We help clinics get patients on biologics faster
Ruma Care automates prior authorizations - we’re starting with clinics that administer the most expensive specialty medications.
Biologics are expensive medications that cost $80-$150K+ per year per patient, and often need to be administered in specific settings called infusion clinics. Medical providers buy these drugs up front to secure pricing deals and safer inventory - they are reimbursed for the cost of the medications through the patients’ insurance.
Because they’re so expensive, these specialty medications are denied by insurers at a rate of 37% each year. When they are denied, providers don’t get reimbursed for the medication and are left covering the costs. Ruma Care solves this so clinics get paid, patients get treated faster, and care teams spend less time fighting insurance.
Launch Video + Ruma Demo
Problem
Clinics can lose money when prior authorizations are denied.
Specialty medications like biologics cost $80K/year, which is why insurers are highly specific with requirements on access. Clinics are required to follow complex, hidden requirements such as:
- Trying cheaper drugs first
- Using specific drug brands or biosimilars
- Submitting through fax instead of portals
None of this is standardized. Each insurance company has different rules, and those rules change quarterly.
Clinics with high volume spend thousands of man-hours on completing these forms: the average prior auth takes 30 minutes and is still submitted through paper, fax, and phone. When it is denied, the process can stretch into weeks or months of appeals, phone calls, and faxes.
During this time, clinics have already invested staff time and often administered high-cost drugs. If reimbursement is denied, that cost is never recovered.
Product
We do solve the problems in 3 ways:
- For each medication, diagnosis, and insurance combination, Ruma extracts the submission criteria required to get the drug approved by insurers.
- We pull out the correct forms, then automate the form-filling for prior authorizations.
- Lastly, we enroll patients in copay assistance programs, all in one workflow and platform.
We turn a process that traditionally spans 70+ online portals, disparate paper forms, and manual phone calling into a single, streamlined platform. As we process prior authorizations, our models learn from denial patterns to understand exactly what insurers need to see to get a prior authorization approved.
We are live across clinics in California and Nevada, and helped them cut the denial rates by 50% and reduce staff time per prior auth by 20x.
Our Story
I quit my big tech job to work as a medical assistant. I wanted to understand why specialty medication access in America is so hard.
Christina experienced this as a patient herself, she spent years fighting payers to get on her biologic treatments.
We met at Yale’s CS50 class freshmen year and built a Yale dining app for food ratings. We took an entrepreneurship break to work in Big Tech (Apple, Uber, & Walmart), and startups (Medallion, Sigma), scaling Uber One across 13M+ users and building ML models for Siri and iPhone users. We built products for customers like United Health Care and the U.S. Health & Human Services. Now we’re building Ruma Care.
Here’s more about our story: https://substack.com/home/post/p-176970044
New Launch of Formulary Navigator - Free tool for providers
We spoke with 150+ providers. Every one said navigating insurance coverage rules is their #1 challenge.
So we created the Ruma Formulary Navigator.
Providers can enter the insurance plan, medication, and diagnosis, and instantly see coverage rules and prior authorization requirements. https://ask.rumacare.com
And we’re providing this for free to bring better access and knowledge to the medical community.
If you know any hospital administrators, doctors, and coordinators at infusion clinics and hospital systems, we’d appreciate an introduction.
Feel free to share this with any doctors, nurses, or medical admin staff struggling to understand new formulary changes in 2026:
Our Ask
If you know any hospital administrators, doctors, and coordinators at infusion clinics and hospital systems, and tech forward digital health clinics, we’d appreciate an introduction.
