Payer preferred-product intelligence for infusion centers
Which biologic each payer wants you to infuse — and what changed.
Every payer prefers a different biosimilar, and preferences change month to month. When an order comes in, Beacana shows your team what that patient's payer actually prefers, so you choose from the right options before anything is authorized or infused. The payer's policy document is behind every answer.
Remicade is approved only after trying one of these and having a reaction tied to its formulation. Prior authorization applies to every infliximab product.
The problem
Nothing in today's workflow tells the infusion team which biosimilar to pick.
The wrong vial is a denial
Payers steer hard between products of the same molecule. Infuse the one they don't prefer and the claim comes back, even when the drug itself was covered.
Preferences change without notice
Payers add products, drop products and swap their preferred biosimilar, often without grandfathering patients already on therapy. Last quarter's list is already wrong.
The answer is buried
It sits in dozens of policy documents per payer, written differently for commercial, Medicare Advantage and Medicaid. Teams keep their own spreadsheets, one molecule at a time.
How it works
Start from the order and the payer.
An order arrives. Before anyone authorizes or infuses it, someone has to work out what this patient's payer will actually pay for, then choose from those options. Beacana answers that in one search.
Enter the order and the payer
Type the medication as ordered, by brand, biosimilar or J-code, and pick the patient's plan.
See that payer's options
Every product the payer prefers for that medication, whether the one ordered is among them, and what stands in the way: precert, step therapy, a move to the pharmacy benefit.
Check the source
Every answer links to the payer policy it came from, so your team can verify it in one click.
Know what changed
A monthly change record lists what each payer moved, with upcoming changes dated so you can plan the switch.
What the change record catches
Not just "preferred." The changes that cost money.
Every payer change is classified by what it does at the infusion chair, so the ones that turn into denials surface first.
Site of care: covered drug, wrong building.
Some payers review whether an infusion may happen in a hospital outpatient department at all. That rule lives in a different set of policies from the preferred-product lists, and it shows up as denials or as patients sent elsewhere. Beacana is mapping which payers require it, and for which drugs.
Who it's for
Built for the people who turn an order into a paid claim.
Infusion and oncology pharmacists
Pick the right product the first time, without researching each payer's policy.
Pharmacy directors and VPs
One current source across sites, instead of spreadsheets that drift apart.
Prior-auth and scheduling teams
Stop spending authorization time on products the payer won't approve.
Revenue cycle leaders
Prevent the denial before the order is placed, rather than recovering it afterward.
Health-system infusion centers, independent infusion groups, and rheumatology, gastroenterology, neurology and oncology practices.
Coverage
Commercial, Medicare Advantage and Medicaid lines, read document by document.
Don't see your payer? Tell us which plans you bill. New payers are added in the order customers need them.
Policy Watch
Payer changes that affect infusion, explained when they're announced.
Aetna Commercial's January changes: bevacizumab, trastuzumab, checkpoint inhibitors and more
Eight classes move, and four products change status for one site of care only.
Anthem Commercial names its first preferred denosumab biosimilars
Two biosimilars join Prolia and two join Xgeva. Anthem's Medicare tables still prefer the reference products alone.
Humana Medicare Advantage swaps its preferred trastuzumab
Kanjinti and Ogivri traded places. Some patients already on Kanjinti are exempt from the new step.
Every answer is cited
Each designation names the payer document it came from, with a link. Nothing is inferred from anything else.
No patient data, no integration
The lookup runs in a browser and never sees patient information, so there is no patient data to share and no integration to scope.
Refreshed every month
Payer documents are checked for new editions monthly, and upcoming changes are dated, not applied early.
Questions
How do I know an answer is right?
Every designation links to the payer policy it came from. If a row ever disagrees with what your payer actually adjudicated, tell us and we'll trace it.
How current is it?
Sources are re-checked every month, and each release carries a data-as-of date. Announced changes appear ahead of their effective date and flip on the day.
Is this the medical benefit or the pharmacy benefit?
The medical benefit: physician-administered drugs billed from an infusion suite. When a payer moves a drug to the pharmacy benefit, Beacana flags it, because that is the most expensive change to miss.
Does it cover my payers?
It covers the national carriers across their commercial, Medicare Advantage and Medicaid lines, and coverage grows every month. Send us your payer mix and we'll show you what's covered today.
Does it replace prior authorization?
No. It makes sure the authorization you submit is for the product the payer wants, which is the step most likely to decide whether it pays.
About Beacana
A small company with one job: the right product, the first time.
We built Beacana because the most preventable denials in infusion come down to one question nobody's workflow answers: which product does this payer want? We answer it from the payer's own documents, and we show our work.