Cohere Health Unifies Medical and Drug Utilization Management into One Precision AI Platform

Expansion helps health plans manage growing drug utilization, clinical complexity, and evolving federal requirements

BOSTON (October 20, 2026) – Cohere Health®, the leading clinical intelligence and operations platform for health plans, today announced its expansion into medical drug utilization management, with drug and medical services decisions now sharing the same clinical intelligence layer on the Cohere Unify™ platform. Health plans gain greater control and clinical precision by drawing on prior authorization data, medical services history, and the broader care context that standalone drug utilization management systems often cannot access.

As medical expense pressures grow, health plans need better ways to manage rising drug spend, increasing authorization volumes, clinical complexity, and regulatory requirements with efficiency and consistency. Cohere Unify helps health plans automate appropriate requests, reduce manual review burden, and connect the clinical, operational, and policy intelligence needed to manage medical drug utilization at scale.

Cohere Health’s clinically trained AI systems, which support 15 million healthcare decisions annually, help assemble the documentation and plan-specific criteria needed for each drug review. The system automates appropriate, policy-aligned requests in real time, while routing complex cases to expert reviewers with the relevant clinical context already attached.

“As therapies evolve, so do the policies and clinical criteria used to evaluate them–and that complexity creates real burden for both providers and reviewers, especially when legacy systems have not kept pace with modern clinical decision-making,” said Brian Covino, MD, FAAOS, chief medical officer at Cohere Health. “We’re addressing that challenge with clinical AI, giving health plans a stronger foundation for managing drug utilization with clinical consistency and rigor.”

That foundation also extends to the infrastructure health plans need to address evolving prior authorization and interoperability requirements. Cohere Connect™, the company’s interoperability solution, is built on FHIR® standards and already in production for CMS-0057-F. Those same proven capabilities will also support CMS medical drug authorization requirements upon finalization of the rule, offering health plans a head start on compliance while improving broader operational efficiency.

Cohere Health’s medical benefit drug utilization management capabilities are now available to new and existing health plan clients. For more information, visit https://coherehealth.com/utilization-management/drug.