Use Case 1
Member Price-Shopping Request
Trigger: Member asks for refill cost comparison
1.Identify member's plan and cost-share structure
2.Query pharmacy pricing across nearby options (retail and mail-order)
3.Calculate member out-of-pocket at each
4.Include manufacturer coupons and GoodRx where beneficial
5.Present options in member's preferred language and format
6.Offer next action (transfer, scheduling, directions)
✓
Members save hundreds annually and adhere more reliably because cost isn't a surprise.
Use Case 2
Adherence-Driven Cost Intervention
Trigger: Pharmacy claims show non-fill or gap
1.Detect adherence gap
2.Identify probable cost barrier
3.Surface cheaper alternatives (formulary tier, coupons, mail-order, therapeutic substitutes)
4.Contact patient proactively
5.Coordinate with prescriber if substitution needed
✓
Cost-driven non-adherence gets caught and resolved before clinical consequences.
Integrations
Pharmacy Benefit Manager (PBM) Real-Time Formulary
Pharmacy Price APIs (GoodRx, RxSense)
Mail-Order Pharmacy Integration
Member Messaging (SMS, Voice, Chat — multilingual)
EHR / e-Prescribing (Surescripts)
Industries
healthcare
See It In Action
A sample conversation with this agent
I'm refilling metformin and atorvastatin—where's cheapest near me?
Checking pharmacies within 5 miles of your ZIP and comparing your plan's cost-share at each. Results: Metformin 500mg x90 at CVS $12, Walgreens $10, Costco $4, mail-order $0 (plan preferred); Atorvastatin 20mg x90 at CVS $18, Walgreens $15, Costco $9, mail-order $0. Combined lowest: mail-order ($0) or Costco ($13). Want me to initiate mail-order transfer or send you directions to Costco pharmacy?
¿Puedo hablar en español?
Sí, por supuesto. ¿En qué puedo ayudarle hoy? Puedo comparar precios de sus medicamentos en farmacias cercanas, verificar su cobertura del seguro, y ayudarle a encontrar la opción más económica.
The patient's copay jumped from $10 to $85 this month—what happened?
Checking. Two things: (1) the medication moved from tier 2 to tier 3 on their plan's January formulary update, and (2) their deductible reset January 1 and they haven't met it yet. Options I can offer them: therapeutic alternative at tier 2 (valsartan-HCTZ instead of olmesartan-HCTZ, save ~$65), manufacturer coupon (saves $40 if eligible), or 90-day mail-order (saves $55 annualized). Want me to send all three options to the patient in their preferred language?