Image depicting at-home infusion treatment

CASE STUDY

National payor-owned specialty pharmacy embraces automation, drives efficiency

Under pressure to streamline operations and lower costs per fill, one specialty pharmacy looked to Infinitus for help supporting more patients and winning new business.

Challenge

A national payor-owned specialty pharmacy was under pressure to increase its operational efficiency and cut costs. At the same time, the specialty pharmacy was struggling with staffing issues and a backlog of benefit verification calls that needed to be completed. The pharmacy’s leadership sought a way to reduce friction and get treatments to those who need them as quickly as possible, helping to better serve patients and be in a position to win new business.

Solution

Seeking to streamline operations and enhance cost-effectiveness, the specialty pharmacy onboarded the Infinitus AI agent to automate benefit verifications, first in support of their home health products and later supporting hundreds of medications across their portfolio. The success of the partnership led the specialty pharmacy to increase its use of the Infinitus AI agent, which now also completes prior authorization follow-up calls. “Everybody loves it,” said one of the specialty pharmacy’s executives. “The reps say it’s such a relief not having to make the calls.”

Outcome

29 minutes

average time unlocked per benefit verification call completed by the AI agent

20 minutes

average time unlocked per prior authorization status call completed by the AI agent

314% increase

in benefit investigations completed by Infinitus YoY, with no additional staffing or technology solutions necessary

98% success rate

for benefit verifications

illustration of a bar graph going up

“Eva saves our employees time to focus on more complex tasks. An additional value add is that Eva can place more calls in a day [than a human], allowing us to service our patients faster.”

An image representing a healthcare leader who provided an anonymized quote

Specialty Pharmacy Executive

Here’s why it worked

The imperative in the pharmacy space to lower costs per fill necessitated a closer look at creating efficiencies in back-office processes. While the payor-owned specialty pharmacy wasn’t specifically on the hunt for an AI tool, its leaders knew they needed to lean into technology to support more patients and win new business. Those needs led the specialty pharmacy to Infinitus.

Infinitus automates the collection of healthcare data that has traditionally required a manual phone call. The Infinitus AI agent automates calls to commercial and government payors on behalf of specialty pharmacies across the US. Known as Eva by the payor agents she calls, the AI agent is powered by a multi-model, multimodal AI system and an in-house knowledge graph that contains up-to-date intelligence on commercial and government payor rules and guidelines that have been gathered from the millions of phone calls completed to date by the AI agent, plus access to EDI, payor APIs, and policy documents.

The specialty pharmacy began its relationship with Infinitus piloting a benefit verification program for some of its home health drugs, and its use has grown from there. “Infinitus is great to work with because of the speed in which we can get services up and running and the flexibility to adjust and optimize quickly as needed,” said the executive. The specialty pharmacy now offloads thousands of benefit verification and prior authorization status calls to Infinitus every month.

“Eva saves our employees time to focus on more complex tasks,” said the specialty pharmacy executive. “An additional value add is that Eva can place more calls in a day [than a human], allowing us to service our patients faster.”

Partners in technology

Like many others, the specialty pharmacy could sometimes struggle with implementing new technologies. Its relationship with Infinitus has been a success in great part because of the Infinitus team’s assistance in making the integration as seamless as possible.

The Infinitus team went above and beyond, providing additional support to IT leaders at the specialty pharmacy. In doing so, Infinitus was able to help the specialty pharmacy ensure its data was well organized and its process as streamlined as possible. Infinitus subject matter experts also provided operational and reimbursement consulting and advice along the way when it was needed, as the specialty pharmacy moved into different drugs, disease states, and centers of excellence.

The additional help led leaders of the specialty pharmacy to praise the Infinitus team’s ability to help them overcome internal hurdles, reporting the quality of service as better than expected and the Infinitus team’s responsiveness as “phenomenal.”

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Everybody loves it. The reps say it’s such a relief not having to make the calls.”

Can Infinitus work for you?

The Infinitus solution for specialty pharmacies augments specialty pharmacy staff by completing tedious tasks such as benefit verification, prior authorization follow-up, and prescription support, quickly and accurately. The Infinitus AI agent acquires more accurate data with a faster turnaround.

Infinitus supports over a thousand therapies, procedures, medications, and tests. We can work with your team to ensure that one of our standardized offerings aligns with your operating procedures and needs.

Make one call to change it all.

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