He walked into Bain and asked to be staffed on anything but healthcare. The fax machines won that round. He came back to delete them.
There is a moment, after a prescription is written and before a patient ever receives the drug, where everything stalls. A form gets faxed. A payer asks for more. A practice re-sends. Somewhere in that loop, a person who was just told they might go blind, or that they have cancer, waits. Syam Palakurthy built a company to collapse that loop into something close to nothing.
That company is SamaCare, and Palakurthy is its co-founder and CEO. From an office on New Montgomery Street in San Francisco, his team runs a cloud platform that handles the unglamorous machinery of getting specialty medications to patients: prior authorization, benefit verification, enrollment in pharmaceutical support programs. The parts of healthcare nobody photographs. The parts that decide whether treatment actually happens.
The numbers are the pitch. More than 15,000 providers run on the platform. The practices it serves — retina, oncology, neurology, rheumatology — represent north of $20 billion in annual specialty drug spend. SamaCare reports cutting time-to-approval by 84%, trimming script abandonment by 24%, and reducing unnecessary denials by 42%. Translated out of the spreadsheet: more people get the drug their doctor already decided they needed.
In May 2024, investors agreed loudly. SamaCare closed an oversubscribed $17 million Series B led by Questa Capital, with existing backers Vive Collective and South Park Commons returning. It brought total funding to roughly $35 million. For a company selling something as deeply boring as workflow automation, that is a vote on the size of the boredom.
“When a patient gets a diagnosis for a condition that requires one of these drugs, that is one of the worst episodes they’ve ever experienced in their life.”
— SYAM PALAKURTHY, ON WHY THE WAIT MATTERSPalakurthy studied at Dartmouth College, where he took a degree in engineering modified with economics — a deliberate pairing. He liked practical problem-solving and he liked markets, and he wanted both in the same toolkit. It is the kind of combination that produces people who look at a broken system and immediately start counting the dollars leaking out of it.
Then he joined Bain & Company. And here is the detail worth keeping: when he sat down with the staffing manager, he asked to be put on essentially anything except healthcare. He wanted to stay as far from it as he could get. The man who now runs a healthcare company once treated it as the one industry to avoid.
Healthcare, it turned out, had a personal claim on him. His father was an electrophysiologist, and Palakurthy grew up watching the ratio that defines modern medicine: roughly 16 administrative support staff for every doctor. A cardiologist surrounded by paperwork. That image — clinicians outnumbered by clerks — is the thesis of his entire career, even the part where he tried to dodge it.
“Anything but healthcare.” He said it on day one at Bain. The industry did not take the hint. A decade later he had founded two healthcare companies and raised tens of millions to fix the exact thing he wanted to flee.
His father’s practice ran sixteen administrative staffers per physician. Most founders cite a market study. Palakurthy cites the dinner table.
Before SamaCare there was Chronic Care Management LLC, where Palakurthy helped primary care practices offer lifestyle coaching for conditions like diabetes and hypertension. Then a turn as Senior Director of Product at ClearCost Health, learning the economics of who pays for what in American medicine. By his own count he has spent more than a decade building technology products for self-insured employers, payers, providers, pharmaceutical companies, and patients — every seat at the table that healthcare puts in a patient’s way.
SamaCare started in 2018, narrow on purpose. The first beachhead was retina care inside ophthalmology — a specialty where delay can literally mean lost vision, and where the drugs are expensive enough that payers fight every step. From there it widened: oncology, rheumatology, neurology, ambulatory infusion centers. The product expanded too, from pure prior authorization into benefit verification and enrollment in pharmaceutical support programs. Palakurthy calls the destination a “Script-to-Therapy Operating System.” The phrase is engineer-speak for a simple promise: from the moment a doctor signs to the moment the patient starts, nothing should be allowed to break.
His framing for failure is a football metaphor he keeps returning to. When a patient is approved, ready, prescribed — and still does not get the drug because a form stalled — the system has, in his words, lost that patient “at the one yard line.” SamaCare exists to stop the fumble.
Strip away the jargon and prior authorization is simple to describe and brutal to live through. A doctor decides a patient needs a specific drug. Before the patient can have it, the insurer demands proof that it is necessary. That proof travels, astonishingly often, by fax and paper. Forms get filled out by hand, sent, lost, re-requested, resent. Each round trip adds days. For specialty medications — the high-cost biologics and infusions that treat cancer, blinding retinal disease, and debilitating rheumatological conditions — those days are not administrative footnotes. They are the difference between a treatment working and a window closing.
Palakurthy describes the process bluntly as a “care-delay machine.” His insight, the one that turns an annoyance into a company, is that the bottleneck is almost never the patient’s willingness or the doctor’s judgment. As he puts it, the fight is “less about convincing patients to use the drug and more about administrative and financial blockers.” The medicine is decided. The paperwork is what fails. So SamaCare went after the paperwork.
That is a deceptively hard target. Every payer wants its own form, its own rules, its own portal. A practice managing prior authorizations across dozens of insurers and dozens of drugs is running an unwinnable game of administrative whack-a-mole. SamaCare’s platform sits on top of that chaos: one place to submit, track, and manage authorizations and benefit checks across payers and drugs, with the manual paper-and-fax steps digitized out of existence. The work is invisible when it goes right. Which is exactly the goal.
Numbers SamaCare reports for practices on the platform. Read them as the difference between a patient who starts therapy and one who quietly disappears from the funnel.
“We want to make it so all administrative obstacles are as simple as a credit card swipe.”
“They’re essentially losing that patient at the one yard line.”
“By digitizing the current manual paper-and-fax-heavy process, our platform reduces the administrative burdens that harm patient care.”
“It’s less about convincing patients to use the drug and more about administrative and financial blockers.”
“My dad was an electrophysiologist… it was 16 administrative support professionals for every doctor.”
“The support of Questa Capital and our current investors will help us accelerate much-needed change to a cumbersome system.”
Palakurthy stacked SamaCare with operators who know the wiring. CTO Nathaniel Fisher arrived with 18 years across Walmart Labs, Evidation Health, Stronghold Payments, and Hivemapper. VP of Finance and Operations Sarah Parmacek co-founded Soundry Health and came up through FFL Partners and, like her CEO, Bain & Company. Kip Theno leads provider sales with 24 years commercializing medical technology, and Raj Sabharwal runs life-sciences business development off two decades in real-world data and health policy.
The pattern is intentional. This is not a team of pure technologists betting they can out-code a regulatory swamp. It is a team that has lived inside payers, providers, and pharma, and decided the swamp was a software problem all along.
Ask Palakurthy what winning looks like and he reaches for the most ordinary transaction in modern life. A credit-card swipe. Instant, invisible, trusted. He wants the distance between a prescription and a patient on therapy to feel exactly that frictionless — no fax, no re-send, no patient lost while the paperwork catches up.
It is an unfashionable ambition. There is no consumer app to demo, no viral moment. Just the slow, stubborn work of making a $20-billion corner of medicine stop tripping over its own forms. Which may be the point. The most valuable problems are usually the ones too dull for anyone else to want.
“Ensure every patient gets on the right therapy, at the right time, irrespective of administrative obstacles.”
— SAMACARE, THE COMPANY HE BUILT TO MEAN IT