COVER STORY

The healthcare industry has seen significant technological advancements in recent years. From basic appointment scheduling to complex surgical processes, modern technology is now being broadly applied throughout the industtry. In many cases, now, new software solutions are bringing greater efficiency and lower costs to healthcare organizations, leading to better care for patients.

Pharmacy benefits management is one of the industries ripe for this disruption, as it has been saddled by antiquated technology for decades. Legacy players and their services typically fail to offer clients transparency on the cost of goods, restrict flexibility to control benefits setup and edits, limit access to timely data insights, and lack integrated solutions. Transparency, long considered a holy grail of pharmacy benefits, is now finally being realized and achieved through modern technology and new innovative solutions.

One of the leading companies bringing new solutions to the space is RxSense. RxSense is a healthcare technology company delivering enterprise solutions that empower organizations to take control of their own pharmacy benefits — with true transparency on cost — for improved financial performance. As a vertically integrated business, it operates distinct but complementary business segments on a unifying platform, including Enterprise Platform Solutions, Partnership Solutions, and Consumer Solutions.

RxSense is a healthcare technology company delivering enterprise solutions that empower organizations to take control of their own pharmacy benefits — with true transparency on cost — for improved financial performance.

Bates, Founder and CEO of RxSense, was with the CEO Views team to share the story of their journey. Rick has over 20 years of experience leading strategy and growth at healthcare companies. Prior to RxSense, Rick was the President and COO for Catalyst Health Solutions where he was responsible for building and leading the company’s aggressive growth agenda. After joining in 2009, Rick grew the company from $2.5 billion to $5.7 billion in revenue, and $1 billion market capitalization to

$4.5 billion market capitalization in 2012. Under Rick’s leadership, Catalyst would become a Fortune 500 company and later became Catamaran after merging with SXC. Rick also held leadership roles at some of the nation’s largest healthcare firms, including UnitedHealth Group, Oxford Health Plans, and Coventry Healthcare.

How it all started

In 2015, Rick brought together a seasoned group of healthcare veterans and consumer technologists to develop a modern tech platform that addresses the pain points of pharmacy benefits administration. The result was a cutting-edge, cloud-based enterprise platform that’s smart and simple to use, offering the speed and flexibility to meet the needs of any client.

“RXSENSE IS A CORPORATE CULTURE THAT PROMOTES COLLABORATION AND ACCOUNTABILITY FOR RESULTS.”

Benefits to its customers

Over the past year, RxSense has provided numerous new clients with its enterprise solutions for pharmacy benefits, including the company’s data analytics technology, which uniquely provides access to clinical and financial performance insights in near real time.

RxSense serves organizations across the pharmacy benefits ecosystem — including pharmacy benefit managers, regional health plans, health systems, third party administrators, new healthcare and pharmacy entrants, and healthcare technology companies.

Most recently, RxSense announced a partnership with EmsanaRx, a new pharmacy benefit manager launched by the Purchaser Business Group on Health. PBGH is a nonprofit coalition of nearly 40 large private employers including Microsoft, Disney, Tesla, Walmart, and Salesforce. EmsanaRx chose RxSense to provide modern, cloud-based technology and full access to plan performance data to help its members make more informed purchasing decisions and more efficiently alter their benefits.

“Our members told us they find most pharmacy benefits programs to be opaque, increasingly expensive and of varying clinical quality. They asked us to come up with a better solution,” said Elizabeth Mitchell, president and CEO of PBGH and chair of the EmsanaRx Board. “Large employers are very interested in EmsanaRx’s work to bring pharmacy benefit management back in line with the needs of their employees by offering greater flexibility and the ability to manage their drug spending. RxSense was chosen as the key partner to help us achieve this for employers.”

RxSense has also announced partnerships with Hy-Vee, one of the nation’s leading grocery chains with more than 275 stores spanning eight states across the Midwest; and ProAct, a 100% employee-owned pharmacy benefit manager.

Hy-Vee selected RxSense to power its own private-label pharmacy benefits manager, Vivid Clear Rx. RxSense is providing Vivid Clear Rx with a full-service suite of modules for pharmacy benefit management and the ability to merchandise its own private-label pharmacy benefit solutions to regional businesses in the marketplace they serve.

Seeking modern self-service solutions, ProAct chose RxSense for its comprehensive enterprise technology solutions. RxSense provides ProAct greater autonomy for benefits management, efficiency for claims processing, and real-time access to data and plan performance insights through RxIQ data analytics, to enhance the value they provide their clients.

RxSense enterprise solutions is a true culmination of top-down efforts to improve healthcare transparency and efficiency through modern technology. With a sophisticated, process-based architecture and simple-to-use interface, RxSense is bringing modern technology solutions to clients to achieve greater efficiency, save time and money, and ultimately result in better healthcare outcomes for patients nationwide.

Values of the company

RxSense is a corporate culture that promotes collaboration and accountability for results. Rick believes that employees are the company’s most valuable asset, and their customer-first philosophy empowers teams to create solutions. Rick shared that RxSense employees also take pride in the fact that they are building a disruptive business dedicated to developing products that lower prescription costs, and ultimately help people lead healthier lives. This year, RxSense was named among Modern Healthcare’s Top Places to Work in Healthcare.

Acquiring talent in a competitive market

Employees play a crucial role in the success of any organization. Speaking about the same, Rick said, “We’ve developed an awesome Talent Acquisition team that has been able to attract high potential talent to RxSense. They’ve created a deep candidate pipeline for all of our teams, and leveraged our own employees’ networks, as they are the ambassadors for our company. We have an established vision and we’ve received a number of industry awards and accolades, which also helped us attract elite candidates in our industry. We understand how the employee market has shifted and how competitive the landscape has become. We’ve been able to bring in top talent by virtue of the fact that we’re an innovative and high-growth healthtech company, with a meaningful mission, outstanding benefits and a willingness to be flexible in how we work with our employees to balance their performance and their personal needs.”

Principle of RxSense’s technology

Responding to our question on what has been the guiding principles of RxSense’s technology and what has kept their innovation cycle going on, Rick said, “One of our guiding principles is delivering the best solutions to support our partners. We are focused on empowering our clients with customizable solutions to meet their business needs. We help partners chart their own course by leveraging real time data insights to transform their business performance and optimize customer savings. I believe we’ve truly built best in class technology to serve the pharmacy ecosystem, that’s unique in how it brings both unprecedented value to clients, and meaningful savings to patients.”

An award-winning journey so far

RxSense is a high-growth health tech company with an attractive financial profile. The company now has over 300 employees and features office locations in Boston, New York City, and Palm Beach Gardens, Florida. RxSense has received dozens of industry awards and accolades, including being named one of Fast Company’s Most Innovative Companies in 2020, Forbes’ Best Startup Employers in 2020 and 2021, an American Business Award winner in 2021 and 2022, a Digital Health award winner in 2020 and 2021, and among Modern Healthcare’s Top Places to Work in Healthcare in 2022. In 2018, Rick was named an Ernst and Young New England Region Entrepreneur of the Year award winner and was a finalist for the national EY Entrepreneur of the Year award.

Future goals

Speaking about their plans for the coming days, Rick said, “We remain laser-focused on building the best technology platform to redefine pharmacy benefits. I believe we offer the most intelligent and intuitive platform for pharmacy benefits administration on the market, and we’re going to continue to innovate to provide our partners with fast, flexible, and customizable solutions to improve their financial performance across the ecosystem and bring care to patients more efficiently.”