This Group of Ex-Pharmacists Is Using AI to Fix Prescription Drug Costs
- Susheel Jain
- Nov 5
- 3 min read
By Susheel Jain, CEO of Exouza
“I’ll never forget patients in tears over $2,000 oncology co-pays, or being told their life-saving medication wasn’t ‘on formulary’. That disconnect between what a clinician prescribes and what a patient can actually receive, convinced me the system needed rebuilding.” — Gary Rice, COO of Exouza
To build a PBM that truly works for patients, I wanted a team who had firsthand experience inside our broken healthcare system. That’s why my Chief Operating Officer, Gary Rice, and my co-founder, Bill Bailey, are real-life ex-pharmacists who worked their way up to executive positions. That’s why my Chief Technology Officer, Dan Cooper, is someone who built national Health Information Exchanges from the ground up.
They’ve seen the system fail patients in real time, not from a spreadsheet, but from the pharmacy floor. And they’ve spent their careers trying to fix it from the inside. Now we’re doing it together, from the outside.
“Pharmacists have always been innovators; we've just been constrained by outdated infrastructure.” Gary continued. “Exouza is freeing that expertise. We’re translating decades of frontline pharmacy experience into algorithms, contracting logic, and patient-centric data flows that actually work. Our goal is simple: to make every prescription transaction fair, fast, and fully explained.”
From the Counter to the Codebase
“There’s never enough time. I would repeat that every day. The time a pharmacist can spend with a patient can have a profound outcome in the care model. Big chains have become the slave to quotas and it’s eroded the patient experience.” — Bill Bailey, Exouza Co-Founder
Bill’s point about the ability for the pharmacist to spend personal time with a patient also hit home. Exouza believes that excellent patient support doesn’t raise costs, it lowers them. That’s why our tech platform is accompanied by white-glove patient services from our team of pharmacists and nurses.
Starting Over on Purpose
We didn’t want to add a tech layer to a broken model. We wanted to rebuild the PBM from the ground up.
That meant no spread pricing. No black-box rebates. No handoffs, no patient run-around.
We built a platform where:
Data moves in real time
Patients know what they’ll pay before they hit the pharmacy counter
Pharmacies get reimbursed quickly and fairly
Health plans can control costs without shifting burdens
We call it OpenPBM.ai — a transparent, tech-powered PBM model that works for everyone.
AI That Works Where the System Doesn’t
When we say “AI,” we don’t mean a chatbot. We mean decision intelligence that’s deeply embedded in how the system operates.
We’ve built AI to:
Scan formularies for gaps and coverage delays
Run prescription auctions to identify the most cost-effective options
Alert plans to pricing anomalies and disruptions
Surface better alternatives when cost or access becomes a barrier
This isn’t just automation. It’s intelligence, applied at the right moment to get patients what they need, faster.
Fix the Incentives, Fix the Experience
Our philosophy is simple: when you align incentives around patient outcomes, the system starts to work.
Doctors can prescribe without guesswork
Pharmacists don’t have to play defense
Plans can manage cost without compromising care
Patients get what their doctor prescribed — and they can afford it
It’s not magic. It’s just better design.
This Is Personal
My team has stood behind the counter.They’ve watched patients walk away without their medication. They’ve seen the stress, the confusion, the quiet shame of being denied treatment by a system that’s supposed to help.
I’ve worked alongside those people pharmacists, doctors, benefit managers and I’ve seen how hard they try to make a broken system work. I’ve also seen how much better it could be if we just redesigned the rules.
That’s why we built Exouza.
This is what happens when technologists, pharmacists, and healthcare insiders come together to finally fix what we’ve all experienced.
We’re not patching the system.We’re replacing it.Stay tuned.
If you are an employer/insurer,