Rick Bates, Founder and CEO, RxSense
Rick Bates, Founder and CEOHistorically, pharmacy benefit managers (PBMs) have utilized legacy systems and processes to help patients and payers save costs on their prescriptions. Even today, with digitalization finally becoming business-critical across healthcare, PBMs are still struggling to execute in an efficient manner. In order to stay competitive and relevant, organizations in the current PBM arena are striving to change existing business models and adopt tech-driven solutions to transform the way they operate and enhance their ability to deliver value. However, as a majority of PBM solutions are very expensive and require extensively complex integration with existing implementations, numerous PBM businesses and organizations are looking for new ways to more efficiently manage their pharmacy benefits, including exploring modern technology solutions.

Bridging this gap with its comprehensive business analytics platform is Boston-based RxSense. A high-growth healthcare technology company delivering industry-leading solutions for pharmacy benefits and prescription savings, RxSense provides leading cloud-based enterprise solutions for pharmacy benefits administration, claims processing, and advanced analytics to help its clients drive flexible, efficient, and transparent operations. For these reasons, RxSense has carved a unique place in the industry, as a premier self-service solution offering clients the ability to implement licensed enterprise software for pharmacy benefits, helping PBMs, health plans health systems, third party administrators, new healthcare and pharmacy entrants and healthcare technology companies.. “Our platform is an end-to-end solution that allows clients to manage their clinical, operational, and financial performance, as well as pricing and contract management in real time across their entire business,” says Rick Bates, founder and CEO of RxSense. Furthermore, with RxSense’s data analytics, businesses can not only enhance their PBM-related processes, but also optimize their operational efficiencies to drive better pricing and contract management across retail partners, specialty collaborators, and more. Bates also emphasizes his company’s purely fee-based and transparent business model, which eliminates the complexity and drainage of resources and cost confusion that come with traditional spread-based services.

RxSense: Delivering Intelligence to PBMs

The comprehensive capabilities of the RxSense platform are backed by the company’s flagship modules: RxAgile and RxIQ. RxAgile is the intelligent front-end solution that simplifies the management of data across all of a PBM operation’s facets, including formularies, eligibility management, and more. Once RxAgile collects the user inputs, the data is run through a rule-based, scalable, secure, stable transaction engine for claims processing. RxIQ—RxSense’s data and analytics engine—delivers actionable health plan performance insights and enables clients to make intelligent decisions across their operations. It also flags clinical and financial anomalies, so they can be addressed in near real time. “Above all, RxSense offers a single platform that is completely integrated and interactive to eliminate the complexity of connecting different piecemeal solutions and drive significant time and cost-savings,” adds Bates.

With such unmatched capabilities, RxSense has ignited several success stories since its inception in 2015. The company recently announced a partnership with New York-based PBM ProAct to transition their business model from a legacy approach to one that is powered by disruptive solutions providing ProAct with greater autonomy for benefits management, efficiency for claims management, and access to real-time plan performance insights. In another case, RxSense assisted Hy-Vee, one of the nation’s leading grocery chains, to power its enterprise solutions for pharmacy benefits to launch its new private label PBM, Vivid Clear Rx. RxSense provided Vivid Clear Rx with a full-service suite of modules for pharmacy benefits management that supplements assets that Hy-vee already owns and operates, and allows Vivid Clear Rx to merchandise its own private-label pharmacy benefits solutions to regional businesses in the marketplace they serve.

RxSense offers a single platform that is completely integrated and interactive to eliminate the complexity of connecting different piecemeal solutions and drive significant time and cost-savings


At the heart of this success is RxSense’s unique and diverse management team, which comprises leading professionals from the realms of PBM, software engineering, consumer technology, and more. “We’ve built a team of best-in-class technology leaders, engineering professionals, data analysts, and customer experience personnel to ensure that our services always deliver real value to our clients,” states Bates. RxSense prides itself on its ability to understand a client’s needs and deliver an unparalleled solution.

Looking ahead, RxSense plans to continue delivering its platform to new clients and help them deliver value to their customers. By doing this, the company wants to spread awareness of its platform and its proven track record in helping businesses run pharmacy benefits more efficiently. Bates also mentions his plan to deploy RxSense’s platform across large national purchasing co-operatives and other businesses. To conclude, Bates reiterates the ethos of his company, “We will continue toward our vision to become the go-to-partner in helping businesses control their drug-spend by creating true transparency across the marketplace.”