A New Era of Pharmacy Benefits Management

Susheel Jain, CEO

Exouza offers OpenPBM.ai, a next-generation pharmacy management administrative platform that empowers employers to better manage rising costs and navigate the complexities of the healthcare ecosystem. By combining intelligent technology, white-glove service and radical flexibility, it drives tangible financial savings, stronger employee engagement and a healthcare experience aligned with current expectations.

This forward-thinking solution comes at a critical time. Pharmacy costs are now one of the largest drivers of healthcare spending, and can account for 25 percent of an employer’s total costs. Despite this, traditional pharmacy benefit managers (PBM) continue to rely on outdated, rigid, and opaque models that offer limited transparency, minimal control and little influence on outcomes. Compounding the issue is the high cost of specialty drugs. Although used by only

about three percent of the population, the high price of these medications means they account for over half of total drug spending. Much of the complexity and inefficiency surrounding drug pricing is the widely used practice of negotiated rates between PBMs and pharmacies. But this practice does not provide real-time, market-based pricing across a variety of prescription drug suppliers. OpenPBM.ai is the first PBM platform that “shops” for the best price for prescription drugs from multiple sources, not just a contracted rate with a pharmacy, delivering unmatched value to both employers and employees.

“Nearly every other industry allows shopping for prices with fully transparency to buyers. Now for the first time, Exouza brings this experience to prescription drug pricing and management. We saw the growing gap and approached it with a blank canvas.” -Susheel Jain, CEO

Exouza Awarded 2025 Platform of the Year

Rather than adapting outdated systems OpenPBM.ai was built from scratch as a modern, agile, and data-driven PBM platform. Its intuitive app and portal—covering administration, finance, access, clinical management and customer service—are designed with an open architecture to integrate best-in-class capabilities, giving

customers the flexibility and customization they need now and in the future. Integration and interoperability with vetted partners and third party systems enables

smooth data flow and real-time tracking of member and drug status at every stage.

If an issue arises with one partner, OpenPBM.ai immediately identifies the next best route and guides the member to an alternative program or solution, ensuring

continuity and support.

Maximizing Pharmacy Impact with Intelligent Flexibility

The OpenPBM.ai platform also goes beyond basic, plan- and group-level configurations to deliver multi-layer flexibility. Third-party administrators and employers configure programs with virtually unlimited personalization, which significantly enhances performance and outcomes. Whether managing a single organization or a multi-region portfolio, the OpenPBM.ai platform offers granular customization by client, geography, member, drug and pharmacy, ensuring each program meets specific needs.

As drug prices fluctuate or member eligibility changes, the platform instantly responds to ensure accurate, consistent and compliant coverage and prescription routing decisions. With embedded AI logic and automated decision support, it dynamically manages plan and program eligibility, routing and sequencing logic, incentive structures, penalties and limitations.

Central to this approach is the use of real-time technology to ensure accuracy and transparency. The platform maintains a continuously updated data infrastructure that instantly delivers precise information to members about copays, eligibility and participation rules.

“Technology is just the starting point—true engagement comes from directly connecting with members, guiding them through the process, and supporting them every step of the way." -Gary Rice, COO

Through direct interaction with members, Exouza improves program participation, boosts retention and generates measurable clinical and financial gains. Whether guiding someone to the most cost-effective pharmacy or helping them understand the full scope of their benefits, every touchpoint is designed to add value.

The combination of ‘high tech’ with ‘high touch’ in the integrated framework has produced industry-leading results. A recent impact analysis with a third-party administrator showed a 52 percent reduction in pharmacy spend. This was driven by six of Exouza’s cost containment programs selected by the client: patient assistance, specialty drug clinical management, copay assistance, importation, clinical prior authorization, and site-of-care optimization for medical benefits. Enrollment across these programs exceeded 55 percent, significantly outperforming industry benchmarks, and member retention remained above 90 percent, month over month.

Driving the Next Wave of PBM Innovation

Exouza remains committed to staying ahead of industry demands through its innovation roadmap. Among its upcoming features is a reverse auction capability that allows contracted pharmacies to bid in real time to fill prescriptions at the most competitive price. Fully automated through backend technology, the auction process is triggered as soon as a member leaves the physician’s office. While members experience a seamless process of the complex infrastructure behind the scenes, they benefit from access to real-time, market-driven pricing.

Exouza is also expanding the use of AI to enable real-time, rules-based routing of prescriptions to the lowest net cost by factoring in discounts, rebates and vendor contracts. These enhancements ensure each prescription is filled accurately and optimally, based on the full context of the benefit plan and market dynamics.

Complementing these efforts is a bold reimagining of pharmacy payments. By tapping into the Federal Reserve’s FedNow banking rails, Exouza facilitates real-time, merchant-to-merchant transactions that bypass the inefficiencies of traditional claims-based reimbursement. This innovation is a game-changer only available through OpenPBM.ai, empowering Exouza to transform payment models that expedite payments to pharmacies who participate in the reverse auction model.

Exouza brings pharmacy benefits back in sync with patient care through intelligent infrastructure and hands-on service, delivering a seamless experience that scales with client needs - and is poised to adapt and innovate as the pharmacy landscape evolves.