Frequently asked questions.

Q1. Why does prior authorization fail to control drug spend?

Prior authorization focuses on clinical eligibility, not cost. Once criteria are met, drugs are often approved without evaluating lower cost alternatives, formulary alignment, or site of care. This creates hidden spend at the point of decision.

Q2. Why are so many prior authorization requests denied or reworked?

Most issues stem from incomplete documentation, inconsistent criteria application, and lack of real-time clinical context. This leads to delays, rework, and unnecessary appeals.

Q3. How can payers reduce drug spend without restricting access?

Payers can improve outcomes by aligning prior authorization decisions with formulary strategy, pricing insight, and clinically appropriate alternatives at the time of review.

Q4. What makes ZEPRX different from traditional prior authorization platforms?

Most platforms process requests using existing rules. ZEPRX builds and optimizes clinical criteria, then evaluates each request in real time to ensure decisions align with both clinical evidence and cost strategy.

Q5. Does ZEPRX replace existing prior authorization systems?

No. ZEPRX enhances existing workflows by adding clinical intelligence, cost visibility, and decision support, helping teams make more accurate and efficient decisions.