In the pharmacy benefits space, more PBMs, health plans and employers are beginning to leverage modern technology to monitor benefits data and identify performance improvement opportunities through real time data access. Many organizations are now realizing the benefits of becoming active participants in the pharmacy benefits process, which both improves their bottom line, and the healthcare outcomes for downstream patients. With the growth of cloud-based platforms and massive developments in artificial intelligence and machine learning, technological advances of recent years continue to permeate the pharmacy benefits industry, creating greater efficiencies that drive down costs for all participants in the ecosystem.  

A company delivering this kind of transformative technology that has been gaining significant industry attention is RxSense. Launched in 2015 by CEO and founder Rick Bates, RxSense is a leading provider of healthcare technology solutions for pharmacy benefits administration and prescription savings. Leveraging his over 20 years of experience leading strategy and growth at prominent publicly traded healthcare organizations such as Catalyst Health Solutions, UnitedHealth Group, Oxford Health Plans, and Coventry Healthcare, Bates realized a significant opportunity to solve decades old challenges of legacy tech that have traditionally hamstrung entities across the pharmacy benefits ecosystem. In 2015, Bates built a team comprising leaders from both healthcare and the consumer tech space to develop modern solutions that break down barriers to efficient pharmacy benefits administration and access to lower cost drugs. Today, RxSense is supporting over 100 clients with customizable solutions to optimize financial performance and deliver better care to patients nationwide.  

We sat down with RxSense CEO Rick Bates to discuss his founder story, the impact of technology on the industry, and the solutions RxSense is bringing to the market.   

EO: Can you tell us about your professional background and how you became CEO and Founder of RxSense? 

RB: I’ve spent the majority of my career working at large publicly traded healthcare companies, including UnitedHealth Group, Oxford Health Plans and Coventry Healthcare. Before founding RxSense, I served as President and COO of Catalyst Health Solutions, a Fortune 500 company, which later became Catamaran. In that role, I was responsible for leading strategy and growth, and this included revitalizing business divisions and underperforming assets and turning them into growth engines. This was an invaluable experience as it allowed me to identify market weaknesses and the business opportunity to bring modern technology to the PBM space. It was the inspiration for my founding of RxSense in 2015.     

EO: How did you go about fulfilling the vision to bring modern technology to the space?  

RB: I knew I needed a team of leaders with the right blend of industry and technical experience to develop technology solutions for pharmacy benefits and prescription savings. I started by hiring a seasoned group of healthcare veterans familiar with the PBM space, as well as consumer technology leaders to develop and market our services. The result of this team’s work was our transformative cloud-based RxIQ enterprise platform.   

Today, RxSense is a vertically integrated business that operates two distinct but complementary business segments: enterprise solutions, and direct-to-consumer. Our proprietary platform powers our enterprise solutions and data analytics for pharmacy benefits administration, as well as our SingleCare prescription savings service for consumers.   

SingleCare handles hundreds of thousands of prescriptions per day, and more than 7 million patients use it monthly to find lower cost meds. To date, we’ve helped our customers collectively save over $6 billion on their prescriptions. On the enterprise side of our business, RxSense now has over 100 customers using our leading RxIQ enterprise software to optimize pharmacy administration and maximize prescription savings. With our technology, our clients can now take control of their own pharmacy benefits, with complete visibility on their drug trend and spend. We’re empowering our partners with customizable solutions to enhance their financial performance, and ultimately, deliver better care to their patients nationwide.  
We’ve also just recently launched our RxIQ Business Intelligence platform – this is a significant development as we’re now delivering our innovative data analytics to a broader customer base, as this is now available to license separately from our industry-leading RxIQ adjudication platform. This provides a new set of prospects across the pharmacy ecosystem with first-hand access to timely data insights through operational, clinical and financial modules – offering immediate intel on business performance and contractual financial metrics, as well as more efficient management of contracting and underwriting. Our enterprise platform and SaaS solutions are truly game changers, particularly for middle market PBMs, healthcare entities, and new entrants looking to manage their own pharmacy benefits.  

EO: What are some of the biggest challenges faced by the healthcare industry, and how does RxSense aim to address these challenges?  

RB: Access to more affordable medications continues to be a challenge for consumers. Americans pay $1300 per year on prescriptions – more than any other country in the world – and 30% of Americans have skipped medication prescribed by a doctor because of the high cost. With nearly 10% of Americans uninsured and almost 60% of U.S. workers now on high-deductible health plans, SingleCare is an incredible resource to help them save on their medications. SingleCare provides considerable savings – up to 80% off the retail price of prescriptions, and an average of about $70 per script. These are meaningful savings, particularly for families filling multiple scripts and people managing chronic conditions.     

In the PBM space, the most significant challenge is the reliance on inefficient legacy technology, and the industry’s “black box” of opaque drug pricing. We’re focused on offering transparency on cost and solving the pain points of archaic legacy systems. Our cloud-based RxIQ breaks down the barriers to price transparency and performance intel, bridging data sets on a singular, simple to use platform for unparalleled efficiency and access. We provide clients with the tools to control their own pharmacy benefits. This includes direct access to real time business performance analytics, formulary management, transparency on the cost of goods, flat fee based pricing and 100% pass through of our market position, and private label prescription discount programs to extend savings beyond our partners to help the patients they serve access more affordable medications. Simply put, we are a product manufacturer delivering best in breed technology driving lower costs for our customers and better health outcomes for their patients.
EO: What sets RxSense apart from other healthcare technology companies, and how do you ensure that your solutions are meeting the needs of your clients and customers? What are the benefits of using the RxIQ enterprise platform compared to legacy systems?  

