For patients starting new treatments, speed is important. When answering questions about patient coverage for newly prescribed drugs, delays in obtaining this information can reduce patient willingness to begin prescribed treatment.
Amgen's U.S. Patient Access and Reimbursement (PAR) team is using artificial intelligence (AI) to address this challenge. By automating parts of the benefits verification process, the team is helping providers and patients receive coverage information faster, sometimes within hours instead of days.
Introducing Eva: AI for benefit verification
Amgen recently began using an AI agent called E va developed by Infinitus Systems, Inc. to assist in the benefits verification process. Designed to complement and support human reviews, E va identifies itself as an automated system when contacting health insurance companies, helping to collect coverage details and generate benefit statements quickly and reliably. You will always have an immediate option to speak to a human representative.
Previously, award confirmation could take up to 5 days. Now, thanks to Infinitus, Eva, and expanded automation, Amgen aims to provide answers to patients within 48 hours, and in many cases sooner, but this will vary depending on payer response times. As a result, more patients can now receive coverage information more quickly. Final coverage decisions remain the responsibility of payers and human reimbursement professionals. Eva's role is to collect and summarize benefit data for review.
“Rather than just asking scripted questions, E va uses natural language processing and machine learning to help interpret and respond to payer data, which is a distinct departure from previous automation approaches,” explains Ravi Dave, director of call center operations. “By expediting the benefit verification process, Amgen supports rapid access to information to help patients begin prescribed treatment.”
All AI-generated answers are subject to review by trained Amgen staff to verify accuracy and fairness. E va undergoes ongoing testing to identify and mitigate potential algorithmic bias.
Fusion of human care and AI innovation
What is unique about E va is its ability to continuously improve based on previous interactions as part of Infinitus' Pay er intelligence knowledge graph. Knowledge Graph and Eva's performance is enhanced through controlled learning based on anonymized, aggregated data (no personally identifiable information or protected health information (PHI) is used to train the general model).
Unlike simple algorithm-driven bots, E va improves accuracy and efficiency with each call and adapts to the complexity of the U.S. payer system. If something doesn't seem right, such as a referral from outside your network, the AI agent can flag it and ask clarifying questions, potentially providing more accurate results.
This means more timely and accurate benefits information for providers and patients. By introducing these efficiencies into the process, Eva also allows call center staff to spend more time doing what people uniquely offer: empathy, coaching, and direct patient support.
“AI, when applied thoughtfully, can transform healthcare, and our collaboration with Amgen demonstrates that agent-mediated communication can significantly reduce the time it takes for patients to initiate treatment,” said Ankit Jain, CEO and co-founder of Infinitus. “And it's not just about efficiency, it's about impact. Every moment saved in the process helps ensure time is spent where it matters most: improving lives.”
“Eva's capabilities improve our ability to serve our patients more accurately and effectively,” said Todd Boyd, senior director of patient access and reimbursement for Amgen's SupportPlus call center. “Each call improves accuracy and efficiency, demonstrating how AI can adapt to the unique complexities of healthcare.”
Amgen continues to explore responsible AI applications to support patients while maintaining our commitment to transparency, accountability, and ethical innovation. Eva is an example of how technology helps Amgen teams work more efficiently, allowing patients to begin treatment with confidence and timely information.
Amgen conducts AI impact assessments and maintains a risk management program consistent with emerging market AI governance frameworks. These safeguards help ensure transparency, accountability, and continuous monitoring of AI systems used to support patient access. Click here to learn more about Amgen's commitment to safe and ethical AI.
