PrescriptSure · Pitch Deck
Pre-Seed · 2026
Pre-Seed Round · 2026
Building the Coverage Intelligence Infrastructure for Medication Access
We empower prescribers, pharmacies, and pharmaceutical manufacturers with real-time insight into drug coverage and access requirements — enabling patients to receive the right therapy without unnecessary barriers.
Raising
$1M
Structure
SAFE
Valuation Cap
$5M
Discount
20%
Runway
18 Months
Presented By
Shady Kassoumeh — Founder & CEO
The Problem
Medication access breaks after the prescription is written
The U.S. medication-access system is reactive. Coverage barriers are discovered only after a prescription is submitted, creating delays, rework, and treatment abandonment.
~60%
of specialty prescriptions encounter coverage barriers
PA, step therapy, exclusions, quantity limits
2–4
full-time staff
per specialty pharmacy dedicated to rejections and prior authorizations
Days → Months
to therapy initiation
while coverage requirements are resolved
High Abandonment
Many patients never start treatment
due to cost, delays, or required alternatives
Every stakeholder asks a different question…
Physician
Can I prescribe this?
Specialty Pharmacy
Can I get this approved?
Manufacturer
Why isn't the patient getting access?
All three questions require the same underlying coverage intelligence — yet today, no one delivers it before the prescription fails.
Workflows Today
Prescribing workflows are broken. Coverage barriers are discovered after the prescription is written.
Today, every stakeholder operates reactively—learning about coverage requirements only after a prescription has already entered the system.
Physician
Can I prescribe this?
- —Prescribes without visibility into payer requirements
- —Manual prior authorizations and alternative selection
Rework & delayed care
Specialty Pharmacy
Can I get this approved?
- —Discovers issues only after claim adjudication
- —Dedicated teams work denials and rejections
Operational burden & therapy delays
Manufacturer
Why isn't the patient getting access?
- —Learns about access failures after the patient is lost
- —Limited visibility into lost prescriptions and barriers
Lost prescriptions & market share
One Root Cause
Coverage intelligence arrives after the decision—not before.
The Result
Delay → Rework → Patient Abandonment
Solution
Coverage intelligence before the prescription fails
Enter an insurance plan and a drug. PrescriptSure instantly delivers the complete coverage picture at the moment decisions are made — not after claims are rejected.
Clinicians
Prescribe with Confidence
Choose therapies that are both clinically appropriate and accessible.
Pharmacies
Approve Faster
Prepare the right documentation upfront instead of reacting to denials.
Manufacturers
Enable Access
Help providers overcome barriers before prescriptions are lost.
One Search. Complete Coverage Intelligence.
The Compounding Advantage
Every search — and every real-world prior authorization outcome captured across the workflow — expands PrescriptSure's proprietary data asset, strengthening the platform and building a durable competitive moat.
Product Demo
PrescriptSure in action: verification in under 60 seconds
Why Now
Five forces are converging on coverage intelligence
Specialty drugs dominate spend
Specialty therapies represent a rapidly growing share of U.S. drug spend and carry the highest prior authorization burden, coverage friction, and abandonment rates.
Prior authorization is exploding
Prior authorization requirements continue to expand across payers, driving record administrative burden across providers and specialty pharmacies.
Regulation is forcing digitization
CMS interoperability and prior authorization mandates (CMS-0057-F) are pushing payers toward electronic prior auth workflows and faster decision timelines through 2026–2027, structurally enabling real-time coverage intelligence.
AI makes coverage automation viable
Modern AI systems now make it possible to interpret payer rules, extract clinical criteria, and generate documentation support at scale — capabilities that were not feasible even a few years ago.
The market has already validated demand
Real-time benefit tools are now embedded in EHRs, proving demand for point-of-care coverage visibility — while still leaving prior authorization logic, criteria interpretation, and outcome intelligence unsolved.
The Convergence
The infrastructure, regulation, and AI capabilities have converged — what was previously impossible is now the missing layer in healthcare.
Market Analysis
A large but structurally fragmented coverage intelligence market
PrescriptSure sits at the intersection of software, payer data, and workflow automation across the medication access ecosystem.
