Access and Medical Necessity Letters with Eric Mensh

Episode SummaryHow drug coverage gets decided and how to fix the paperwork bottleneck. Eric Mensh walks through what “market access” means in practice, why prior authorizations and appeals create friction for patients and providers, and how denial and appeal dynamics shape drug adoption. He also shares how his team built the aSound platform to cut medical necessity letter creation from about an hour to roughly 10 minutes, and what he is watching as the product expands beyond its initial rollout.Key TakeawaysMarket access is the coverage and payment layer that determines whether an FDA-approved drug actually gets paid for after it is prescribed.Prior authorization is often an automated gate, but the real bottleneck shows up when plans require medical necessity documentation and the office has to assemble a full support packet.Denials can be common in specialty drugs, yet appeals are underused, which shifts costs and frustration onto patients, providers, payers, and manufacturers.Provider time is the scarce resource in the system, so solutions that reduce letter-writing and packet-building can change behavior without asking clinicians to do more work.Insurance companies, manufacturers, providers, and patients all have incentives that can collide, which makes practical workflow improvements more realistic than trying to rebuild the entire system.Technology adoption in healthcare tends to move stepwise, so momentum often comes from solving the next most painful downstream task after an earlier workflow gets automated.TimelineEarly00:00 Introductions and Eric’s background from physical therapy into medical sales02:00 What “market access” means and why payment determines whether prescribing matters05:00 How coverage differs for self-administered drugs versus provider-administered drugsMiddle08:00 Formularies, coverage policies, and the setup work that reduces friction for providers12:00 Why drug pricing and access became more complex over time16:00 A concrete scenario where advertising drives requests, but plans steer to preferred drugsLate20:00 The paperwork problem, denial rates, and why appeals matter23:00 Why the system feels dysfunctional and where each stakeholder gets stuck26:00 The gap in the market: supporting medical necessity documentation, not just prior auth30:00 aSound’s launch timing, early rollout approach, and what growth depends on next32:00 Where to learn more and how to contact EricLinks and ResourcesLinkedIn: https://www.linkedin.com/in/eric-mensh-87644a1/Company: http://access-pointe.com/