pharmacy benefit checks at the point of prescribing
  • Surface copay estimates, tier placement, prior auth requirements, and quantity limits
  • Offer plan‑preferred alternatives before submission

Specialty Medication Enrollment & Coordination

  • Submit enrollment packets with required consents and labs
  • Monitor program statuses and outstanding documentation tasks
  • Keep care coordinators aligned with payer/manufacturer hub workflows

Denial Prevention & Appeals Automation

  • Proactively gather required PA documentation and respond to information requests
  • Route denials to staff with determination reasons and appeal prompts
  • Drive cleaner claims by ensuring PA coverage before dispensing

Audit and Compliance

  • Export complete PA packets with timestamps, questionnaires, attachments, and determinations
  • Maintain machine‑readable audit trails aligned to payer/plan requirements
  • Prove authorization coverage and claim provenance during reviews

Available Endpoints

Authentication

POST /sessions: Establish a session using credentials. Supergood manages MFA (SMS, email, TOTP) and SSO/OAuth when enabled. Returns a short‑lived auth token maintained by the platform.

curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/sessions \
  --header 'Authorization: Basic <Base64 encoded token>' \
  --header 'Content-Type: application/json' \
  --data '{
    "username": "[email protected]",
    "password": "<password>",
    "mfa": {
      "type": "totp",
      "code": "123456"
    }
  }'

Example response

{
  "authToken": "eyJhbGciOi...",
  "expiresIn": 3600,
  "user": {
    "id": "u_cmm_29b71a",
    "name": "PA Admin",
    "entitlements": ["prior_authorizations", "benefit_verifications", "specialty_enrollments"]
  }
}

Prior Authorizations

POST /prior-authorizations: Create an electronic prior authorization request with payer‑specific fields, questionnaire responses, and attachments. Use this to initiate PA and reduce downstream denials.

curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/prior-authorizations \
  --header 'Authorization: Bearer <authToken>' \
  --header 'Content-Type: application/json' \
  --data '{
    "patientId": "pt_9b42f0",
    "prescriberId": "pr_41cf92",
    "payerId": "payer_rx_medicaid_oh",
    "prescription": {
      "ndc": "00093-7464-56",
      "drugName": "Lisdexamfetamine 30 mg",
      "dosage": "30 mg",
      "directions": "Take 1 capsule by mouth daily",
      "quantity": 30,
      "daysSupply": 30
    },
    "diagnosisCodes": ["F90.0"],
    "urgency": "standard",
    "questionnaire": [
      {"questionId": "q_adhd_prev_therapies", "answer": "Trialed methylphenidate 20 mg for 6 weeks"},
      {"questionId": "q_contraindications", "answer": "None"}
    ],
    "attachments": [
      {"type": "clinical_note", "fileName": "progress-note-2026-01-18.pdf", "contentType": "application/pdf", "signedUrl": "https://upload.supergood.ai/signed/abc123"}
    ],
    "referenceId": "ehr-order-42391"
  }'

Example response

{
  "paId": "pa_58d3e0",
  "status": "pending",
  "submittedAt": "2026-01-19T15:02:02Z",
  "payer": {"id": "payer_rx_medicaid_oh", "name": "Ohio Medicaid"},
  "requiresAdditionalInfo": false,
  "referenceId": "ehr-order-42391"
}

GET /prior-authorizations: Retrieve PA requests with status, outstanding information, and determination details.

Query parameters

  • patientId: string
  • prescriberId: string
  • payerId: string
  • ndc: string
  • status: enum (pending, info_required, approved, denied)
  • updatedSince: ISO 8601 datetime

Example response

{
  "items": [
    {
      "paId": "pa_58d3e0",
      "patientId": "pt_9b42f0",
      "prescriberId": "pr_41cf92",
      "payerId": "payer_rx_medicaid_oh",
      "prescription": {
        "ndc": "00093-7464-56",
        "drugName": "Lisdexamfetamine 30 mg",
        "quantity": 30,
        "daysSupply": 30
      },
      "status": "approved",
      "determination": {
        "decision": "approved",
        "effectiveDate": "2026-01-20",
        "expirationDate": "2026-07-20",
        "reason": null,
        "authorizationNumber": "A-2026-11872"
      },
      "outstandingQuestions": [],
      "attachments": [
        {"type": "clinical_note", "fileName": "progress-note-2026-01-18.pdf"}
      ],
      "updatedAt": "2026-01-20T09:45:17Z"
    }
  ],
  "page": 1,
  "pageSize": 50,
  "total": 1
}

Benefit Verifications

POST /benefit-verifications: Run a pharmacy benefit check for a specific drug and patient to understand coverage, tier, copay estimate, and UM requirements before prescribing.

curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/benefit-verifications \
  --header 'Authorization: Bearer <authToken>' \
  --header 'Content-Type: application/json' \
  --data '{
    "patientId": "pt_9b42f0",
    "payerId": "payer_rx_medicaid_oh",
    "pharmacyNcpdp": "3675432",
    "prescription": {
      "ndc": "00093-7464-56",
      "quantity": 30,
      "daysSupply": 30
    }
  }'

Example response

{
  "benefitVerificationId": "bv_71af2b",
  "coverage": {
    "covered": true,
    "tier": 3,
    "copayEstimate": 25.00,
    "priorAuthRequired": true,
    "stepTherapyRequired": false,
    "quantityLimit": {"maxQuantity": 30, "periodDays": 30}
  },
  "alternativesAvailable": true,
  "createdAt": "2026-01-19T16:05:42Z"
}

Formulary Alternatives

GET /formulary/alternatives: Retrieve plan‑preferred alternatives for a given drug, including tier, UM flags, and substitution notes for prescriber decision support.

