Latest trends in healthcare AI: Pharmacies, payers, and pharma


Here’s a survey of how pharmacies, payers, and pharmaceutical companies are using artificial intelligence right now.

Pharmacies: Personalizing care, making better decisions

A May 2019 article in the American Journal of Health-System Pharmacy, “Using artificial intelligence in health-system pharmacy practice: Finding new patterns that matter,” looks at the use of AI in prescription anomaly detection for the purpose of calling out strange or unusual prescriptions. In the study, the investigators looked at the real-world prescribing patterns for metformin 500 mg, By first teaching the AI the usual prescribing patterns for this drug, then letting the AI systematically apply these patterns to classify electronic prescriptions from 2017, the investigators said the AI flagged 6% of the prescriptions as having unprecedented instructions never seen in the prior year. “There are many decision tasks in pharmacy that could potentially be better informed by using AI,” the article’s authors say. “These include drug treatment decisions, drug selection decisions, drug dosing decisions, and decisions about inventory par values, to name a few. It is not difficult to find decision tasks in pharmacy to which AI could be applied.”

Payers and PBMs: Using real-time data for tracking population health

At an educational session held at HIMSS2019, executives from some of the largest pharmacy benefit managers (PBMs), e-prescription enablers. and payers in the United States stressed the importance of enabling intelligent analytics and seamless access to data to control spending and meet federal goals for patient empowerment, according to Health IT Analytics. “We need to make sure patients get on their medication and stay on it,” said Dr. Troyan Brennan, executive VP and chief medical officer at CVS Health. “Data transparency and pricing transparency are only going to help that. If we let people know there’s going to be a PA [prior authorization] or that there’s a cheaper alternative, they can take action based on that information. That means the patient is more likely to pick up their medication, and they’re probably going to take it. That drives savings throughout the care process and can contribute to the better outcomes we’re all looking for.”

Pharmaceutical companies capitalize on digital therapeutics

One of the hottest areas for pharma companies is digital therapeutics. As defined by the Digital Therapeutics Alliance, these are “evidence-based therapeutic interventions driven by high quality software programs to prevent, manage, or treat a medical disorder or disease.”

According to a January 2020 article in Managed Healthcare Executive, with digital therapeutics, data collection occurs via FDA approved, clinical grade wearables, and this data is combined with patient-reported data. All of the data is then analyzed with an FDA-cleared analytics engine, says writer Kuldeep Singh Rajput. “Active and passive data collection and predictive analytics powered by artificial intelligence (AI) can offer timely insights into efficacy and outcomes as well as quality of life measures such as functional capacity. When digital therapeutics are leveraged, drug therapy can be titrated for optimal effectiveness—and a worsening condition can be predicted well in advance of when it would have otherwise occurred, enabling earlier interventions.”

Digital therapeutics can also help pharma companies support patients with medication adherence. The results of a survey of patients released in February 2020 by Human Care Systems showed 57% believe that pharma companies should offer patient support services, and 63% say that they would opt into such services. Patients with more serious conditions such as cancer or lupus showed an even greater interest in these services. But 80% of respondents are unaware of the patient support services offered by drug manufacturers.

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