Our Solution

The First AI-Enabled Clinical Efficacy Platform

Ethicos Health’s AI-Enabled Clinical Efficacy Platform transforms prior authorizations by making them more clinically meaningful while reducing specialty pharmacy costs for health plans, their clients, and their members.

By continuously monitoring longitudinal patient data against real clinical endpoints, we give plan sponsors clear insight into what matters most: is the medication working for each member?

How It Works

Leveraging our AI-enabled platform, payers instantly convert their existing clinical guidelines into machine readable algorithms, evaluate longitudinal patient data against each medication’s intended outcome, and automate provider outreach to close data gaps and communicate results.

By continuously assessing patient data against clinical guidelines, eliminating ineffective therapies, and “gold carding” members on the right ones, plans improve clinical outcomes, reduce costs, reduce administrative burden on clinicians, and deliver a far better overall experience.

Numbers Speak

The cost of healthcare in America has reached a breaking point – driven by the cost of specialty pharmacy.  The numbers are staggering.

But it’s not just a cost issue.

What many don’t realize is that these exorbitantly priced specialty medications are frequently ineffective for a significant portion of patients.

$125 Billion

The expected size of the GLP-1 market in 2033. The market size in 2023 was $36.8B

92%

Of employers report serious concerns about the rising cost of specialty pharmacy.

75%

Of the FDA pipeline represented by biologic therapies.

Market Value

Ethicos Health lowers cost while improving experience for plans, patients and providers.

Lower Specialty Pharmacy Costs

Pay only for medications proven effective for each member, eliminating spending on ineffective or low value treatments.

Manage Prior Authorizations Efficiently

Evaluate drug efficacy at scale, managing higher volumes with existing resources to drive cost savings.

Enable Value Based Drug Contracting

Establish efficacy-based payment models for successful transitions to value-based care.

Improve Member Experience

Fast track members on effective therapies to reduce friction and boost satisfaction, while making approvals and denials evidence-based and transparent.

Accurately Predict Costs

Improve financial predictability and support more accurate underwriting for specialty drug expenditures.

“Leveraging AI, we simplify complex guidelines to ensure patients receive tailored, effective medications. With a focus on patient safety and cost savings, Ethicos Health partners with plan sponsors to optimize pharmaceutical care and enhance outcomes by supporting providers with clear, clinically validated, actionable information.”

Mark McConnell, Co-Founder

Our platform brings order to the chaos of specialty pharmacy management.

We ensure patients, providers and plan sponsors are aligned to optimize health outcomes, patient safety and cost.

✓ CLINICAL FOCUS TO OPTIMIZE CARE

✓ DESIGNED FOR ALL STAKEHOLDERS