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In this episode, Vic interviews Miriam Paramore, founder of RxUtility, about her extensive background in healthcare technology and her new venture aimed at improving medication affordability. They discuss the role of pharmaceutical copay coupons, highlighting the $10 billion in savings available to consumers annually, with specific mention of discounts for high-cost drugs like Ozempic and other GLP-1 medications, which can reduce the cost to as little as $25 per prescription. Miriam explains ...
In this episode, Vic interviews Miriam Paramore, founder of RxUtility, about her extensive background in healthcare technology and her new venture aimed at improving medication affordability. They discuss the role of pharmaceutical copay coupons, highlighting the $10 billion in savings available to consumers annually, with specific mention of discounts for high-cost drugs like Ozempic and other GLP-1 medications, which can reduce the cost to as little as $25 per prescription. Miriam explains how RxUtility seeks to democratize these savings by integrating with existing healthcare systems, making it easier for patients to access and use coupons for prescription medications. The episode also covers RxUtility's business model, scaling plans, and its impact on patients and the healthcare industry.
Connect w/ Miriam Paramore
00:00 Introduction and Background of Miriam Paramore
01:00 Early Career in Healthcare Tech
03:00 Transitioning into Management Consulting and Tech Solutions
06:00 Pharmaceutical Coupons and the $10 Billion Opportunity
10:00 The Scale of Pharmaceutical Savings Available
15:00 The Awareness and Distribution Problem in Healthcare Savings
20:00 The Creation of RxUtility and Its Mission
25:00 How RxUtility Partners with Healthcare Systems
30:00 Examples of Major Drug Savings: Ozempic and Farxiga
35:00 Impact of RxUtility on Patient Affordability and Adherence
Every week, healthcare VCs and Jumpstart Health Investors co-founders Vic Gatto and Marcus Whitney review and unpack the happenings in US Healthcare, finance, technology and policy. With a firm belief that our healthcare system is doomed without entrepreneurship, they work through the mud to find the jewels, highlight headwinds and tailwinds, and bring on the smartest guests to fill in the gaps.
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Thank you.
Okay, this is Health Further recording at the Nashville Healthcare Sessions with Miriam Perrymore.
Miriam, thanks for doing this.
Hi
Vic, it's so good to see you.
It's great to see you.
Nice to be doing this in this tech savvy podcasting
booth.
Yes, we have done podcasts before, but You and I have, and I've done lots of other podcasts.
I've never done it in this fishbowl kind of environment.
I
know it feels kind of good to be in here and, you know, a little secret.
Yes.
People are walking by and waving and hopefully listening to the podcast.
So, um, I'm excited to dive in with this.
So you have been working on RX utility, which we're going to get into the whole point of the podcast, but.
Before we start, maybe give the audience a little bit of your background.
Yeah.
Um, because you've come through healthcare for profit, uh, for a long time.
Yeah.
Around Nashville and, uh, back to the old, uh, MD on, all kinds of All those days.
Maybe give like a three to five minute summary to help people with context of where you come from.
And then I want to dig really into like the new adventure and really giving back.
Yeah, thank you.
Um, yeah, so I have been in healthcare for four decades now.
And you're
only 35 years old.
Exactly.
So I don't know how that works.
I know, it's
so hard.
It's such a setup.
But, um, All of that time was, uh, has been in tech.
And my first job out of college was I was a programmer for HCA right here in Nashville.
Um, we had things called mainframes back then, and languages like COBOL and assembler and things that no one would know, you know what they are.
Uh, but it grew up in the industry.
I got into management consulting, which sort of shifted me into, um, what do, computers do for business problems.
And I found the business side more interesting.
So I kind of continued to grow up.
I became, uh, the CEO as a, of a subsidiary of Anthem when I lived in, uh, Indianapolis.
And that did transaction processing for the Blue Cross Blue Shield franchises that they ran out of there and the Medicare.
