Chemotherapy, immunotherapy, and targeted therapy require prior authorization from every major payer — and denials delay treatment while your staff spends hours on appeals that should never have been necessary.
| Drug / Class | Common Denial Reason | PriorZap Prevention |
|---|---|---|
| Keytruda (pembrolizumab) | Missing PD-L1 test documentation | Flags missing biomarker at order entry |
| Opdivo (nivolumab) | Step therapy — must try older agent first | Documents contraindications automatically |
| Ibrance (palbociclib) | Diagnosis code doesn't match payer criteria | Validates ICD-10 alignment before submission |
| Revlimid (lenalidomide) | REMS program documentation incomplete | REMS checklist embedded in CDS alert |
| Herceptin (trastuzumab) | HER2 status not documented in claim | Pulls HER2 result from FHIR record |
| Avastin (bevacizumab) | Not first-line for stated diagnosis | Line of therapy automatically documented |
Deploy at the point of prescribing inside Epic or Oracle Health. Every chemotherapy order triggers an automated prior-auth check before it leaves your EHR.