For patients starting a new therapy, speed matters. When it comes to answering questions about a patient's coverage for a newly prescribed medicine, delays in obtaining this information can discourage patients who are waiting to start their prescribed care.
Amgen’s U.S. Patient Access & Reimbursement (PAR) team is addressing this challenge with artificial intelligence (AI). By automating parts of the benefit verification process, the team is helping providers and patients receive coverage information more quickly, sometimes within hours instead of days.
Meet Eva: AI for Benefit Verification
Amgen recently began using an AI agent named Eva developed by Infinitus Systems, Inc. to assist with the benefit verification process. Designed to complement and support human review, Eva identifies itself as an automated system when contacting health insurers to help collect coverage details and generate benefit statements quickly and reliably. It always offers an immediate option to speak with a human representative.
Traditionally, verifying benefits could take up to five days. Today, thanks to Infinitus, Eva and expanded automation, Amgen now aims to provide answers to patients within 48 hours, often even sooner, but this will depend on payer response times. As a result, more patients can now receive coverage information faster. Final coverage determinations remain the responsibility of payers and human reimbursement specialists. Eva’s role is to gather and summarize benefit data for review.
“Eva doesn’t just ask scripted questions, it uses natural language processing and machine learning to assist with interpreting and responding to payer data. That’s distinctly different from prior automation approaches,” explains Ravi Dave, director, Call Center Operations. “By expediting the benefit verification process, Amgen supports faster access to information that may help patients begin their prescribed treatment.”
All AI-generated responses are subject to review by trained Amgen staff to help validate accuracy and fairness. Eva undergoes ongoing testing to identify and mitigate potential algorithmic bias.
Combining Human Care with AI Innovation
What makes Eva unique is its ability to continuously improve based on prior interactions as part of Infinitus’ payer intelligence knowledge graph. The knowledge graph and Eva’s performance is enhanced through controlled learning based on de-identified, aggregated data (personally identifiable or protected health information (PHI) are not used to train general models).
Unlike simple algorithm-driven bots, Eva improves with every call to enhance accuracy and efficiency, adapting to the complexities of the U.S. payer system. If something doesn’t look right, like an out-of-network referral, the AI agent can flag it and ask clarifying questions, potentially delivering more accurate results.
This means more timely and accurate benefit information for providers and patients. By introducing these efficiencies to the process, Eva also enables call center staff to spend more time on what people uniquely provide: empathy, guidance and direct support for patients.
“AI can transform healthcare when it’s applied thoughtfully. Our collaboration with Amgen demonstrates how agentic communications can significantly shorten the time it takes for patients to begin therapy,” says Ankit Jain, CEO and co-founder of Infinitus. “And it isn’t just about efficiency—it’s about impact. Every moment saved in the process helps ensure that time is spent where it matters most: improving lives.”
“Eva’s functionality is improving our ability to serve patients more accurately and effectively,” says Todd Boyd, senior director, Patient Access & Reimbursement, at Amgen’s SupportPlus Call Center. “With each call, it becomes more accurate and efficient, demonstrating how AI can adapt to the unique complexities of healthcare.”
Amgen continues to explore responsible AI applications that support patients while upholding our commitments to transparency, accountability, and ethical innovation. Eva represents one example of how technology can help Amgen teams work more efficiently, which can help patients begin their treatment journeys with confidence and timely information.
Amgen conducts AI impact assessments and maintains a risk-management program consistent with emerging state AI governance frameworks. These safeguards help ensure transparency, accountability, and continuous oversight of AI systems used to support patient access. Click here for more information about Amgen’s commitment to safe and ethical AI.