And it was primarily around claims, so eligibility and claims and payment.
So Yeah.
So
back in the early days, always.
Technology, big data, transaction processing, payments, from the, from the early days.
From
the very early days.
And so the Blue Cross Blue Shield plans, it was very common for them to in source that capability.
And then as the sort of clearinghouse, um, ecosystem evolved with MDON being one of the leaders there.
Um.
Um, the transaction processing started to get outsourced.
So
it became more efficient to outsource that and share that across many providers and payers.
So that multi sided network, which we would call it now, which we didn't call it then was, was what is the baseline of the RCM component of the health IT ecosystem now, but was the very first baseline.
of digitizing what used to be on paper, claims, creating a standard for format and content, and then creating the privacy and security rules around which HIPAA was written and then high tech.
So it was really the beginning of digitizing any kind of workflow in healthcare pre EHR.
And of course, then EHRs came out and then you had clinical formats and et cetera.
So my career has kind of grown up through that.
And um, at this point after, um, being an executive on the MD on team and we took that public and then I left and I was about.
11 years ago, I've run another publicly traded company, which was a multi sided network, but it was between the life sciences industry and the healthcare service delivery industry, which is a really a key opportunity that RxUtility fits within, but hadn't really thought of it that way at the beginning.
But, um, we talk a lot about interoperability in healthcare and the need for it.
And of course there's all kinds of health IT nerdy news about that all the time, which we follow.
Um, Um, but, but that is really inside the service delivery and payment ecosystem and the life sciences ecosystem is like, you know, sort of like Australia is to North America.
It's like a totally different world, content, and there's no digital bridge between those two worlds.
Uh, continents.
So it's, it's interoperability on, on steroids or, you know, or, or squared, uh, problem.
So what I learned about with, uh, my last, uh, day job being the president and chief strategy officer of a small cap NASDAQ stock called Optimize Rx was one bridge that was happening for messaging to providers within the EHR, uh, from pharma manufacturers.
And so I learned about what we.
All probably are familiar with in terms of coupons, and maybe you've seen some coupons for medications.
Um, but you may not be really aware of kind of what that means.
Um,
Well, I see at the end of, you know, watching the NFL, watching any TV really these days, there'll be, there'll be drug ads on.
Yeah.
And at the end, they'll typically be a little tag on says if you have trouble affording your medications.
Yeah.
Yeah.
Come see us here.
But I've never actually used a coupon and before we started talking previous to this.
Yeah.
I didn't really realize the extent to which coupons were available.
Yeah.
And that's one of the things that I'm.
And I'm fairly educated in healthcare.
Yeah, you're an insider, right.
So I was shocked seven years ago when I really learned about the scale.
I knew they existed.
And so pharmaceutical manufacturer coupons, what are they?
They're just like if you were a Pampers coupon for diapers.
Um, it's a branded.
That's a brand of diapers, and the manufacturer gives those coupons out to consumers to, you know, incentivize them to, to buy, uh, to offset the price.
So manufacturers do this for branded drugs.
You know, are
they required to do it, or it's just like with Pampers or anything else?
They're not required.
It's election.
They can do what
they required to do it.
What they do when, when the R& D cycle of life sciences creates a drug, and then they begin to bring it to market, they call that commercialization.
That's commercialization.
And inside the commercialization, um, process, one of the steps is called market access.
And that involves, who are the providers that would need to prescribe this drug, and how do we educate them?
And then who are the consumers that would likely take this drug, and how do we reach them?
And so, part of that access is around information, but part of it's around affordability.
And at that time, in commercialization, the manufacturer makes a decision, am I going to sponsor, a coupon program, and they set up a budget to fund these coupons.
And so many of them do it, that there are 10 billion worth of savings available every single year for consumers to take advantage of through these coupons.
Let me just
pause to focus on that.
Yeah.
10 billion.
in coupons per year are available for U.
S.
I think it's you have a U.
S.
That's right.