Market Size
US healthcare software, data, and analytics tied to prescribing, coverage, and access workflows
Reachable market over 5–7 years via specialty workflows and coverage intelligence layer
Initial wedge: early enterprise contracts and specialty pharmacy penetration
Scaled adoption across manufacturer-led distribution channels
Market Structure: Who actually matters
Providers (~1M prescribers)
RTBT tools are free and embedded in EHRs → low standalone willingness to pay
Distribution surface, not core revenue
Specialty Pharmacies (~3–4K)
Only ~500–1,500 are truly independent and addressable
Early wedge + real-time workflow data engine
Manufacturers (~50 large + 400+ mid)
$250K–$2M per brand in market access spend
Primary revenue engine
Market Access Teams
Embedded within manufacturers
Buyers within pharma contracts
PBMs / Health Plans
Highly consolidated, structurally difficult sales cycle
Long-term upside layer
Core Insight
There are effectively four buyers in this ecosystem — Providers, Specialty pharmacies, Manufacturers, and Payers / PBMs — but only one scalable enterprise revenue engine exists today: Manufacturers — where budget, urgency, and measurable ROI converge.
Business Model
Two primary buyers, one distribution layer
PrescriptSure is free for providers to maximize adoption and data capture, while monetization is driven through specialty pharmacies and pharmaceutical manufacturers.
Free Layer — Providers
Distribution + workflow entry point
- Free coverage intelligence at point of prescribing
- Drives usage, data generation, and system embedding
- No direct monetization
Purpose: eliminate friction and become embedded in clinical decision-making
Revenue Stream 1 — Specialty Pharmacies
Workflow efficiency SaaS
- Coverage verification + PA preparation tools
- Subscription: $15–30K / year per pharmacy (or tiered by volume)
- ROI driven by reduced rejections, labor savings, and faster turnaround
Value: operational efficiency + reduced manual rework
Revenue Stream 2 — Pharmaceutical Manufacturers
Market access + coverage intelligence platform
(Primary Engine)
- Enterprise contracts with brand teams and market access organizations
- Coverage intelligence + prior auth insights + access analytics
- Pricing: $250K–$2M per brand / year
Value: improved patient access, fewer lost prescriptions, better field visibility
Long-Term Expansion
Expansion into infrastructure and intelligence layers that compound the core coverage workflow:
API access for EHRs, payers, and pharmacy systems
Transactional prior authorization + documentation automation
Aggregated coverage and outcomes data products
Ecosystem integrations across prescribing and access infrastructure
Value: owning the intelligence layer that powers medication access decisions across the healthcare ecosystem and fuels growth towards $100M+.
Go-To-Market Strategy
Sequenced expansion driven by workflow, sales cycles, and data accumulation
PrescriptSure expands in phases aligned to adoption friction, procurement cycles, and data network effects.
Phase 1 (Yr 1–2) — Pharmacy Wedge
Land where ROI is immediate
- Direct outbound to independent specialty pharmacies with a clear operational ROI
- Reduces 2–4 FTEs per pharmacy tied to PA rework and rejection handling
- Targets high-friction specialties: oncology, immunology, rare disease
- Single buyer, single workflow, high urgency use case
Goal: Prove measurable efficiency gains and generate early usage density
Phase 2 (Yr 2–3) — Manufacturer Pipeline Activation
Start early to match enterprise sales reality
- Manufacturers require long procurement and compliance cycles (6–18 months), including legal and MLR/PRC review
- Pipeline opened at seed stage
- Contracts targeted for Series A–B conversion
- Revenue modeled as delayed and contract-lumpy
Goal: Align product maturity with pharma procurement timelines
Phase 3 (Yr 3–5) — Provider Distribution via EHRs
Scale reach through embedded workflows
- EHR integrations become the primary provider distribution channel
- Lightweight/free provider access acts as top-of-funnel adoption layer
- Provider usage drives data capture, not direct monetization
Goal: Expand system-wide coverage intelligence without sales friction
Phase 4 (Yr 5–10) — Intelligence Layer Expansion
Monetize accumulated coverage + outcome data
- Denial prediction and documentation intelligence products
- Expanded pharmacy + manufacturer analytics offerings
- Selective engagement with payers/PBMs where economically viable
Goal: Evolve into a coverage intelligence infrastructure layer
Core GTM Logic
Adoption starts where ROI is immediate (pharmacies), scales where budgets exist (manufacturers), and expands where distribution is embedded (EHRs).
Traction
Validated across all three stakeholders
Deep customer discovery across physicians, specialty pharmacies, and manufacturer field teams consistently confirms the same unmet need: a shared intelligence gap in medication access workflows.
