Comprehensive Drug Reimbursement Services
At Rx Navigator Solutions, our team of regulated health professionals provides end-to-end drug reimbursement navigation—streamlining access to medications while reducing administrative burden for healthcare providers.
Whether you need support for individual cases or ongoing navigation services, we bring clinical expertise, efficiency, and proven strategies to every patient journey.
Complete Navigation Solutions for Healthcare
Drug reimbursement isn’t just about forms—it’s about understanding the clinical rationale, regulatory requirements, and system workflows that determine access to care.
Our regulated professionals deliver a comprehensive, patient-centered approach that ensures no detail is missed and no patient is left behind.
Core Reimbursement Services
Expert support across all provincial and federal programs in Canada.
01.
Benefits Verification & Eligibility Assessment
We assess coverage options across public and private plans in all provinces and territories, providing clarity for both patients and providers.
- Private Insurance Plans – Detailed plan analysis and cost estimates
- Public Drug Programs – Coverage checks for programs like ODB, Trillium, BC PharmaCare, Alberta Drug Benefit, Saskatchewan Drug Plan, and others
- Federal Programs – NIHB, VAC, WSIB, and IFHP coordination
- Out-of-Pocket Cost Estimates – Clear breakdowns to support patient planning
Average turnaround: 24-48 hours | Success rate: 98%+ accurate estimates
02.
Prior Authorization Excellence
Our team streamlines prior authorization processes for public and private payers nationwide, ensuring complete, clinically supported submissions.
- Application completion with clinical justification
- Preparation of evidence-based criteria documentation
- Insurer communication and follow-up
- First-submission optimization for faster decisions
Average approval time: 40% faster than industry standard
03.
Provincial & Exceptional Access Programs
We manage access to provincial special authorization programs across Canada, including:
- Ontario’s EAP, BC Special Authority, Alberta’s SCAP, and more
- Full application coordination from start to finish
- Direct communication with prescribers
- Renewal tracking and continuity of coverage
EAP Success Rate: 78% first-submission approval
04.
Appeals & Resolution Services
When initial access is denied, we step in with strategic, clinically grounded appeals:
- Private payer appeals and escalation management
- Public plan denials (e.g., EAP, formulary exceptions, compassionate access)
- Coordination of multi-stage appeals, including external review processes
- Documentation, reporting, and outcome tracking
Appeal Success Rate: 85%+ successful reversals
05.
Financial Assistance & Cost Relief
We help identify and manage supplementary support options for eligible patients:
- Copay and manufacturer assistance programs
- Bridging supply coordination while coverage is pending
- Full navigation of Patient Assistance Programs (PAPs)
- Multi-payer coordination for layered coverage solutions
06.
Training & Workflow Optimization
We support healthcare organizations in building sustainable, in-house navigation practices:
- Custom SOPs and reimbursement protocols
- Practical training for pharmacy and clinic staff
- Ready-to-use workflow templates and tools
- Efficiency and communication improvements
Flexible Service Models
Support that fits your workflow, patient volume, and budget—no matter where you’re located in Canada.
Case-by-Case Support
Ideal for:
Features
Monthly Retainer Programs
Ideal for:
Features
Getting Started
Every engagement begins with a confidential consultation to understand your challenges, processes, and desired outcomes. From there, we recommend the optimal approach—whether that’s case-by-case support or a full retainer partnership.
Ready to streamline your drug access process?
Ready to optimize your drug access process? Contact our regulated health professional team for a consultation tailored to your specific needs. All discussions remain confidential under professional practice standards.
Testimonials
What our clients have to say
