Sales of specialty medications for chronic and complex conditions represent an increasing share of the U.S. healthcare market. They now account for more than half of prescription drug spend, a percentage projected to rise as costly new therapies are approved and utilization increases. At the same time, fewer than 2% of people in the U.S. use these high-cost treatments—meaning specialty pharmacies must compete for a limited target audience. And with the rise of consumerization and drug price sensitivity, these businesses also need new ways to differentiate themselves in the market and demonstrate value for consumers and the healthcare providers who treat them.

A Fortune 100 health insurance company saw this situation as an opportunity for its in-house specialty pharmacy. Working with ZS is helping the carrier forge deeper ties with prescribers nationwide and win more specialty prescriptions.

With a specialty pharmacy sales team and marketing team competing in an increasingly crowded market, the health insurance company recognized that traditional reporting was not measuring up. Not only could data not be effectively and efficiently used to meet aggressive business goals, but it also fell short of the increasing administrative burdens and various competitive factors reps were tasked to manage. Traditional reporting could neither offer action-oriented insights nor keep pace with the effort needed to continuously monitor prescriber behavior.

For this initiative, ZS developed a Salesforce-integrated app to surface AI-driven insights to the sales team. The insights were generated leveraging ZS’s intelligent platform by first bringing together more than 20 data feeds, including specialty pharmacy claims, and then leveraging ZAIDYN Customer Engagement to launch an insights-based artificial intelligence engine to orchestrate prescriber engagement through direct sales calls, practice-targeted internet display ads and emails, and other prescriber-facing channels.

Multiple deployment releases have occurred since the initial implementation, and the program is being managed on a real-stage release methodology. The project followed a three-pronged approach:

• Define desired insights to reflect strategic objectives. New accounts are accelerated after physicians make their first prescription to the specialty pharmacy, and reps are alerted to mitigate potential service issues. Prescribers writing fewer prescriptions than average or experiencing a bump in prior authorization denials, for example, might require immediate attention and support.
• Integrate data and validate hypotheses. Ongoing testing helps to ensure each program trigger is meaningful and can be acted on by reps—from prescription sales to market prescriptions, payer spend, rejections and demographics, and more. Statistical “difference of differences” testing validates sales lift and informs ongoing program refinement.
• Launch and operate the program—and measure program performance. ZS hosted internal focus groups and worked alongside the health insurance company’s reps to identify internal silos and to understand their territories. Learnings are packaged as “insights” rather than “tasks” to help ensure adoption, and delivery of insights has been ramped up and calibrated over time. Monthly success stories are shared across the team and help to encourage reps to share insights with their colleagues, and reps can provide real-time feedback by indicating whether an insight was useful.

Results have been impressive. The program ran with a return on investment of approximately 8:1 during its first year, and it’s routinely generating  approximately 5% more prescriptions per month. Reps act on approximately 70% of insights, and sales calls led with field insights are reported to be more than twice as effective as prior outreach.