Build an evidence packet for a stalled insurance drug approval with ChatGPT
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Evidence: Company case studyA write-up published by the company that makes the AI tool or uses it.
Context: Published by OpenAI Academy; OpenAI makes ChatGPT.
Outcome
Rich Kaplan has catastrophic antiphospholipid syndrome, a rare autoimmune clotting disorder. Kaplan's insurer wouldn't cover an expensive prescribed medication without evidence it had helped someone with a condition that rare, and 90, then 120 days passed. Kaplan asked ChatGPT to find every reference to the drug being used for the disease and got back a referenced, five-page synthesis of trials, case reports and studies. With a short plain-language note added ('I'm alive today. I have a rare disease. I'm trying to stay alive longer.'), the packet was approved through the insurer's third-party arbitration process.
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Prompt Recreated prompt
The source didn't share its exact prompt, so we wrote this from what it describes.
Find every reference to [MEDICATION] being used for [DISEASE]. Show the clinical trials, case reports, studies, anything that exists, with references, so I can send it to my insurer.
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Optional stronger version
Our rewrite with extra checks. The poster didn't test it.
Before you start, ask me 1–3 short questions about the details below and wait for my answers. Once I've answered, confirm the plan in one line and run the whole task start to finish. Goal: Put together a referenced evidence summary my doctor and I can use to support an insurance request for a prescribed medication. Questions to ask me first: - What's the medication and the condition, and what exactly did the insurer say is missing? - Is there a deadline, appeal or review stage I'm in right now? - Will my doctor be reviewing or signing what we send? Inputs (fill in or confirm): - Medication: [MEDICATION] - Condition: [CONDITION] - Insurer's denial or request letter: [LETTER] - Deadline: [DEADLINE] Rules: - Only include studies, trials and case reports you can link to or cite in full; never invent a reference, author or result. - For each source give the title, year, type (trial, case report, review), how many patients, and one plain sentence on what it found. - Say clearly where the evidence is weak or mixed. - Keep my medical details to what the insurer actually needs. - Don't give medical advice or suggest changing treatment; this is for my doctor and the insurer. Checkpoint: Show me the source list before writing the summary, so I can check it with my doctor. If you get stuck: If you can't find evidence for this exact use, say so and list the closest related evidence, labeled as such. If a site needs a login, stop and ask me. Verify before you finish: Open or re-check each citation you list and mark any you couldn't confirm. Output: A short plain-language cover note from me, then a referenced summary (a few pages at most) with a source table. Done when: My doctor has a summary where every source is real and checkable, ready to send with the request.
Source
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