Stop your spouse running out of Humira because nobody warned you the prior auth expired. Track every approval's clock, get a 30-day heads-up, and have the appeal letter half-written when denial hits.

Source signals

• SIG-20260426-us-caregiver-tools-prior-auth-paper-trail: «1 in 3 insured adults call prior authorizations a major burden» (KFF) + «Mayo never got a letter or email notifying her that the clock had run out on her first prior authorization»
• SIG-20260426-us-caregiver-tools-printable-binder-anti-app-cohort: confirms PDF/letter handling is part of the workflow
• SIG-20260426-us-caregiver-tools-mychart-sibling-google-calendar-rejection: confirms caregivers do "manual ETL" between portals and personal systems

What we ship

**Core features (MVP)**

• **Add an authorization**: caregiver photographs the approval letter or uploads a PDF. LLM extracts medication, insurer, approval period, plan ID, denial reason (if any).
• **Expiry calendar**: vertical timeline of all authorizations and upcoming expiry dates.
• **Multi-channel alerts**: 60/30/14/7-day reminders by email + SMS, with a script for the call to the clinic and a nudge to the physician.
• **Denial workflow**: caregiver uploads denial letter → LLM extracts the reason → suggests 1 of 5 appeal templates (medical-necessity / step-therapy override / formulary exception / external review / state insurance commissioner). Pre-filled draft, caregiver edits and prints.
• **Call log**: 5-second log of phone calls — "Insurer: Cigna, Rep: Sarah, Ref#: 12345, said: refile via fax to 1-800-…" — structured, attached to appeals as paper trail.

**Primary user flow**

1. Caregiver signs up, adds a "patient" (themselves or a relative).

2. Uploads 1–5 current approval letters — LLM parses in minutes.

3. Sees calendar: "Humira approval expires Mar 15, 2027 (47 days)".

4. 30 days out — SMS: "Time to ask Dr. K to refile Humira PA — clinic phone: 555-0100".

5. On a denial — "start appeal" button, 80% draft already written, caregiver adds 2–3 sentences and prints.

6. Free: 1 patient, 3 authorizations, 30-day call log. Pro: $14/mo or $119/yr — unlimited authorizations, multi-patient, unlimited history, IRS export.

**What it looks like**

• **Landing page**: hero "1 in 3 insured adults call prior authorization a 'major burden'. We make it 30 minutes a quarter, not weeks." — pain-anchored, with the KFF citation in plain sight.
• **Main app screen**: red/yellow/green light per authorization, top banner "Next expiry: Humira in 47 days".
• **Appeal letter**: one-page draft in legal format, ready to print on the clinic's letterhead.

**MVP build plan (9 days)**

• Day 1–3: Postgres schema (patients, authorizations, denials, calls, appeal_drafts), FastAPI core, R2 for letter PDFs.
• Day 4–5: LLM letter parser (structured JSON: medication / period / denial_reason).
• Day 6–7: alert pipeline (cron + Twilio + Resend), expiry calendar UI.
• Day 8: appeal templates (5 types) + draft generator. Stripe paywall.
• Day 9: KFF-citation landing, deploy, launch.

Reasoning

KFF polling is brutal: 1 in 3 insured adults calls prior auth a "major burden". The cohort numbers in the millions. Existing solutions split into: (a) provider-side platforms like Waystar (B2B for clinics, not patient-side), (b) general chronic-care apps (aidyhq, chroniccare.agentive — bundling PA into a broader apparatus), (c) Counterforce Health (focused on appeal letters, but not tracking expiry). We build a focused PA tracker for the consumer side: expiry alerts (which Counterforce does not do) + LLM letter parsing + a one-page appeal generator. 9 days on our stack. Regulatory risk is low: caregiver uploads their own letters and uses the outputs themselves; we are a document organizer, not a legal-advice tool (explicit disclaimer). We do not store PHI as a HIPAA-covered entity — we are a document-storage SaaS (like Dropbox), not a healthcare provider.

