Electronic PAP Eligibility, Built Around Verified Coverage
Verify available coverage pathways before approving free drug.
Value Health connects electronic insurance discovery, benefit verification, income screening, eligibility determination, and ongoing re-verification in one ePAP workflow.
When “Uninsured” Is Based Only on Self-Attestation
Patients may report having no insurance while still holding active commercial, Medicare, Medicaid, VA/TRICARE, or secondary coverage.
Coverage can also change after enrollment through new employment, open enrollment, or Medicaid eligibility.
Without Electronic Verification, PAP Programs May:
Verify Coverage Before Making a PAP Determination
Discover Available Coverage
Using permitted patient information, electronic insurance discovery searches connected eligibility sources for active commercial, government, and secondary coverage.
Verify Coverage and Benefits
Integrated electronic benefit verification confirms plan status and available benefit information for the prescribed therapy.
Identify the Right Access Path
Patients with viable coverage can be routed to benefit verification, prior authorization, copay support, foundation assistance, or another funding option. Patients without an available coverage pathway continue to PAP eligibility review.
Digital Enrollment and eConsent
Capture patient information, consent, prescriptions, and supporting documents through a connected digital experience.
AI-Powered Document Intake
Classify incoming documents, extract required information, and identify missing data without repetitive manual entry.
Income and FPL Screening
Extract income information from supported documents and compare household income with program-configured Federal Poverty Level criteria.
Rules-Based Determination
Apply insurance, income, residency, prescription, and therapy-specific rules consistently across applications.
Human Review for Exceptions
Route complex, incomplete, or low-confidence cases to trained reviewers with the supporting information and decision history.
Fulfillment Routing
Send approved patients to the appropriate PAP or non-commercial dispensing channel.
Eligibility starts with Enrollment, but it doesn’t stop there
A patient’s coverage can change at any time.
Value Health supports scheduled coverage checks during refill cycles and annual re-enrollment to:
This keeps PAP support aligned with the patient’s current situation–not information collected months earlier.
Built for Stronger Program Control
Value Health combines verified coverage data, configurable rules, automation, and human oversight in one traceable workflow.
Evaluate available insurance and funding pathways before approving PAP assistance.
Accelerate complete applications while routing exceptions to qualified reviewers.
Apply configurable rules across patients, therapies, and program requirements.
Maintain documents, rule results, reviewer actions, and determination history in one connected workflow.
Integrate eligibility information and next actions with hub platforms, pharmacies, HCP portals, FRM workflows, Salesforce Health Cloud, and Life Sciences Cloud.
Put Every Patient on the Right Access Path
Connect insurance discovery, income screening, eligibility determination, fulfillment, and re-enrollment in one electronic PAP workflow.