Pilot Results
18
Clinicians in active workflows
130+
Verifications completed
~1 min
Lookup time
↓ from 30+ minutes manual
96%+
Reduction in verification time
65+
Staff hours saved
Across early clinical usage
Ecosystem Validation
MMIT
Payer and formulary data integration partner
FDB
Drug database infrastructure partner
Athenahealth
EHR ecosystem alignment pathway
Key Signal
Early usage confirms that coverage intelligence is not a feature request — it is a systemic workflow dependency across all stakeholders.
Product Roadmap
From coverage workflow → proprietary intelligence → automation layer
PrescriptSure evolves through three compounding product layers built on real-world coverage and prior authorization data.
Phase 1 (Yr 1–2)
Workflow + Data Capture Layer
Wedge product that builds the dataset no one else has
- Coverage status, tier, criteria, step therapy, quantity limits, alternatives
- Prior authorization guidance + documentation support
- Structured capture of PA submissions and outcomes (core moat asset)
Core objective: embed into workflow and generate proprietary access intelligence
Depends on: pharmacy workflow adoption + data capture enforcement through daily usage
Phase 2 (Yr 3–5)
Intelligence & Distribution Layer
Turn captured workflow data into market intelligence
- Market access & coverage intelligence for manufacturers
- Access friction & barrier analytics ("where and why scripts fail")
- Coverage Intelligence API (enterprise integrations)
- Early EHR-embedded coverage experience (distribution, not core revenue)
Core objective: monetize proprietary dataset + expand distribution reach
Depends on: sufficient scale of real-world PA + coverage outcome dataset
Phase 3 (Yr 5–10)
Automation & Decision Layer
AI-driven coverage execution layer
- Denial prediction and prior authorization outcome forecasting
- Plan-specific documentation generation
- Coverage change monitoring and alerts
- Workflow automation layered on existing ePA infrastructure (not replacement)
Core objective: shift from intelligence → autonomous workflow execution
Depends on: years of structured outcome data + established integration footprint
Defensibility Analysis
Three moats that compound over time
PrescriptSure’s defensibility is not single-layered—it is built through the interaction of data, workflow, and distribution.
Primary Long-Term Moat
Proprietary prior authorization outcome intelligence
Licensed formulary and coverage data is commoditized. The durable advantage comes from capturing real-world outcomes:
Which documentation led to approval or denial
By drug, plan, and indication
At scale across real prescribing workflows
This dataset cannot be purchased—it must be generated through embedded workflow usage over time.
Near-Term Stickiness
Embedded into daily prior authorization workflows
Specialty pharmacy teams using PrescriptSure for PA preparation and coverage checks experience operational switching costs:
Reduced rework and denial cycles
Faster approval preparation
Institutional reliance on accumulated case history
Sticky in practice, but fully dependent on continued data and workflow depth to strengthen over time.
Partner-Led Reach
EHR + ecosystem embedding
Integration into EHRs and pharmacy systems (e.g., Athenahealth, Epic) provides scalable distribution, but is structurally partner-dependent:
Strong initial reach
Limited control over platform dependency
Can be substituted if value weakens
Most powerful when combined with differentiated data and workflow depth.
Core Insight
None of these moats are sufficient alone. The defensibility comes from their compounding effect.
Funding Strategy
Capital aligned to data, workflow, and enterprise revenue inflection points
Each funding stage unlocks a new layer of product maturity, dataset scale, and commercial expansion.
Prove workflow adoption + begin data capture
Milestones
- 10 paying specialty pharmacy customers
- Validated workflow integration and usage
- Early structured prior authorization outcome capture
Product
- Pharmacy workflow + coverage intelligence (v1)
- Outcome capture layer (initial moat formation)
Revenue: $150K–$300K ARR
Scale workflow usage + open manufacturer pipeline
Milestones
- 25–50 active pharmacies
- Demonstrable accumulation of proprietary PA outcome dataset
- Manufacturer pipeline initiated (long-cycle enterprise sales)
Product
- Documentation intelligence layer
- Early analytics capabilities
Team Expansion
Sales leadership + engineering scale
Revenue: $1.5M–$3M ARR
Convert dataset into enterprise revenue engine
Milestones
- 100–150 pharmacies in production
- 3–5 manufacturer contracts closed
- EHR integration pilots underway
Product
- Market access analytics (GA)
- Coverage Intelligence API v1
Revenue: $6M–$12M ARR
Scale intelligence layer + automation
Milestones
- Manufacturer contracts become primary ARR driver
- EHR embedding live at scale
- Proprietary dataset becomes a competitive moat
Product
- AI-driven denial prediction
- Prior authorization automation
- Workflow intelligence layer
Revenue: $30M–$60M ARR → path to $100M+
Competitive Landscape
No platform connects coverage data, prior authorization, and outcomes in real time
The market is fragmented across data providers, transaction rails, and EHR features—each solving a narrow part of the workflow.
