Gross-To-Net Services

Secure your spend. Support their journey.

Plug the leaks and stop $5 billion in benefit revenue loss without disrupting care.

Webinar - June 17th:

GTN FOMO: Dangers You're Missing Post-Launch

The ConnectiveRx Gross-to-Net Platform

Eliminate GTN leaks across the pharma value chain. Our proprietary platform uses real-time, AI-driven, in-workflow detection to safeguard your copay investments and ensure patients get their treatments. 

  • ShieldRx
    • AI-driven misuse detection
    • Real-time claim intervention
    • Behavior pattern scoring—Patients, Pharmacies, and HCPs
  • Gatekeeper
    • AI-powered government insurance claims check
    • Instant eligibility decisions
    • Real-time verification embedded across workflows
    • 310+ million patient profiles
  • Pre-Claim Accumulator & Maximizer
    • Proprietary algorithms flag issues BEFORE 1st claim
    • Smart BIN/PCN/GRP matching powered by Machine Learning
  • Advanced Adjudication
    • Dynamic, AI-informed offer logic 
    • Real-time rules engine
    • Customizable at the patient/plan level

Real-Time Copay Protection Starts Here

Rectangle 5

  • Instant confirmation of Patient, Prescriber, and Pharmacy legitimacy

  • Verifies that the HCPs specialty aligns perfectly with the prescribed therapy

Little Worlds Village 1920x1080

  • Identifies inflated patient responsibility before payment occurs

  • Detects suspicious pharmacy behavior & abnormal claim patterns

  • Spots OCC code switching (i.e., 08 ➡️ 03)

08 House Scene Simplified Horizontal_RGB-square

  • Rejects suspicious claims instantly to prevent misuse

  • Flags high-risk pharmacies for further review

  • Protects your copay budgets so funds reach the right people

ShieldRx: Real-Time Solution Tied to Copay Adjudication

Real-Time Validation

  • Instant confirmation of patient, prescriber, and pharmacy legitimacy
  • Verifies that the HCPs specialty aligns perfectly with the prescribed therapy.

Misuse Detection

  • IDs inflated patient responsibility before payment occurs
  • Spots OCC code switching (such as 08 to 03)
  • Detects suspicious pharmacy behavior and abnormal claim patterns

Actionable Outcomes

  • Rejects suspicious claims instantly to prevent misuse
  • Flags high-risk pharmacies for further review
  • Protects your copay budgets so funds reach the right people

Protect Your Copay Program with Confidence

  • Real‑Time GTN Protection, Embedded in Pharmacy Workflow

  • Advanced AI Oversight that Secures Copay Investment

  • Live in Weeks, Not Months

The ShieldRx Engine

flow of shieldrx with arrows and boxes

Behind The Flow of ShieldRx

Write-Enroll_white

Historical Claims Data:

Models Powered by Retrospective Coupon Data

Verify_white

Verifying the Patients Existence:

310 Million Patient Profiles to Validate Name Checks

RxMonitoring_white

Pharmacist Profiles:

Building Off Actions, Interactions, Attestations, and Claims Activity

Doctor-Patient_white

HCP Validation:

✅ NPI Level Data

✅1.8 Million HCP Profiles

✅HCP Taxonomy

RxManufacturers_white

Pharmacy Business Profiles:

Established vs. New Types ➕ Geography Factors

Behind The Flow of ShieldRx

Historical - ShieldRx Engine Flow LP Carousel (2)
Patient - ShieldRx Engine Flow LP Carousel (2)
Pharmacist Profile - ShieldRx Engine Flow LP Carousel (2)
HCP Validation - ShieldRx Engine Flow LP Carousel (2)
Pharmacy Profile - ShieldRx Engine Flow LP Carousel (2)

Behind The Flow of ShieldRx

Historical Claims Data

SpeedInsights-Reporting_white

Models Powered by Retrospective Coupon Data

Verifying the Patients Existence

PatientProfile-Identify_white

Utilizing 310 Million Patient Profiles

Pharmacist Profiles

RxMonitoring_white

Building Off Actions, Interactions, Attestations, and Claims Activity

HCP Validation

Doctor-Patient_white

✅ NPI Level Data

✅ 1.8 Million HCP Profiles

✅ HCP Taxonomy

Pharmacy Business Profiles

RxDelivery_white

Established vs. New Types Combining Location Factors

Advantages to Copay and Gross-to-Net Solutions:

 ✔️ One platform, fewer handoffs, fewer failures
 ✔️ Real‑time checks end‑to‑end
 ✔️ AI everywhere: pre‑claim, in‑claim, post‑claim
 ✔️ Faster risk detection (pre‑claim + in‑stream)
 ✔️ Closed‑loop learning (plan dictionary updates)
 ✔️ Integrated Resolution Center & attestations
 ✔️ Unified reporting & analytics (single source of truth)
 ✔️ Lower data movement → reduced PHI exposure
 ✔️ One SLA, one audit trail, one owner
 ✔️ Best-in-class, call-center representatives

FAQs about ConnectiveRx Gross-To-Net Platform

Are Gross-To-Net strategies focused on prospective or retrospective analysis?

Many GTN strategies still rely on analyzing past claims, which makes it difficult to recoup misused funds. ShieldRx enables real-time detection, at the point of adjudication, protecting your copay investment and transforming your GTN management from reactive to proactive. 

Does GTN monitoring slow down pharmacy dispensing for valid patients?

Not at all. Our GTN Platform works in real-time during the adjudication process and requires no action from the patient, provider, or pharmacist. It makes instant decisions, blocking bad actors without disruption or delaying care for the patients waiting at the pharmacy counter.

How does the CRx GTN Platform protect the patient journey?

By stopping fraud and misuse at the adjudication level, our Gross-To-Net Platform validates the integrity of the claims, ensuring that your copay funds are available for patients who rely on them to afford their medication.

How does advanced adjudication lead to stronger GTN?

Advanced adjudication that aligns with your business rules allows for your copay program to appropriately respond to payer restrictions.

Can government patients adversely affect your GTN?

Yes, since government patients aren’t eligible for copay assistance, our AI-driven solutions are centered on the most advanced screening for this patient population to stop them from entering the program and using the funds. 

Bridging the Gap Between Access and Protection with ConnectiveRx

Out-of-pocket costs should never stand in the way of life-saving care. Unfortunately, copay misuse drains billions of dollars from programs designed to help patients access. Teaming up with a partner that understands the delicate balance you strike between optimizing gross-to-net revenue and supporting the patient journey is paramount. Connect with our GTN experts today!

Learn More