AI Pharmacy

Medicare Part D performance comes down to two things: managing pharmacy cost and maximizing the revenue tied to member medication performance.

AI Pharmacy helps plans do both by engaging members in the conversations required to identify the right intervention, and then acting on it.

Reduce pharmacy cost. Move members toward lower-cost, clinically appropriate alternatives through biosimilar conversion, brand-to-generic programs, specialty pharmacy redirection, step therapy, and mail-order optimization. Instead of applying the same outreach to every member, AI Pharmacy identifies the barrier or opportunity and matches the intervention to it.

Improve adherence and Star performance. Reach members before a medication gap becomes a quality or clinical issue. Understand why a member stopped filling, resolve barriers such as cost, side effects, transportation, or confusion, and drive behaviors that improve adherence measures, including 30-to-90-day conversion and other high-value Part D quality initiatives.

Prevent avoidable medical spend. Medication performance is ultimately a clinical outcome. Closing adherence gaps and resolving therapy issues earlier can prevent deterioration that leads to avoidable emergency and inpatient utilization.

Across a full pharmacy population, these opportunities span dozens of programs and millions of member interactions. Traditional outreach can identify who needs attention, but it cannot consistently determine why, or carry the member through to the right next action.

AI Pharmacy gives Part D teams a scalable way to optimize the pharmacy P&L: lowering drug and medical costs while improving the Star measures that drive plan revenue.