That's
U.
S.
Yes.
Thank you.
What percent are redeemed?
Yeah, great question.
Only about 20 percent which means we're leaving
short for billion billion or eight billion billion on
the table.
Right.
And so I was fascinated with that because one of our solutions at Optimizer X was digitally communicating savings into the EHR, but we did it on such a small scale and we were one of the best in the industry that we might have 50 brands at a time.
But in reality, nobody really knew like how many brands and so forth because no one had brought this information together.
So I became very motivated when I became aware of the scale and then I began to understand the problems that there really only two problems and like so many things in life.
It's awareness first, like what are, what are we talking about, it's awareness, and then it's distribution.
So, digital distribution, neither of those things really exist around this story, or you would have known, because you're an insider and you do this all the time.
Yeah, and I think anyone, including me, I would prefer to not pay the full price.
If I can get a coupon digitally and easily, I would opt to do that.
I think most people would.
Absolutely.
And it, and so if we can put my, my mission, our mission as a company is to put every single dollar of that 10 billion of savings into the hands of consumers.
Let's get it all out there.
There are questions about, you know, who does this benefit?
And, you know, it's got to let somebody down.
I would say that, you know, these things.
It is sort of a rising tide, um, scenario.
There's not really kind of a loser.
here because, uh, we all know affordability is a challenge.
We know that 30 percent of people say they don't get their medications, pick them up because of cost.
We know that there's abandonment, um, you know, after the first fill because of cost.
Um, and we know that Financial toxicity is really a cause of, um, people not getting the care that they need.
So this is one tool, that's why I call the business RX Utility.
This is simply a tool to mobilize and democratize those savings so they can get out there to the consumers.
Yeah, and I
want to dive into exactly how, but before we do that.
I, I think because it's voluntary by the companies, there really is no downside.
They are electing to provide these coupons in order to help their branding or help it get, um, be more access to more patients.
And you are bringing awareness to people and allowing consumers to use that more.
But that seems like a win win all around.
I mean, it's very positive.
I think so too.
And it's one of these, it's a rare jewel.
You and I have been in the healthcare industry for a long time and we've seen lots of initiatives try to Improve outcomes and lower cost and I don't know if you saw this last week.
The commonwealth report came out
Yeah,
and the united states is last again against the
20th year in a row of
the other 10 Used to be 11, but now it's 10 Um nations that are compared.
We're the worst in outcomes and we're the worst in cost and it's not by a little bit It's by a lot everything else clusters here stuff's up here So it can be hard to feel motivated around making a positive change But when you find a little nugget of something like this, that as you said, this are already funded, these tools already exist.
So if we can just tell people and make them aware and then get digital liquidity.
to these things, then I believe they will flow easily through our health IT ecosystem to the provider and the consumer.
And then we're really off to the races with those savings.
So,
so tell me the origin story of RX Utility.
How did you conceive of it?
And then how are you going to market to make this, Bring awareness and also make it easy for folks to collect these coupons and benefit from them.
Yeah.
Thank you The origin story really when I left OptimizeRx after five years So I had this awareness that this great bucket of money was available that nobody was used But even I didn't know really how big it is So I started researching and I did probably six months of solid research, but in parallel with that I was doing A lot of private equity advising.
I'm an operating advisor for Goldman Sachs.
I was advising, you know, KKR, Sixth Street and others, and I was doing board work and I was, um, looking at a lot of portfolio companies, a lot of startups and, and seeing what people were trying to do to innovate and, and how people were putting money into what efforts.
And then at the same time I was doing that, Vic, you know, this, that the whole market adjustment, Happened, meaning that companies were overvalued, were valued on growth, um, with no respect for profitability.
Um, and then that all adjusted.
Yeah.
There,
there were all the stimulus checks, all the stimulus that kind of flows through when money was cheap, the financial assets and, and made public stock and private assets very highly valued.
And so now we've had an adjustment and now we've
had a Correct Yeah.
