Case Study

Pharma Marketing AI Helps Prevent Drops from Medicare Coverage Gaps

Client

Pharma Marketing AI

Key Results

46K+ Incremental Prescriptions

The challenge

Challenge

A mature brand from a top 5 pharma manufacturer faced rising risks of therapy switching and non-adherence due to the Medicare "donut hole" coverage gap. With an older patient population relying heavily on Medicare, out-of-pocket costs spiked unpredictably based on individual medication spend. Providers lacked visibility into when patients would enter the gap, making it difficult to proactively offer financial support—often leading patients to consider lower-cost generics.

By predicting Medicare "donut" entry and delivering EHR-integrated financial support messaging.

The solution

AI-Driven Predictive Modeling

Developed a proprietary AI model leveraging multiple real-world datasets. Accurately predicted point-in-time when patients were likely to exceed Medicare spending thresholds. Identified at-risk patients just before entering the coverage gap where medication costs spike.

Targeted Provider Engagement

Delivered brand-specific financial support information to treating physicians. Integrated messaging directly within the EHR workflow. Ensured outreach occurred at the point of care when treatment decisions were being made.

The results

Results

Program Duration: 6 months

Impact: Enabled identification of previously unknown physicians treating at-risk patients, expanding outreach.
Increased engagement by delivering support only when relevant to patient needs.
Enhanced provider-patient interactions by adding meaningful, timely value.

Key results

Incremental Prescriptions: Driven by precise patient identification and timely HCP engagement.

46,000

of HCPs Enrolling Patients for the First Time: Expanded outreach to previously unidentified physicians.

27%

ROI: Demonstrated high efficiency and impact of the AI-driven campaign.

6:1

Results that speak for themselves.

From rare disease to mass markets, our clients move faster, waste less, and turn coordinated marketing into measurable script lift.

Data Driven Decision-Making Drove 10:1 Return on TV Ad Spend

Learn how data-driven decision making in pharma delivered a 10:1 ROI on TV ad spend through precise targeting and omnichannel engagement.

The ad ranked in the top 25% for impressions per new prescriptions (NRx) generated.

25%

Return on Advertising Spend (ROAS) Digital Display

10:1

Audience segments ranked in the top one-third for impressions per NRx generated.

3/4

AI-Powered EHR Messaging Drives Significant Referrals for Rare Disease Treatment Referral

Discover how AI in HCP engagement improved rare disease referrals by delivering timely, EHR-based education to pediatricians and specialists.

Higher Overall Referral Rate in the test group compared to the control group.

23x

Increase in Pediatric Endocrinology Referrals in the test group versus the control group.

110x

Increase in Pediatric Genetics Referrals in the test group

~6x

Improving Audience Quality for CTV with Clinical Connected Datasets

See how OptimizeRx drove ROI in pharma CTV advertising by using clinical data and Micro-Neighborhood® targeting to improve audience quality.

OptimizeRx targeting had the best performance of all partners in both audience quality and cost per diagnosed patient

Our Micro-Neighborhood® targeting platform produced higher audience quality than the national benchmark

Higher audience quality rate than the next performing partner

60%

Healthcare marketing is evolving.

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