Reveal the drivers of how your brand is affected by managed care

Dynamic Claims is the claims-based managed care product you can use to get comprehensive and actionable insight to better align brand investment in the managed markets segment.

Integrating managed care claims from over 24,100 unique retail pharmacies, Dynamic Claims (DC) reveals plan formulary co-payment tiers by stratifying the percentage of approved claims by co-payment amount for a competitive drug market basket and for a managed care plan of interest.

Dynamic Claims provides the actual patient pay amount at the pharmacy and can be analyzed at the market or product level by plan, employer group or PBM. The plan level data in Dynamic Claims can also be analyzed at the national, service area/region and plan affiliate level (where applicable). You can use DC to gain insight into plan benefit designs and what impact they have on your brands. DC can also be utilized to formulate direct-to-patient (DTP) compliance strategies based on reversal rate to ensure approved claims are actually purchased by the patient.

Transform information into actionable insights that can enhance performance of your brands. Dynamic Claims is available in a variety of configurations:


• Dynamic Claims
• New or refill claim attribute
• 65+ Patient Age Grouping
• Co-pay tiers
• ‘Quantity’ Attribute
• Reject Reason Groupings
• Co-pay analysis segmented by managed care plan, market and product
• Analyze managed care behavior at the PBM, National and Plan level
• Sub-plan employer group level reporting
• Dynamic Claims Lifecycle
• Captures drug switching due to formulary restrictions or patient pricing sensitivities
• Basis for ROI on being a preferred formulary product or lost opportunity from a tier 3 formulary position
• Sub-plan, employer level detail revealing plan benefit designs
• Therapeutic intervention analysis (rejections, reversals)
• Pharmacy reimbursement and incentives

Product Elements
Get insight into formulary position, benefit design controls, rebate contracts, or other marketplace dynamics:

• Approximately 40% of all retail channel claim transactions
• Front-end, user friendly MicroStrategy graphical user interface available
• Pharmacy-based claims not limited to just PBM or plan sources