Query parameters

  • payerId: string
  • ndc: string
  • therapeuticClass: string (optional)

Example response

{
  "items": [
    {
      "ndc": "00093-7510-56",
      "drugName": "Methylphenidate ER 36 mg",
      "tier": 2,
      "priorAuthRequired": false,
      "stepTherapyRequired": true,
      "notes": "Preferred generic; requires trial of IR formulation"
    },
    {
      "ndc": "54868-1234-00",
      "drugName": "Amphetamine/Dextroamphetamine 10 mg",
      "tier": 2,
      "priorAuthRequired": false,
      "stepTherapyRequired": false,
      "notes": "Preferred alternative"
    }
  ],
  "payerId": "payer_rx_medicaid_oh"
}

Specialty Enrollments

POST /specialty/enrollments: Submit a specialty medication enrollment packet with patient, prescriber, insurance, consent, and clinical data. Track program status and outstanding documentation.

curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/specialty/enrollments \
  --header 'Authorization: Bearer <authToken>' \
  --header 'Content-Type: application/json' \
  --data '{
    "patientId": "pt_77c210",
    "prescriberId": "pr_41cf92",
    "programId": "prog_manufacturer_xyz",
    "medication": {
      "ndc": "55555-1234-01",
      "drugName": "Infliximab 100 mg vial"
    },
    "diagnosisCodes": ["K50.90"],
    "insurance": {
      "primary": {"payerId": "payer_rx_medicaid_oh", "memberId": "M0123456"}
    },
    "consents": [
      {"type": "hipaa_authorization", "signedAt": "2026-01-19T14:02:33Z"}
    ],
    "clinicalData": {
      "labResults": [{"name": "CRP", "value": 12.4, "unit": "mg/L", "date": "2026-01-10"}]
    },
    "attachments": [
      {"type": "office_note", "fileName": "gi-note-2026-01-12.pdf", "contentType": "application/pdf", "signedUrl": "https://upload.supergood.ai/signed/def456"}
    ],
    "referenceId": "care-coord-88301"
  }'

Example response

{
  "enrollmentId": "enr_9a2d10",
  "status": "submitted",
  "programId": "prog_manufacturer_xyz",
  "outstandingItems": ["benefits investigation in progress"],
  "createdAt": "2026-01-19T16:22:05Z",
  "referenceId": "care-coord-88301"
}

Get full API Specs →

Technical Specifications

  • Authentication: Username/password with MFA (SMS, email, TOTP) and SSO/OAuth where enabled; supports service accounts or customer‑managed credentials
  • Response format: JSON with consistent resource schemas and pagination
  • Rate limits: Tuned for enterprise throughput while honoring licensing and usage controls
  • Session management: Automatic reauth and cookie/session rotation with health checks
  • Data freshness: Near real‑time retrieval of PA, benefit, and specialty artifacts
  • Security: Encrypted transport, scoped tokens, and audit logging; respects CoverMyMeds entitlements and compliance requirements
  • Webhooks: Optional asynchronous delivery for PA updates, determination results, and specialty status changes

Performance Characteristics

  • Latency: Sub‑second responses for list/detail queries under normal load
  • Throughput: Designed for high‑volume PA and pharmacy benefit verification pipelines
  • Reliability: Retry logic, backoff, and idempotency keys minimize duplicate actions
  • Adaptation: Continuous monitoring for UI/API changes with rapid adapter updates

Getting Started

  1. Schedule Integration Assessment

Book a 30‑minute session to confirm your CoverMyMeds product mix, licensing, and authentication model.

  1. Supergood Builds and Validates Your API

We deliver a hardened CoverMyMeds adapter tailored to your workflows and entitlements.

  1. Deploy with Monitoring

Go live with continuous monitoring and automatic adjustments as CoverMyMeds evolves.

Schedule Integration Call →

Frequently Asked Questions

Q: Which CoverMyMeds products can this integration cover?

Supergood supports workflows across commonly used CoverMyMeds portals and provider/pharmacy‑facing tools, subject to your licensing and entitlements. We scope coverage (ePA submission and tracking, benefit verification, formulary alternatives, specialty enrollment) during integration assessment.

Q: How are MFA, SSO, and attachments handled for automation?

We support username/password + MFA (SMS, email, TOTP) and can operate behind SSO/OAuth when enabled. For documentation flows, we manage portal uploads with signed URLs, track acknowledgements, and retain audit metadata (file type, timestamps, submitter) programmatically.

Q: Can I prevent denials by checking PA and benefits before prescribing?

Yes. You can run benefit verification and formulary checks in real time, and conditionally submit PAs with complete questionnaires and required attachments. Determination statuses and reasons feed back into your RCM so you can avoid non‑covered fills and claim denials.

Ready to automate your CoverMyMeds workflows?

Supergood can have your CoverMyMeds integration live in days with no ongoing engineering maintenance.

Get Started →

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