Case Study: Major US pharmacy benefits manager (PBM) boosts mail-order conversions and operational efficiency with FICO predictive analytics

Analytics help a major PBM improve patient engagement and operational efficiency

A leading U.S. pharmacy benefits manager serving over 60 million lives faced a costly, labor-intensive outbound campaign to persuade patients to switch to mail-order pharmacy—an important step to lower dispensing costs, boost medication adherence and improve patient satisfaction and outcomes.

FICO built a propensity model using claims and third‑party demographic data to score and rank patients, letting the PBM prioritize outreach to those most likely to convert. In a 60‑day pilot the analytic approach raised conversion rates 31.4% vs the prior rules‑based method; the top 10% scored patients converted 3.5× more than the bottom 80%, and targeting the highest‑scoring segments captured the majority of converters—driving better adherence potential and much greater operational efficiency.