Quarterly analysis of prior authorizations without manufacturer-sponsored SamaCare intervention support shows 76.5% average net approval rate and 2.09-day average time to resolution, with meaningful variation by specialty, therapy stage, medication, and payer workflow

SAN FRANCISCO, July 28, 2026 /PRNewswire/ -- SamaCare, the leading intelligent system for medical benefit prior authorization, today released its Q2 2026 Market Access Benchmarks for medical benefit drugs, providing life sciences companies and specialty providers with real-world visibility into how prior authorization impacts patient access to care.

Derived from prior authorization activity across the SamaCare platform, the Q2 benchmarks reflect baseline performance for medical benefit drugs submitted by thousands of practices nationwide without manufacturer-sponsored SamaCare intervention support. The benchmarks focus on two core measures of patient access: average prior authorization net approval rate and average time to resolution.

For Q2 2026, SamaCare's benchmarks show (calculated for PAs without SamaCare support):

• Average Net Approval Rate: 76.5%
• Average Time to Resolution: 2.09 days

While these headline metrics provide a high-level view of medical benefit prior authorization performance, SamaCare's Q2 analysis shows that access conditions vary significantly beneath the aggregate average.

For example, Q2 data show meaningful differences between therapy initiations and continuations. Across most measured specialties, continuation prior authorizations had higher net approval rates than initiation prior authorizations, suggesting that first-time therapy starts remain a critical point of access friction. Retina was the exception, with initiation approval rates slightly exceeding continuation approval rates during the quarter.

Drug-level analysis also showed meaningful variation by individual medication and therapy type. Therapies with more complex access pathways, including select specialty biologics, newer formulations, biosimilars, and drugs where route of administration or site of care may affect coverage, showed greater variability in approval rates. In particular, immunoglobulin therapies, chronic inflammatory biologics, and select neurology therapies showed more variable baseline approval performance.

The data also suggest that newer formulations and route-of-administration changes, such as subcutaneous delivery, may create distinct access patterns, even when they are associated with established therapeutic franchises. For manufacturers, this underscores the importance of monitoring access performance at the product and formulation level, not only at the brand, class, or specialty level.

"Average prior authorization performance only tells part of the story," said Syam Palakurthy, Founder and CEO of SamaCare. "For market access teams, the real question is where access breaks down, for which patients, in which specialties, and under which payer workflows. Q2 datas show that medical benefit prior authorization performance can look very different depending on whether a patient is starting therapy, continuing therapy, or navigating access requirements for a specific medication."

SamaCare's payer-level analysis found additional variation in both approval rates and time to resolution. Across payer-specialty combinations, the median payer-level average time to resolution was approximately 2.1 days, while the slowest 10% of payer-specialty combinations averaged more than 8.8 days. Drug-payer analysis also showed that the same medication can have materially different approval rates across payer workflows, underscoring how payer policy interpretation, documentation requirements, and operating models can influence patient access even when the prescribed therapy is the same.

For life sciences organizations, these differences can shape brand performance, patient starts, abandonment risk, field reimbursement strategy, provider education, and patient support. For specialty practices, they can determine how much staff time is required to move a patient from prescription to treatment.

"Medical benefit access is not one national average," Palakurthy added. "There are thousands of local workflows happening across therapies, providers, payers, plans, and sites of care. The more clearly we can see that variation, the better the industry can target interventions that help patients start and stay on the therapies their physicians prescribe."

SamaCare's Market Access Benchmarks are derived from the company's broader intelligent system for medical benefit prior authorization, which combines workflow automation, payer policy intelligence, real-world provider data, and AI-driven insights to help reduce administrative barriers to care. Separately, manufacturer-sponsored SamaCare intervention programs have produced an average 84% faster time to resolution and 42% lower denial rates.

In addition to public quarterly benchmarks, SamaCare provides life sciences organizations with deep therapy-specific analytics to identify patient access barriers, benchmark performance, and inform targeted interventions across market access, patient services, field reimbursement, and provider engagement teams.

To explore the Q2 2026 Market Access Benchmarks, visit https://www.samacare.com/market-access-benchmarks.

Methodology

SamaCare's Q2 2026 Market Access Benchmarks are derived from real-world medical benefit prior authorization activity across the SamaCare platform. Net Approval Rate represents the percentage of prior authorizations ultimately approved by payers. Average Time to Resolution represents the average number of days required to receive a payer decision from time of initial prior authorization submission. Public benchmark data is aggregated and de-identified.

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.

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SOURCE SamaCare