Cohere Health vs CoverMyMeds (McKesson)
Two Prior Authorization vendors, side by side. Facts from public sources; judgments are ours.
At a glance
Derived from public facts · a rough scale, not a ranking
| Cohere Health | CoverMyMeds (McKesson) | |
|---|---|---|
| Pricing model | Enterprise contract (custom) · scoped by UM volume and model | Free to providers (funded by payers/pharma) · Payers, PBMs, pharma fund the network |
| Speed to go live | deep payer UM integration, multi-month program | Free self-serve portal; EHR-embedded options exist |
| Automation model | Software platform · AI-assisted utilization management decisioning | Data / network utility · medication ePA network and portal |
| Built for | Payers | Small practices, Mid-size groups, Enterprise systems, Payers |
| Security posture | HITRUST, HIPAA | No certifications published |
| Company maturity | 7 yrs (est. 2019) | 18 yrs (est. 2008) |
| Financial backing | $200M · Series C | Subsidiary of McKesson |
| Named customers | 3 named | None public |
| Published results | Specific numbers public | No public numbers |
| Documented integrations | 3 listed | 5 listed |
| Third-party validation | None found | None found |
Bottom line
- Pick Cohere Health if you are a health plan replacing legacy utilization management with AI-driven prior auth at Humana-proven scale.
- Pick CoverMyMeds if you want free electronic prior auth for medications with the broadest payer and pharmacy network.
Cohere Health
Intelligent prior auth platform for payers
- Founded
- 2019
- HQ
- Boston, MA
- Stage
- Series C
- Raised
- $200M
What it does
- Automates prior auth intake, review, and approval for health plans
- Auto-approves up to 90 percent of eligible auth requests
- Applies evidence-based clinical policies and physician-facing nudges
- Provider performance analytics to steer utilization management
- Payment integrity claims validation via Cohere Validate
- Delegated UM services across MSK, cardiology, imaging, sleep
Where it's strong
- Proven at national scale: over 12 million prior auth requests a year across roughly 600,000 providers, including a nationwide Humana deployment.
- High auto-approval rates (up to 90 percent) materially cut turnaround times and provider abrasion, which matters as CMS-0057 deadlines arrive.
- Well capitalized at $200M raised and expanding beyond prior auth into payment integrity, reducing single-product risk.
What buyers should weigh
- It sells to health plans, not providers; a provider organization only encounters Cohere through a payer that has adopted it.
- Much of its track record is concentrated in the Humana relationship, so plans of smaller size should ask for comparable references.
- Delegated UM and clinical policy alignment make implementations substantial projects with real compliance and integration work, not a light SaaS install.
Named customers
Humana · Geisinger Health Plan · Medical Mutual of Ohio
Integrations
CoverMyMeds (McKesson)
The largest electronic prior authorization network for medications
- Founded
- 2008
- HQ
- Columbus, OH
- Stage
- Subsidiary of McKesson
- Raised
- n/a
What it does
- Electronic prior authorization for retail and specialty drugs
- Specialty enrollment and hub services (RxLightning)
- Medical benefit PA for oncology and radiology (FastAuth)
- Benefit checks and prescription price transparency
- Patient affordability and copay program delivery
Where it's strong
- Network effects are real: it completed 43 million prior authorizations in the 2025 reverification season and most prescribers already have accounts.
- Free for providers and pharmacies, which makes adoption easy.
- McKesson ownership ties it into specialty distribution and pharma services that competitors cannot match.
What buyers should weigh
- Coverage is payer-dependent and shifting: Independence Blue Cross dropped CoverMyMeds for Surescripts ePA in August 2025, so verify your payer mix routes through it.
- It centers on medication PA; medical benefit and procedure prior auth needs mostly require other tools despite the FastAuth acquisition.
- Its revenue comes from pharma and payers, so provider-side feature priorities can lag.
Integrations
Compare against the rest of Prior Authorization
Deciding between these two?
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