Generic Opportunity Score for Drug Utilization Measurement
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Solution Overview
Problem
Current metrics for measuring generic drug utilization, such as GDR and GSR, fail to project future performance and do not account for the total potential generic opportunity, including the use of generic alternatives, which limits savings opportunities for payers and consumers.
Innovation Solution
The introduction of a Generic Opportunity Score (GOS) system that assesses the potential for generic equivalent and alternative substitutions, providing a personalized evaluation of generic utilization opportunities and savings, allowing for prioritization by therapeutic class and tailored solutions.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Measurement precision
If Generic Substitution Rate (GSR) is used to measure generic utilization, then the measurement focuses on generic equivalents, but it excludes generic alternatives and reaches saturation levels (90-97%) that translate to minimal growth opportunities
Solution Approach 1:
The patent segments the generic utilization measurement into three distinct components: Generic Equivalents (GEO), Generic Alternatives (GAO), and Total Generic Opportunity (TGO). This segmentation allows the system to measure and track different types of generic substitutions separately, enabling a comprehensive view of the entire generic market opportunity rather than focusing on a single saturated metric like GSR.
Solution Approach 2:
The patent introduces a new dimensional framework by adding the concept of Generic Alternatives (GAO) to the traditional Generic Equivalents (GEO) dimension. This expands the measurement from a one-dimensional GSR metric to a multi-dimensional assessment that includes both GEO and GAO, thereby capturing the full spectrum of generic substitution opportunities across different therapeutic classes.
2Quantity of substance
If Generic Dispensing Rate (GDR) is used to measure generic utilization, then the measurement includes all medications, but it does not provide insight into the potential remaining opportunity or upper limit of generic dispensing
Solution Approach 1:
The patent performs preliminary identification and classification of medications into Generic Equivalents, Generic Alternatives, and Non-Generics before calculating the opportunity score. This preliminary action enables the system to pre-determine the theoretical maximum generic dispensing potential for each therapeutic class, allowing subsequent calculation of the Generic Opportunity Score that reflects remaining opportunities rather than just current dispensing levels.
Solution Approach 2:
The patent implements a feedback mechanism by calculating the Generic Opportunity Score (GOS) as a percentage that compares actual generic dispensing performance against the theoretical maximum opportunity. This feedback loop provides continuous information about remaining opportunities, enabling stakeholders to identify gaps between current performance and potential, and adjust strategies accordingly to capture additional value.
3Ease of operation
If current metrics (GDR and GSR) are used, then the measurement is straightforward, but it fails to project future performance and does not account for therapeutic class prioritization
Solution Approach 1:
The patent transforms the static GDR/GSR metrics into a dynamic Generic Opportunity Score (GOS) framework that incorporates therapeutic class-specific parameters, conversion rates, and future projections. The system dynamically adjusts calculations based on therapeutic class characteristics, medication availability, and predicted generic adoption rates, enabling forward-looking performance projection while maintaining operational simplicity through automated scoring.
Data Source
AI summary
A computer implemented method and/or computer system determines a Generic Opportunity Score (GOS) and/or a generic drug's performance demonstrating how a generic utilization can be better identified and improved relative to the total overall generic opportunity, which can provide savings information relative to a clinically appropriate generic alternative. In some embodiments, the process and/or system determines the GOS as the proportion of generic prescriptions dispensed relative to the maximum number of prescriptions that have a generic equivalent or a clinically-appropriate generic alternative. In some embodiments, the process determines the GOS as the number of generic claims dispensed over the total number of generic claims plus the brand claims that have a generic equivalent or generic alternative. In some embodiments, the data utilized will be provided through a prescription claims database, which can be segmented into three distinct groups: Generic Code Number (GCN), Brand/Generic Code, and Channel, i.e. retail or mail.