Forus (formerly Tandem AI)

Overview

Forus, formerly Tandem AI, is an AI-native medication-access platform that automates the prescription journey from PA submission through pharmacy coordination, payer follow-up, and patient affordability for providers and patients, with a $1B valuation reported in early 2026 after a $100M round. The platform is positioned upstream of pharmacy rejection, embedded at point-of-prescribing in the EHR rather than activated only after a denied claim.

Forus is best read as a provider-side, AI-native medication-access platform, not as a payer UM tool, an outsourced hub, an appeals service, or a specialty-pharmacy. The relevant manufacturer wedge is broader than PA-only: EHR-native automation triggers at point-of-prescribing across PA, pharmacy routing, and affordability in a single workflow.

Reimbursement and PA Capability Model

The framework below standardizes how Rx Almanac evaluates reimbursement-prior-auth capabilities, so buyers can compare vendors like-for-like while the readout column stays vendor-specific. For this table, Forus (formerly Tandem AI) is evaluated as a provider-side, AI-native medication-access platform, not as a payer UM tool, an outsourced hub, an appeals service, or a specialty-pharmacy.

Capability	Buyer should compare	Forus (formerly Tandem AI) readout
Electronic PA initiation and payer connectivity	ePA submission, payer integrations, plan-specific requirements, real-time decisioning, and transaction reach.	Core PA casework. PA submission is a primary platform capability; validate live payer and EHR reach in RFP.
Benefits verification and coverage discovery	Eligibility, pharmacy/medical benefit checks, policy criteria, coverage route, and reimbursement path identification.	Coverage workflow. Coverage and affordability checks feed pharmacy routing and patient-affordability decisions.
Clinical documentation and appeals support	Document collection, criteria matching, appeal packets, peer-to-peer prep, and denial management.	PA casework. Forus reports elimination of roughly 13 hours/week of clinical PA work for providers; test appeals depth and denial workflows in diligence.
Provider workflow integration	EHR, portal, fax, call, pharmacy, and practice-management workflows that reduce office burden.	Core network reach. EHR-native automation triggered at point-of-prescribing is the platform’s structural design.
Automation, AI, and queue prioritization	AI agents, rules engines, form completion, status retrieval, queue triage, and exception handling.	Core automation workflow. AI-native architecture built without legacy technical debt; PA, pharmacy routing, and affordability run on one agentic stack.
Reporting, status visibility, and policy intelligence	Case status, payer trend reporting, denial reasons, turnaround metrics, and policy-change intelligence.	Confirm reporting layer in the RFP. Confirm dashboards, status fields, and what visibility flows to provider, hub, specialty-pharmacy, and manufacturer teams.

Buyer Fit

• Right buying motion: Include Forus when the bottleneck spans PA submission, pharmacy routing, and patient affordability at the point of prescribing — not only PA form completion.
• Best-fit buyers: Providers and patient-access teams running specialty and small-molecule programs where access friction at prescription drives abandonment; manufacturer commercial teams looking for upstream access visibility.
• Less ideal fit: Payer-side UM operations, outsourced hub case management, fulfillment, and dispensing.
• Commercial fit: Pricing is undisclosed; Forus reports a triple-stream B2B/B2B2C model (SaaS subscription plus value-chain economics). Scope governance, data rights, and reporting in the SOW.
• Pre-award diligence: Confirm payer and EHR reach, provider workflow placement, clinical review boundaries, appeals depth, and whether the engagement is provider-side, hub-side, or manufacturer-side.

Differentiators

• AI-native architecture: Built from scratch on agentic AI without legacy technical debt; one platform spans PA, pharmacy routing, and affordability.
• Point-of-prescribing automation: EHR-native triggers act upstream of pharmacy rejection rather than reactively after a claim is denied.
• Broader medication-access scope: Beyond PA-only competitors, Forus combines PA submission, pharmacy coordination, payer follow-up, and patient affordability in one workflow.
• Provider ROI signal: Forus reports elimination of roughly 13 hours/week of clinical PA work for participating providers.
• Founder profile: Sahir Jaggi (ex-Oscar Health Director of Product Strategy and Product Lead for Care Delivery and Patient Experience) brings payer-system depth to the design.

RFP Questions

• Which payer plans and EHR systems are live for the product’s expected patient mix?
• How does Forus route prescriptions across pharmacies, and how does affordability logic prioritize the brand?
• What clinician review, transcript QA, and audit controls govern AI-generated PA submissions and appeals?
• What status, denial-reason, and turnaround data can the manufacturer receive without crossing patient or provider compliance boundaries?
• How does the platform integrate with hub case management, specialty pharmacy, and manufacturer data warehouses?
• What references at manufacturer scale (not only provider-only) are available for comparable programs?

Recent Activity

• 2026-05 - Forus replaced Tandem branding across its website and LinkedIn presence; this profile now uses Forus as the active name while preserving Tandem AI as an alias.
• 2026-01 - Reported $1B valuation after a $100M round (Bloomberg, Modern Healthcare, PYMNTS).
• 2023 - Company founded by Sahir Jaggi (ex-Oscar Health Director of Product Strategy and Product Lead for Care Delivery and Patient Experience).