Quick competitive read

Profiled 5 closest consumer-side competitors (CMP-IDEA-049-*). Density: **medium-low (4 direct denial-stage players + 1 adjacent billing-stage)**, but **white space on the expiry-stage axis remains wide open** — none of the 5 track prior-auth expiry dates as a focused product feature.

• **Counterforce Health (counterforcehealth.org)** — Free, grant-funded nonprofit (Durham NC, founded 2025, $280K NIH/PennAITech grants, ~20K users helped). AI drafts appeals + voice agent "Maxwell" follows up by phone. Denial-stage. **Does NOT track expiry.** Strongest defensive partner candidate (we hand off to them when an expiry-miss leads to a denial).
• **Claimable (getclaimable.com)** — $39.95/appeal, seed-funded (Humanrace Capital + Walkabout Ventures, founded 2024). Specifically targets autoimmune (Crohn's/UC/RA — exact overlap with our cohort) plus GLP-1, expanding to cancer/MS. 4 drugmaker partnerships. Per Bloomberg: their own investor admits "DTC alone doesn't scale". Denial-stage, no expiry tracking. **Closest direct overlap on cohort, but our subscription model targets calmer recurring-care moment, not panic moment.**
• **Fight Health Insurance (fighthealthinsurance.com)** — Free, open-source side project of Holden Karau (Netflix engineer, $10K personal dev cost, founded 2024). Single-developer team risk. Denial-stage, no expiry tracking. **The "free forever" anchor** — our $14/mo must be qualitatively different.
• **Patient Advocate Foundation (patientadvocate.org)** — 501(c)(3) since 1996, free 1-on-1 human case manager. Drugmaker-grant funded (perceived COI in some communities). Pipeline overloaded, triage favors high-acuity oncology. **Adjacent — high-touch human service, not software.** Caregiver in calm/planning mode falls between their cracks; that's our white space. Partnership: refer complex cases out.
• **Goodbill (goodbill.com)** — $0 to start, 20% of savings success-fee. Founded 2022, B2C + B2B-employer tiers. **Adjacent (billing-side, post-bill) but frame parallel** — "Goodbill for hospital bills; us for prior-auth deadlines" is a tight positioning line. Their Reddit virality is a distribution lesson.

**White space confirmed**: every direct competitor (Counterforce, Claimable, FHI) is denial-stage / reactive. The preventive expiry-tracking lane is unoccupied. Risk vector: any of the three could add expiry tracking as a free feature — Karau in a weekend, Counterforce in a sprint, Claimable in a quarter. **Defensibility = niche cohort focus (specialty meds + caregiver multi-patient UX) + brand specialization in r/CrohnsDisease / r/MS / r/cancer + structured paper-trail workflow that one-shot appeal tools won't bolt on cheaply.** B2B/employer/specialty-pharmacy tier (à la Goodbill) is the natural 12-month monetization expansion.

• **Waystar / Cohere / Olive / Surescripts / CoverMyMeds / Myndshft** — B2B provider-side PA automation; explicitly out of scope (different audience).
• **Manual workarounds**: Notes app, paper folders, calendar reminders, Crohn's & Colitis Foundation appeal templates — current status quo for most caregivers.

Initial pricing hypothesis

Free: 1 patient, 3 authorizations, 30-day call log. Pro: $14/mo or $119/yr — unlimited authorizations, multi-patient, unlimited history, IRS export. WTP is high here: a single missed renewal = weeks without a $5K/month biologic. The cohort already pays $200/hr to advocates — $14/mo is an easy ask.

Distribution hypothesis

1) **Reddit r/CrohnsDisease, r/MultipleSclerosis, r/cancer, r/ChronicIllness** — solo-dev post "I built a prior auth expiry tracker because my husband almost ran out of Humira", authenticity-driven.

2) **Patient-advocacy nonprofits** (Crohn's & Colitis Foundation, MS Society, Patient Advocate Foundation) — outreach offering free Pro for their staff coordinators in exchange for a mention in their digital newsletter.

3) **Specialty-pharmacy waiting-room QR codes** — small-pharmacy outreach; win-win for them (fewer "my PA expired" calls into their queue).