Applying AI and RWE to Prevent Discontinuation Due to Medicare Coverage Gaps
See how OptimizeRx Evidence-Based Physician Engagement generated 46K+ incremental prescriptions by predicting when patient drug costs were about to increase.
CLIENT GOAL
A mature brand wanted to prevent therapy switching or non-adherence due to a known gap in Medicare coverage ‒ the “donut hole”.
THE CHALLENGE
- Older patient population, many of which relied on Medicare for prescription coverage.
- Coverage gap triggered at different times for different patients, based on overall medication spend.
- Providers unaware when patients would hit the donut hole, so struggled to proactively flag financial support program.
- Patient out-of-pocket costs increased significantly during the coverage gap, making generic alternatives more attractive.
Download full case study
Download full case study
Predictive Algorithms
Proprietary AI model drew on multiple real-world datasets to identify patients just before they were about to enter the coverage gap where medication costs would increase.
HCP Audience Expansion
Predictive model allowed brand to identify previously unknown physicians with patients at risk of therapy discontinuation, increasing audience size and messaging reach.
Better Relevance and Actionability
Financial support programs introduced to HCPs only when it was relevant to their patients, increasing engagement and adding value to provider-patient interactions.
Point-of-Care Integration
Program introduced directly in the EHR workflow, raising awareness of financial support when and where providers were making care and prescribing decisions.