Creating & Running a Detection & Reporting System

  • Savings offers, such as copay offset and vouchers, have become a mainstay of pharmaceutical marketing, but systems designed to detect potentially inappropriate use of these offers have not been widely developed. A client team responsible for these programs suspected they were losing money due to inappropriate use—or even fraud, in some cases—but found they had few options for detecting this activity and routinely monitoring their programs.
  • We engaged with members of the client’s security, commercial operations, finance, and legal teams. With these insights, and with our assembled team of outside experts, we were able to develop a set of almost two-dozen possible ways that pharmacies and prescribers might inappropriately use these offers, either accidentally or with more sinister motives.
  • We then created techniques and processes that allowed us to validate these hypotheses, eventually filtering them down to a small set of primary predictors and an additional set of supporting elements.
  • The client’s initial efforts focused on just a small subset of highlighted pharmacies resulted in reversed claims that more than paid for the pilot program, and the governance board created to oversee the initiative approved scaling of the project to include multiple years of data and almost all of the company’s promoted products.
  • Our team continues to manage the program, and has invested in additional data analysis and visualization tools to further improve the process and expand these efforts.
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