Adjustment.
Yeah.
We've a correction, right?
Yeah,
exactly.
So I'm looking at all of these ways that people are trying to put capital to work to innovate health care and put tech to work to innovate health care, and I thought, gosh, you know, I want to do something that I believe will actually work versus all of these things that we've tried to do over the years, and I want to do something that's specific tech.
And very close to the patient.
So my motivation is this is a tool that exists.
We don't have to go convince people to create these funds.
They exist.
We just need to close that awareness gap and that distribution gap.
And I know how to do that.
Cause I've built multi sided back to my, I've built multi sided networks, my whole career.
So, uh,
interesting thing is that.
I, I think, you can correct me, as you, uh, become aware of the coupons and then get one plugged in related to your prescription and your pharmacy, that benefit will last for every fill.
That's correct.
For a year, or sometimes for longer than a year.
Yeah, they persist, which is a great thing.
And when these are designed, you know, I mentioned the market access phase of commercialization, then.
Yeah.
Typically, the design of the coupon is around the therapeutic life of the drug.
So, if you're supposed to take it for 12 months, it's going to last for 12 months.
If you need to keep taking it, you're going to renew and it's going to keep on going.
So, technically, these things get into the, um, pharmacy claim.
and they act like the secondary payer.
That's how they technically work.
But we could, you know, kind of save that for a nerd, uh, call.
But, um, once the consumer, you know, activates or gets, becomes aware and this thing gets in the system, it really does advantage them.
Um, and we can, I've got some examples, you know, if you want to talk about.
Let's start with kind of in general how you're going to market.
So you are going to partner with other businesses, maybe
exactly
maybe a health system or a Pharmacy benefit chain or I don't know if you have anything similar that you already have heard of, but large, large groups where they have many patients or members that they're in communication with and not go direct, at least at first, you're not going to go direct.
Is that right?
That's right.
So people can't go to the AHRQ's utility website and just sign up.
That's right.
You have partners that they can sign up with.
That's right.
Well, it's a little bit different.
So it's, let me.
Provide the nuance here.
So it's just the name of RX utility is intentional because RX, everybody knows what that is.
Utility makes you think of something that's in settings or it's a tool.
It is, it is a tool.
And who is it a tool for?
So it's a tool designed to be used by the existing health IT ecosystem.
So who are those people?
Well, those are the people that at the, uh, point of treatment or even pre treatment, they're the people like aphresia that'll do your scheduling and then your check in.
And when you're in the office, there's the EHR and within that, there's the prescribing module.
When you check out, that patient engagement app might say, some of them do.
My friend just recently had a, uh, appointment and had Athena's app said to her, you know, thanks for coming basically to the office and here's your script and don't forget to pick it up basically.
Yeah.
And no coupon,
no coupon there yet.
But right there, if the script has a coupon, then Athena, if they had a, um, they subscribed to my file and it's an, it's a simple API interaction.
Uh, they say, Hey, is there a coupon for this drug?
And then if there is, then that, that's brought back.
So I, you know, I've spent my whole career and I know so many people in health IT really well intentioned, great tech flows, the content, this is in, in, uh, you know, most simple terms, quote, just content.
Okay.
So just as they subscribe to the MediSpan file, which is a list of all the drugs they would subscribe to my file, which is a list of all of, the coupons.
And whenever they interact with a human, whether this be pre treatment, treatment, post treatment, especially if you're in an MTM, medication therapy management environment, or chronic care management, you're always touching that person's medication record as part of that care management.
We know that medication Non adherence is the number one cause of poor outcomes.
So on the back end, let's say you didn't catch the coupon on the front end.
That's okay.
You could have that care management software also subscribe to the file and simply ping, you know, of the six or seven.
Or 12 drugs that this chronically ill person takes.
Is there a coupon for this one, this one, this one?
And if there are, now we surface it and we get it flowing.
And so, um, Yeah, so