Millions of Americans struggle with medication costs every year, often walking away from prescriptions they can’t afford. RxUtility is tackling this problem head-on by connecting health systems, pharmacists, digital health partners and consumers with real-time access to all manufacturer copay coupons.
We spoke with Miriam Paramore, the Founder and CEO of RxUtility, to learn how the company uses AI and human oversight to curate the first-ever comprehensive database of copay coupons. She shared why billions in potential savings go unused, and how their API is helping patients access affordable medications more efficiently than ever before. Paramore is a self-made entrepreneur, investor and board member with decades of experience driving innovation in health IT and data.
What is RxUtility, and how do billions in prescription savings go unused every year?
RxUtility is a tool that helps people save money on medicine. That’s why we put “utility” right in the name of the business. Our vision is a world where no one has to ask: “Can I afford this medicine?”
One way for people to save money on branded drugs is a pharmaceutical manufacturer copay coupon. These coupons are funded by the drug manufacturers to offset the out-of-pocket costs consumers pay at the pharmacy counter. Your copay is determined by whether a drug is covered by your insurance, which tier it’s in and whether it’s a specialty drug.
People often don’t know the cost of a medication until they’re paying at the pharmacy counter. High-tier specialty drugs can cost hundreds or even thousands out of pocket. Research shows that when a copay hits around $30, many people walk away without picking up the drug. This leads to poor outcomes because doctors don’t know patients aren’t taking their medications until much later. Affordability is the number one cause of medication non-adherence, and non-adherence is the main cause of poor outcomes.
So, our goal is to make these copay coupons easy to access. There’s about $30 billion available for consumers every year through these coupons.
What are the primary barriers to using copay coupons?
There are two main reasons people don’t use pharma copay coupons. First is a lack of awareness. Patients, doctors and pharmacists often don’t know they exist. Second is lack of digital distribution. The coupons are online, but finding them requires first tracking down the right websites, then navigating their complex structures, often ten-layers deep.
What does “AI-powered, consumer-focused, human-guaranteed” mean, and how do AI and humans work together to keep the data accurate?
RxUtility built the only AI-curated database of pharma copay coupons, consolidating their locations and content. Healthcare technology solutions can subscribe to our database via a simple API, which allows providers, consumers and pharmacists to see savings directly in their workflow.
We’ve integrated additional data sources for depth and complexity, and we surveil the FDA’s novel drug file to track upcoming drugs and copay offers. After AI helps create and compile the data, humans perform additional quality assurance to ensure accuracy. Being consumer-focused means the business is always centered on saving patients money. That’s our top priority.
What effect does RxUtility have on patients’ costs and the healthcare system as a whole?
Our tool reduces financial toxicity for consumer who use commercial insurance. For those drugs that are branded, copay coupons can reduce costs drastically—from $1,000 to $5 or even $0. More than half of our database brings consumer costs down to $10-$0.
This creates a win-win for everyone. Consumers get affordable medications, pharmacies can dispense drugs, providers ensure patients are treated and payers avoid higher medical claims from untreated patients. It’s a simple affordability tool that improves outcomes and lowers overall costs.
What is the impact on patient satisfaction and related industry scores?
Patient satisfaction and patient experience are key metrics in provider quality scores. By integrating coupons into existing patient workflows such as patient satisfaction apps, patients are reminded to pick up their prescriptions with savings applied. This improves patient satisfaction, which in turn boosts provider quality scores and insurance member satisfaction. The result is a rising tide. Patients get their medicine while providers achieve higher quality scores. Payers benefit from healthier members getting better outcomes while their member satisfaction scores improve. Everyone wins when outcomes go up and costs come down.
How do you see RxUtility evolving in the next few years to provide patients with better pricing and more informed choices?
Healthcare is shifting as more patients are underinsured or uninsured, and high-deductible health plans drive a growing cash-pay economy. There are often times when it is cheaper for a consumer to pay with cash rather than using their commercial insurance. One of my generic prescriptions is a $10 copay with my insurance, but it’s only $2.18 if I pay cash.
For fully informed choice, patients need to know all price options: the insured price, copay coupon price and cash price. There is clear market demand for what I call a “best price calculator” that the consumer can easily access and rely on.
The next step for RxUtility is to stream real-time cash prices alongside copay coupons. We have started working with our partners to create this calculator so that it can pop up anytime, anywhere. Our goal is to organize and stream this data so consumers have complete price visibility and real choice.
For more information, visit RxUtility or check out the new report “Healthcare Is Losing the Fight for Medication Affordability.”
