MedicarePharmAssist is a clinical decision support tool designed to identify medication savings and adherence opportunities—within each patient's existing Medicare plan. We help ACOs, hospitals, and care teams meet quality targets, reduce avoidable utilization, and support cost-conscious, patient-centered care. No change of insurance plan is recommended - only actionable strategies within the patient's current coverage.
Key Features
• Plan-specific medication cost optimization (no plan switching required)
• Pharmacy network navigation and refill timing insights
• Generic, biosimilar, and OTC substitution identification
• Patient affordability guidance (LIS eligibility)
• Subsidy/program utilization opportunities
• Clear, prioritized output for case managers or discharge planners
Operational Fit
• No EMR integration required
• Use by care teams and offered directly to patients
• HIPAA-compliant infrastructure
• Ideal for post-discharge, chronic care, and complex case workflows
Strategic Alignment
Our tool is aligned with CMS value-based initiatives and can support:
• ACO REACH and MSSP cost/utilization goals
• Medicare Advantage Star Rating adherence metrics
• CAHPS satisfaction improvements through cost transparency
Collaborate with Us
We are currently piloting with ACOs and health systems seeking tools that enhance medication access without workflow disruption. If your organization is focused on reducing cost-related non-adherence while supporting CMS-aligned care goals, we welcome a conversation.
Help your patients save money on their medications.
Use Case Alignment
Organizations participating in value-based care arrangements—such as the Medicare Shared Savings Program (MSSP), ACO REACH, or Medicare Advantage—face overlapping challenges:
• Reducing avoidable ED visits and hospitalizations
• Improving patient satisfaction and medication access
• Meeting adherence-based quality metrics (e.g., Star Ratings, MIPS, CAHPS)
• Navigating complex plan formulary rules and refill behaviors
MedicarePharmAssist addresses these challenges through automated, individualized insights based on a patient’s current plan, medication list, and behavior patterns.
How the Tool Works (Technical Overview)
Our engine performs a multi-dimensional analysis using:
• Formulary and cost-sharing data (CMS Part D files, crosswalked to patient plans)
• Patient-level behavior patterns (e.g. refill cadence, pharmacy preference, drug class sensitivity)
• Plan-specific pharmacy pricing logic (including preferred networks, quantity limits, tiering, and step therapy)
• Public assistance availability (manufacturer programs, LIS eligibility, etc.)
Output is provided as a concise, prioritized savings summary, highlighting:
• Alternative pharmacies (e.g. preferred networks, mail order)
• Quantity optimizations (e.g. refill and threshold timing)
• Generic/biosimilar substitutions
• OTC or plan-included alternatives
• Subsidy/program utilization opportunities
No change of insurance plan is recommended—only actionable strategies within the patient's current coverage.
Trusted Data Source
• CMS Medicare datasets — Our data is sourced directly from the Centers for Medicare & Medicaid Services (CMS) and is updated on the same schedule as CMS releases its official data.
• We use CMS data including Medicare plan formularies, drug tier structures, preferred pharmacy networks, etc.
