Get in touch

CareSet is a healthcare analytics company that turns 100% of Medicare, Medicare Advantage, and Medicaid claims data into pharmaceutical enterprise operational intelligence. Working with the government open and claim-based datasets since 2012, we help pharma teams at every stage of the drug lifecycle, from pre-clinical and medical affairs strategy through market access, commercial operations, and regulatory decisions. We maintain a commitment to open data and public good alongside commercial work, operating under five independent accountability frameworks: pharmaceutical commercial validation, investigative journalism, federal governance, academic peer review, and federal emergency response.

CareSet obtained our first CMS Data Use Agreement with VRDC access in 2015. Presently, CareSet leverages 100% adjudicated Medicare claims across Parts A, B, C, and D. CareSet holds the longest continuous track record of commercial access to complete Medicare data and obtained early access to monthly updates at the beginning of COVID-19.

CareSet delivers census-level Medicare claims data, 100% of adjudicated claims without extrapolation or projection. Competing solutions from sample-based claim aggregators miss low-volume prescribers and overlook providers outside voluntary sharing arrangements, which distorts competitive intelligence. CareSet's approach ensures you see every prescriber decision and payer across the Medicare FFS population. For specialty drugs and rare diseases, where low-volume prescribers represent your entire audience, CareSet's access to monthly Medicare claims, 100% of Parts A, B, C and D, is the standard for decision making across the drug lifecycle.

CareSet reveals your actual payer mix and how formulary and specialty pharmacy coverage translates into real-world prescribing, persistence, and treatment adherence behavior. CareSet shows plan-level Part D visibility across MAPD and PDP, so you can know payer-driven treatment patterns before you enter pricing discussions. For specialty drugs, despite specialty pharmacy and institutional pharmacy blocking data from manufacturers, CareSet clarifies the differences between specialty pharmacies, their networks, and their impacts on the patient journey. This lets your market access strategy rest on CareSet's data-driven expert analysis and insights rather than assumptions.

Medicare is the dominant payer across oncology, cardiology, immunology, and neurology. CareSet connects payer policy and formulary decisions directly to prescribing outcomes, showing where access barriers exist and which payers drive or block adoption. CareSet's claims data reveals how prior authorization, step therapy, and coverage decisions affect actual patient treatment patterns, allowing you to model payer impact and build managed market strategy on real prescribing behavior rather than payer contracts alone.

Partnering with the largest manufacturers to present data to the FDA, CareSet's adjudicated Medicare claims are real-world data that supports treatment sequencing analysis, comparative effectiveness studies, disease burden analysis, and line-of-therapy modeling across the entire Medicare population. RWE research using CareSet's data has been published in peer-reviewed journals including Health Services Research, Journal of the American College of Radiology, and PLOS ONE. With longitudinal claims data dating back to 1999, and experience analyzing patient journeys, treatment patterns, and outcomes, CareSet maintains leading edge methodologies necessary to clean, process, and interpret claims data effectively, capturing long-term trends that enable regulatory submissions and strengthen partnership credibility.

CareSet's Medicare claims link inpatient, outpatient, physician, and pharmacy in one dataset to map the complete treatment pathway, including the hospital systems that do not resell their claims data to commercial claims aggregators. We can show your team where patients are lost before treatment initiation, which specialists and referral patterns drive treatment decisions, and how site-of-care varies by geography and payer and impacts treatment adherence.

Our clients quickly identify where their new and existing therapies can compete. In complex disease areas such as hematology, oncology, and immunology with variable treatment regimens, sequences, and combos, CareSet's deep expertise, battle tested frameworks, and knowledgeable teammates uncover patterns in days that would otherwise remain invisible. Industry leading reporting speed on KPIs including treatment switching rates, therapy discontinuations, and prescribing behaviors all drive pharma decision making and medical policy.

CareSet clients see healthcare providers at the HCP, NPI, department, and Health System levels. Sales and marketing leaders confidently leverage CareSet to identify KOLs, prescriber networks, and assess individual physician treatment patterns that standard commercial sources simply cannot assess, including reaching the 226 Academic Medical Centers resolved to the treating physician. Typically, CareSet reports on an additional 10 to 25% of prescribers invisible in standard commercial databases. In rare disease and oncology, manufacturers can block prescription data from data aggregators, and specialty pharmacies and institutions withhold data from manufacturers. Despite the blocking in both directions, CareSet fills critical gaps by uncovering previously unidentified and hidden drug usage, enabling timely engagement with advancing patient populations.

Access to Medicare data is not the same as expertise in using it. CareSet's clients leverage 25+ years of longitudinal claims data, frameworks, process, patient privacy systems, working in tandem with Medicare claims experts, beginning in 2012. Combined together, we offer the best understanding of patient journeys, treatment patterns, and physician decision-making that simply cannot be replicated. CareSet's algorithms and analytical approaches have already made impacts across healthcare, with data consumers ranging beyond pharmaceutical commercialization, to investigative journalism, federal governance, academic research, federal emergency response, as well as ACOs, health systems and health insurers. Raw data can be misleading without proper context and analysis. CareSet's longest continuous track record of commercial Medicare access means we understand the nuance, complexity, and methodology necessary to transform data into operational intelligence.

CareSet's systems are validated across five independent accountability frameworks. Pharmaceutical clients use CareSet's work to guide go-to-market strategy across dozens of launches, monitoring hundreds of Brands. ProPublica and The Wall Street Journal have relied on CareSet's Medicare analysis for investigative reporting. As a recent visitor to the White House to celebrate the 60th anniversary of Medicare, CareSet also presented at the White House Open Data Innovation Summit, and the Biden Cancer Moonshot Summit. In mission critical moments, the Federal COVID-19 response teams used CareSet's data testing and validation infrastructure during the pandemic to assess hospital and skilled nursing facility affiliations and bed utilization. Academic researchers cite CareSet's data in dozens of peer-reviewed publications. This diversity of validation across commercial, journalistic, governmental, academic, and emergency applications tests CareSet's methodology in ways routine use does not. As more companies gain access to Medicare data for the first time, CareSet's 25+ years of experience remains the difference between raw numbers and actionable insights.