Stephen argues that patient affordability remains one of the most critical—and often overlooked—barriers to treatment adherence. Drawing on his experience as a community pharmacist, he suggests that cost isn’t just a financial issue—it’s a clinical one.
To learn about RIS Rx’s Benefit Patient Solution (BPS) and other tools, request your savings snapshot.
Read on for Stephen’s insights.
The $700 Copay That Changed Everything
By Stephen Hom, EVP, Chief Commercial Officer, and Co-Founder, RIS Rx
I’ve seen it myself.
Back when I was managing a small community pharmacy, a patient I’d been helping for months—someone managing a tough, insulin-resistant case of Type II diabetes—was standing at the counter, prescription in hand, panic in his eyes.
The new insulin his doctor prescribed was working better than anything he’d ever tried. But the copay? $700. In the rural community where I worked, that number might as well have been $7,000,000. He said quietly, “It’s the only thing that works for me. I just can’t afford it.”
Affordability Isn’t Just a Financial Issue—It’s a Clinical One
As a pharmacist, I’d spent years learning everything about how drugs work. But in that moment with this patient, none of it mattered.
The therapy was right, the prescription was approved, the coverage checked out. And still, the system had failed him. That’s when it hit me: affordability isn’t just a financial issue. It’s a clinical one. If a patient can’t afford to start therapy, the medicine never has a chance to help.
We made calls, dug into every assistance program we could find, and brought his copay from $700 down to $0. When I told him, he laughed through tears and said, “I’d do backflips if I could.”
That moment has stayed with me ever since. It reminded me that for all our industry’s complexity and sophistication, access is still deeply personal.
The Costly Tug-of-War That Leaves Patients Behind
According to GoodRx, about 1 in 3 Americans skips or delays filling prescriptions due to cost. Medication cost is the top reason for unfilled prescriptions in the U.S.—often because copay program complexity and shifting PBM rules leave patients confused or uncovered.
One month, a patient might be enrolled in a program that brings their copay down to almost nothing. Two fills later, they’re reclassified into a different one. And for every confused patient, there’s a provider’s office fielding calls and a manufacturer trying to make sense of why adherence dropped.
At RIS Rx, we saw that chaos firsthand—and we knew the answer couldn’t be more retroactive audits.
From 10-15 Patients Per Day to 10-15 Patients Per Second
When I was working as a frontline pharmacist, I could help 10-15 patients a day with affordability. RIS Rx helps 10-15 a second.
Our approach sets the stage from day one: monitoring in real time, evolving as programs and PBM rules evolve, and catching leakage before it happens.
Why a proactive model wins:
- Accuracy in advance. We identify issues before they occur—before they affect patients or performance.
- Reduced noise. Fewer misclassifications mean fewer escalations, less provider frustration, and most importantly, a lower chance of patient dropping off of therapy.
- Operational efficiency. Partners have been able to optimize staffing thanks to lower call volumes and cleaner processes.
- Better outcomes. When patients stay informed and supported, adherence rises, and so does recovered value.
Accuracy matters: for the income statement, yes, but also for the experience.
Fewer errors mean fewer phone calls, fewer complaints, and fewer physicians deciding to switch to a competitor just to stop the chaos.
In fact, one of our manufacturer partners recently optimized their call-center staffing because the number of escalations dropped so dramatically after integrating RIS Rx. That’s an operational, financial, and patient win. And the impact is real: In 2024, our customers saved $450 million. In 2025, we’re forecasting over $1 billion in recovered revenue.
How RIS Rx Keeps Access Connected—and Recovers Over $1 Billion in Revenue
Our team is pharmacist-led by design. Many of us, including myself and my co-founder Gerard Rivera, came from the front line. The expertise we built manually—informed by thousands of real interactions and every nuance of benefit design—is now embedded in our technology.
Through our Benefit Patient Solution (BPS) and other tools, we identify disconnects in real time, make the right calls on behalf of patients and providers, and recover revenue that would otherwise be lost. The goal is a seamless experience: the patient, pharmacist, and provider don’t see the complexity underneath. They just see that access works.
When I look at our dashboards, I still picture patients like the man with the $700 copay. Every data header represents a part of that journey from prescription to affordability to adherence.
See How We’re Fixing Access: Get Your Savings Snapshot
Every decision, every algorithm, every data point comes back to a simple goal: making sure no one has to choose between feeding their family and affording their medication.
That’s why we created the RIS Rx Savings Snapshot: a quick, shareable diagnostic that shows where your programs are leaking, how much you could be recovering, and what it means for the patients counting on you.
See why we have a perfect NPS score: Click here to request your savings snapshot.
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