RB: We know how the system works and this allowed us to build solutions that are helping simplify this complex industry for our partners and clients. We empower organizations with the tools to optimize their own pharmacy benefits, and take control of their pharmacy trend and spend with access to real time data insights. Our solutions are customizable so healthcare entities can tailor the solutions based on their business needs. RxIQ is also an intuitive platform, as our user-friendly interface enables operations staff to quickly and easily manage configuration changes and reporting – without the need for expensive IT support. RxSense isn’t another adjudication engine or even a PBM; our technology delivers enhanced financial solutions across the entire pharmacy benefits environment. We’re a technology solutions provider that I believe offers the most intelligent prescription processing and savings platform on the market. One of the things that separates us is the deep insights we have into consumer behavior. We’re well versed on price elasticity on drugs and our pricing algorithms help us deliver the lowest costs. Our technology is creating massive operational efficiency for our customers: businesses that previously took 6-12 months to set up pharmacy benefits on legacy systems can now do so in 6-12 weeks using RxIQ. Changing a drug formulary might have previously taken 4-6 weeks and now only takes about 30 minutes on our platform. While the operational efficiency we provide is significant, I think an even greater benefit of partnering with us is getting full visibility into cost management and improving clinical performance. We’re providing our partners with tremendous efficiencies and value.  

EO: Can you tell us about a particularly successful project or initiative that illustrates the impact or effectiveness of your solutions?   

RB: A good example is the way we addressed the Public Health Emergency (PHE) response to the COVID-19 pandemic. This situation presented a lot of challenges in the PBM space, including the government mandate on January 10, 2022, for insurers to cover the cost of at-home rapid result COVID test kits just five days later. To help our clients comply and ensure that members could walk into a pharmacy, pick up a test kit, and not have to pay anything at point of sale, our team quickly aligned its resources for a rapid response. We developed a solution for all of our clients that was in place by January 15, without requiring members to pay anything out of pocket, complete and submit any forms, or wait for reimbursement. This highlights the incredible flexibility of our platform, and our team’s ability and commitment to respond quickly on behalf of our clients and partners. 

EO: What do you think is the next big thing in the pharmacy space?   

RB: I think the most significant market shift will eventually be 100% cash payment for all generic drugs at retail and mail. There will remain a place for expensive brand and specialty drugs to be covered by insurance, but generics account for about 90% of all prescription drug fills. This will create efficiencies and eliminate markup for consumers.    

EO: How do you prioritize the needs and interests of RxSense’s stakeholders, including customers and employees?  

RB: Our business priorities are to deliver technology solutions for pharmacy benefits and prescription savings that drive greater value for our customers and better health outcomes for patients. Regarding our employees, RxSense embraces a people-first philosophy. We’ve established a company culture that promotes collaboration, empowers our employees, and celebrates the success of teamwork across the organization. Our employees take pride in the fact that we are building a disruptive business dedicated to developing products that lower costs and help people lead healthier lives. It’s great to see our company is being recognized for this, as we were named among Inc. Magazine’s Best Workplaces in 2023 and Modern Healthcare’s Best Places to Work in Healthcare in 2022 and 2023.   

EO: Can you provide insight on what you believe is an important key learning for leaders?  

RB: I think one of the most significant learnings for those in leadership roles is recognizing when you’re wrong and making the necessary adjustments. You will always have assumptions about how a market or customers will respond. Leaders will often look at situations through the lens of their own personal experiences, but this can sometimes be misaligned with the perception of the customer. It’s important to find the balance as you push a business forward, with pragmatism and humility when something isn’t working, and the realization that a pivot isn’t a sign of weakness, but one of strength.     

EO: Can you provide an example of a time when you had to make a difficult decision as a leader, and how you approached that decision? 

RB: I recently made the decision to launch RxIQ Business Intelligence, our analytics dashboard, as a standalone analytics product for pharmacy benefit managers and health plans. This was previously sold only as part of our RxIQ adjudication platform – as I strongly believed in the power of those products together – but I realized that it would be more beneficial to the business to sell it as its own product, to support customers that only have a need for data insights. ​​RxIQ Business Intelligence provides detailed reports on a plan’s performance so clients can quickly and easily gain first-hand actionable insights on drug costs, financial performance, and clinical outcomes. I think RxIQ Business Intelligence has an incredible value prop on its own, and it may be the most valuable asset that we’ve created to date. 

EO: What do you see as the future of healthcare in America, and how do you see RxSense contributing to that future? 

RB: Technology will continue to create greater efficiencies and lower costs.  In our space, health plans and employers are starting to leverage technology to monitor benefits data and identify performance improvement opportunities through real time access, and are becoming active participants in the PBM process – this will continue to have positive downstream effects for patients. With the preponderance of high-deductible health plans, more Americans are now making choices on their health services, so I think consumerism will continue to drive positive change in terms of transparency, access, and lower costs – which in turn improves adherence and healthcare outcomes. I believe RxSense will continue to grow as a disruptive force in our space delivering technology that provides transparency on pricing and lower cost prescriptions to businesses and consumers alike.