Cheryl Allen-Munley, Nick Jenkins, Toheeb A. Biala, Evelyn Huszar
For most patients, filling a prescription at a pharmacy is akin to visiting a roulette table. The patient’s responsibility, copay, seems based more on chance than on logic. In actuality, copays are established through complicated negotiations and contracts between the drug manufacturers, third party payers, and the pharmacies. To rectify this problem, efforts were undertaken to develop models to first predict the amount copay and, secondly, to determine the drug’s formulary status (preferred / non-preferred / non-covered) based on the simulated pharmacy claims data provided by CoverMyMeds.