SOUTHBOROUGH, Mass.–(BUSINESS WIRE)–January 6, 2014–

According to NEHI, prescription non-adherence is costing the US healthcare system $290B annually. Over 15% of the Medicare beneficiaries reach the prescription coverage gap or “Donut Hole” annually and over 50% of these beneficiaries discontinue medication refills. RxAdvance announced today a unique and patent-pending service called “Donut Hole Predictor & Medication Management Using Therapeutic Alternatives” solution that can predict which Medicare beneficiaries are likely to reach the donut hole very early into the benefit year, and how to prevent them from reaching it using innovative technology, people, and processes. In addition, identifying target populations and offering alternatives and appropriate low cost therapies can promote medication adherence and reduce medical and pharmacy expenditures.

Today, more than 15% of Medicare beneficiaries enter the donut hole which has the unintended consequence of discouraging people from filling their medications when they have to pay higher costs. Many researchers have pointed that Medicare Part D beneficiaries are twice as likely to completely stop taking their medications when they enter the donut hole. People with chronic conditions, such as Alzheimer’s disease, diabetes and depression, have a much higher risk of reaching the coverage gap. According to studies, beneficiaries with cardiovascular conditions who had no financial assistance during the donut hole coverage gap were 57% more likely to discontinue their medications than beneficiaries with consistent drug coverage. As a result, there are many medication adherence problems in elderly patients, which ultimately cost billions of dollars in terms of avoidable emergency room visits, hospitalizations, physician visits and other healthcare costs.

RxAdvance, as a full service pharmacy benefit management (PBM) company, believes that the responsibility lies with PBMs to predict the coverage gap for each patient, determine alternative paths, and collaborate with the patient, prescribing provider, and the plan sponsor’s clinical and pharmacy staff to extend the coverage period and improve adherence. “We had a deep insight into this issue, and our goal was to get the answer plan sponsors are looking for. RxAdvance’s analytics predict the patient’s drug spend well in the beginning of the benefit year using a patent-pending cutting-edge algorithm, which combined with our data-driven clinical approach, predictive analysis, and comprehensive services, power our ‘Donut Hole Predictor & Medication Management Using Therapeutic Alternatives’ solution. It precisely studies patient disease, medication history, and utilization patterns to predict when a beneficiary would reach the coverage gap, and also provides alternative lower cost paths and comprehensive services to help beneficiaries avoid the donut hole,” says Ravi Ika, President and CEO of RxAdvance Corporation. “This system gives real-time calculation capabilities with system suggested low-cost therapeutic alternatives and the ability to override for some of the preferred choices by patients and providers, while re-estimating the coverage periods for informed decision making. It not only reduces avoidable medical expenses significantly but also helps to engage the patient through mobile platforms and the provider at the point of care,” Ika adds.

About RxAdvance Corporation

RxAdvance is a full service pharmacy benefit management (PBM) company created specifically for transforming the future of healthcare. We are a single resource to help you better understand and manage standard formulary and specialty pharmaceutical and biologics usage. We bring together member, provider, and payer pharmacy and care management staff with our own pharmacy and care management staff to facilitate the type of information sharing and decision making that ultimately yields the best clinical and financial outcomes. Our tailored, world-class services for all plan sponsors – health plans, accountable care organizations (ACOs), state Medicaid programs, and employer groups– blend state-of-the-art technologies with experienced and talented professional teams to optimize the plan sponsor’s return on investment and competitive stance in the market. For more information, visit

RxAdvance Corporation
Pooja Sammeta, 508-804-6900