TEAM 35

ClassifyMyMeds: Predicting Prior Authorization Approval and Volume for CoverMyMeds

When a patient tries to get a prescription from a pharmacy, a claim is created against the patient's insurance (payer). Such a pharmacy claim might be rejected for various reasons and might require prior authorization (PA). A PA is a form that providers submit on behalf of a patient to the insurance making a case for the prescribed therapy. In this project, we surveyed many classifiers for predicting how likely a certain PA will be approved, and forecast future volume of PAs with time series analysis techniques. Additionally, we identify the formulary for each payer and predict the number of times certain drugs can be refilled.