How AI Can Help You Run a Smarter, Cheaper, and More Transparent Prescription Plan

By Susheel Jain, CEO of Exouza

In my last post, I talked about my incredible team of ex-pharmacists, technologists, and entrepreneurs who are united with me trying to improve the prescription drug insurance industry. We’re using AI to lower costs, improve access to critical drugs, and rewrite the patient experience for the better.

Today, let’s focus on Exouza’s customers, the organizations that buy, sell, and administer health plans. These are benefits brokers, third-party administrators, and buyers of public and private employee health insurance.

This post is for you. Here’s how our AI-driven PBM platform helps you reduce costs, eliminate friction, and take control of your prescription drug program while improving your members’ experience.

Why Are Prescription Plans So Much More Limited than Medical Plans?

When you purchase a medical plan, there are tons of options. PPOs, HMOs, high-deductible plans, and tiered networks. Each has its own balance of access, cost, and coverage. You can compare models, evaluate trade-offs, and make informed choices.

But when it comes to prescription benefits, nearly every option feels the same. You’re locked into one opaque pricing model. The flexibility and transparency that define medical plan design simply don’t exist in the pharmacy space. Exouza is working to provide optionality in the prescription space as well. 

Bringing Managed Care Options to Prescriptions

So what does this mean?

With Exouza’s platform - OpenPBM.ai - your PBM includes a deep suite of options similar to what you’d find in a managed care setting. You will choose a range of programs and features when you onboard a plan. Then your members will start seeing promotions. However your members prefer to communicate (text, email, web), they will get updated about incentives, wellness programs, and discounts that are relevant to their specific needs and treatment. 

The Role of AI

We designed the OpenPBM.ai platform to quietly and consistently make your plan run better. It doesn’t need to ask you what to do. It just does the right thing.

● Smarter Formulary Management

Our system constantly scans formulary performance and matches coverage with cost and access. You get optimized placement and fewer disruption issues, without manual oversight.

● Automated Prescription Auctions

Approved prescriptions are automatically shopped within your network. Pharmacies can compete to fill the script at the best rate, in real time.

● Verified Rebate Tracking

No more black-box rebate math. You get clean performance reporting tied to actual claims activity that you can explain to any procurement office or plan buyer.

● Program Enrollment and Optimization

When a member qualifies for a specialty funding program or clinical pathway, the system identifies them and triggers the enrollment logic automatically. You don’t need to track it down yourself.

If You Can’t See It, You Can’t Manage It

Most plan buyers have very limited visibility into what their PBM is really doing.

• You’re told you’re saving money, but you can’t verify how much

• Reporting is delayed and often incomplete

• Pricing, formularies, and rebates are completely opaque to you

• You find out about member disruption only after the calls start

• You know there are clinical and manufacturer-funded programs available, but it’s still somehow your responsibility to figure out which members qualify and how to enroll them

The burden keeps shifting to you. And the data you need to make confident decisions is either missing or months too late to matter.

Why OpenPBM.ai Works Better

There’s no legacy architecture to work around, and no layers of manual processing underneath the surface.

AI isn’t bolted on here. It’s the core engine that powers every transaction, formulary decision, and pricing model we use.

• Lower net spend without chasing down savings

• Less noise from pharmacies and members

• Faster implementation and cleaner handoffs

• Transparent rebate and pricing data

• Confidence that your plan is working the way it’s supposed to

• Fewer surprises, fewer fires, fewer escalations

When a plan runs well, you hear about it less. And that’s the point.

You Don’t Need More Work. You Need Less.

The pharmacy benefit is too important to manage with guesswork and delayed reports. We built Exouza to handle the complexity for you, and to do it transparently.

Because making pharmacy benefits work shouldn’t require detective work.