Today's Players
The Gap
Coverage intelligence is fragmented and never closes the loop from decision → approval → outcome.
PrescriptSure Positioning
The only real-time coverage intelligence layer across prescribing, prior authorization, and outcomes.
The Team
Built at the intersection of healthcare workflow, cloud infrastructure, UX, and clinical practice.
Shady Kassoumeh
Founder & CEO
Product leader with experience building and scaling SaaS products from validation through launch. Leads product strategy, fundraising, market validation, and go-to-market execution for PrescriptSure.
Mohammad El-Zaghah
Co-founder & CTO
Cloud and systems architect with deep expertise in AWS, secure infrastructure, and scalable healthcare platforms. Leads technical architecture, security, and platform engineering.
Dr. Samer Nachawati
Co-Founder & Strategic Advisor
Practicing physician with direct experience in outpatient prescribing and prior authorization workflows, ensuring product decisions reflect real-world clinical and operational constraints.
Leen Habbal
Co-founder & Head of Product & UX Research
UX research and product leader with a Master's in UX Research and Design. Focused on workflow design, usability testing, and building high-friction healthcare products that achieve real-world adoption.
Dr. Haroon Rasheed
Prospective Chief Medical Officer & Strategic Advisor
Board-certified pain management physician and CEO of Texas Pain Specialists. Provides clinical expertise and frontline insight into prescribing workflows, prior authorization, and specialty medication access.
Larry Warnock
Advisor, GTM & Venture Strategy
Venture and go-to-market advisor supporting commercial strategy, investor positioning, and scaling execution.
Why This Team Wins
- 01
End-to-end execution capability across product, engineering, UX, and clinical workflow
- 02
Deep domain alignment with real prescribing and prior authorization pain
- 03
Healthcare-native design thinking focused on adoption, trust, and workflow fit
- 04
Balanced leadership across build, validate, and scale functions
The Ask
Pre-Seed — Validating the Coverage Intelligence Wedge
Raising
$1.0M SAFE
Valuation Cap
$5M
Discount
20%
Runway
~18 months
Use of Funds (18-Month Allocation)
- Build and validate the core workflow + data capture system.
- Pharmacy coverage intelligence workflow (production-grade v1)
- Prior authorization guidance + documentation support
- Structured capture of PA submissions and outcomes (core dataset creation)
- Lightweight integrations where needed to support workflow adoption
- Security, reliability, and healthcare-grade infrastructure
Goal
Prove that real clinical and pharmacy usage reliably generates structured, proprietary coverage + PA outcome data
- Drive early adoption in specialty pharmacy workflows.
- 10 specialty pharmacy deployments
- Direct outbound sales + onboarding support
- Workflow training and adoption enablement
- Early manufacturer discovery conversations (pipeline formation)
Goal
Validate willingness to adopt + measurable operational ROI in real pharmacy environments
- Foundation for healthcare contracting and operations.
- Contracts, data licensing, and healthcare compliance support
- Vendor management and legal infrastructure
- Foundational clinical advisory engagement
What This Round Actually Proves
This round validates that real-world pharmacy adoption of a coverage intelligence workflow can generate proprietary structured data — creating the foundation for a scalable, defensible platform.
Building the intelligence layer that turns insurance complexity into predictable, actionable medical decisions.
Vision
A healthcare system where no patient is denied a clinically appropriate therapy due to preventable coverage friction.
Millions of prescriptions are delayed, denied, or abandoned each year — not because treatments fail, but because coverage requirements are not visible at the moment of prescribing.
PrescriptSure exists to eliminate that information gap at scale.
Mission
To make coverage, formulary, and prior authorization intelligence usable at the point of decision — and convert every interaction into a real-world dataset of medication access outcomes.
Shady Kassoumeh
Founder & CEO
sk@prescriptsure.com