Prescription received
e-Rx auto-captured via Surescripts — patient matched, clinical team notified instantly.
Patient
Maria G.DOB 04/12/1968
Match confirmed
Drug
Ocrevus300 mg / 10 mL
NDC resolved · J0202 mapped
Service model
IOI + MID eligibleICD-10 G35 — MS
Mapped
e-Rx · Surescripts
→
OnePulse Connect
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Clinical team notified
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Patient SMS queued
Benefits investigation
Eligibility · Prior auth · Formulary · Buy & bill · Patient OOP — one automated pass in 3 minutes.
Eligibility✓ Aetna PPO active
AWP per dose$22,400
Prior auth✓ Valid thru 12/31/26
Expected reimb.$18,670
Formulary✓ Specialty tier 4
Patient OOP$0.00 via PAP
Buy & bill✓ Pathway confirmed
PA required?Yes — initiating
BI complete ✓ 9:07 AM · 3 minutes · PA workflow auto-triggered
Prior authorization
OnePulse Connect auto-submits PA with clinical criteria, diagnosis documentation, and prescriber attestation.
Auto-submission — 9:08 AM
OnePulse Connect pulls ICD-10 G35, J-code J0202, clinical notes, EDSS score, prior therapy history (Tysabri — failed). Submits to Aetna via Surescripts / CoverMyMeds integration.
PendingReal-time status check
OnePulse Connect pings the payer API every 4 minutes. Criteria checklist auto-populated: step therapy ✓, diagnosis documentation ✓, prescriber NPI ✓, formulary exception if needed.
TrackingApproval received — 9:31 AM · 23 min turnaround
Valid through 12/31/2026 · Quantity limit: 6 infusions/year · Auth # AET-2026-04419.
Approved
If PA is denied — the appeal path
OnePulse Connect keeps the case moving. Every denial triggers an automatic appeal workflow before the patient ever knows there was a problem.
Denial received — reason code flagged
OnePulse Connect parses denial reason: step therapy not met, medical necessity, or formulary exclusion. Routes to the correct appeal type automatically.
DeniedPeer-to-peer review scheduled
OnePulse Connect alerts the prescriber and schedules a P2P call with the medical director. Packages clinical evidence: EDSS scores, prior treatment failures, published clinical guidelines.
In progressFirst-level appeal filed
Letter of medical necessity auto-generated. Supporting literature attached. Submitted within 24h of denial — within the payer appeal window. IRO escalation queued if needed.
FiledBridge supply initiated in parallel
Manufacturer free-drug bridge or samples requested automatically while the appeal resolves. Patient never experiences a gap in therapy.
No gap in care
Financial assistance — full waterfall
OnePulse Connect searches every available assistance source simultaneously — manufacturer, foundation, state, and federal — before the patient is ever told what they owe.
1
Manufacturer Patient Assistance Program (PAP)
Genentech Access Solutions checked. Uninsured / underinsured patients: full free drug. Income threshold applied automatically. Enrollment packet auto-generated.
✓ Applied — $0
2
Manufacturer Co-pay Card / Co-pay Assistance
Ocrevus co-pay program checked. Commercially insured patients with remaining OOP: up to $25,000/year offset. eEnrollment completed in OnePulse Connect.
✓ Enrolled
3
Independent Foundation Grants
National MS Society, HealthWell Foundation, Patient Advocate Foundation, PAN Foundation — all checked for open grant cycles, eligibility, and application deadlines.
Checked — on file
4
State Pharmaceutical Assistance Programs (SPAP)
State-specific programs cross-referenced by patient zip code. EPIC, PACE, and equivalent programs flagged where applicable as payer-of-last-resort.
State verified
5
Medicare Extra Help / LIS + Medicaid dual eligibility
For Medicare patients: Low Income Subsidy screening automated. Dual-eligible patients routed to the correct pathway. Reimbursement protection maintained.
Screened — N/A
Care path selection
Physician selects pathway — both models share the same OnePulse Connect platform, assessment engine, and outcomes infrastructure.
MID
Medically Integrated Dispensing
Physician dispenses oral or injectable therapy directly from the office. Patient receives medication same day — site of care, not site of separation.
IOIselected for Ocrevus
In-Office Infusion
IV biologic administered in the physician's own infusion suite. Full nursing supervision, OnePulse Connect pre-infusion assessment, real-time clinical monitoring.
PA ✓ approved
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Assistance ✓ $0
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Schedule infusion
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IOI + MID same visit
IOI + MID in parallel
Infusion + dispense — same appointment, no outside pharmacy, no separate visit, no gap in care.
Appointment
Today · 10:30 AMSuite 2 — Chair A
Concurrent Rx
Copaxone40 mg / mL
In-office stock · MID dispense
Nurse assigned
L. Fleming, RNDuration ~3.5 hrs
Pre-infusion Ax ✓
→
IOI Suite 2
+
MID Dispense
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RPh counseling on demand
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48h follow-up auto-set
Patient communication
Automated HIPAA-compliant SMS at every milestone — PA status, $0 cost confirmed, appointment, follow-up.
OP
OnePulse Health
Shortcode 55400
Outcomes tracking
Assessment scores, adherence, gap-in-therapy — OnePulse Connect builds the evidence base for every manufacturer conversation.
✓
Mfr. outcomes report auto-generated
✓
CMS Star crosswalk complete
Next infusion auto-set · Gap-in-therapy tracked · Cycle complete — next queued · Mfr. data package ready
