Ed Gaudette (1:44)

So many issues with that too. I'll relay a story about in a second. Before we do that, share a little bit about your role and how you got into healthcare.

Mariam Paramore (1:54)

Oh my goodness. When I was in college back in the day, there was this degree called computer science. I always liked math and data, so I have a math and computer science degree and I needed a job and I lived in Nashville and I became a programmer for Hospital Corporation of America, or hca. So I just was a nerd and then grew up in the industry of healthcare and information technology. And that took me on a 40 plus year journey now of running and building and managing health tech companies. And now I spend time getting bootstrapping this company, RX Utility, which I started a little over a year ago with this consumer affordability focus. And it's a great, gives me a chance to take into consideration sort of all of the experiences that I've had and the deep subject Matter expertise, the technical skills, but as importantly, my personal network and really do something that you mentioned earlier before we got on the air, which is try to give back some. Now, this is a for profit business. Of course we expect to be successful, but it's a mission driven business at the same time. It's an exciting place to be in my life and being able to do something very creative with technology.

Ed Gaudette (3:10)

Okay. All right. So are you a founder?

Mariam Paramore (3:12)

I am the founder.

Ed Gaudette (3:13)

You are. You have a co founder now.

Mariam Paramore (3:15)

I'm the founder and the CEO and funding the business.

Ed Gaudette (3:19)

Bootstrap, right?

Mariam Paramore (3:20)

Bootstrap, Correct.

Ed Gaudette (3:21)

That's what that means, kids.

Mariam Paramore (3:22)

That's exactly what that means. Yes, exactly.

Ed Gaudette (3:24)

Kids. Yeah. That's risky too.

Mariam Paramore (3:26)

It is very risky. It's something that I'm very fortunate to be in a position to do it. And that's a result of working really hard for a long time. It's something that I wanted to take. Speaking of risk, I wanted to take a risk on. When we have our choices around what we prioritize a lot of the way. What's really important to somebody is where they spend their time and where they spend their money.

Ed Gaudette (3:52)

Yes.

Mariam Paramore (3:52)

And so I decided to really put my money where my mouth was and see if I could build something that really helps consumers.

Ed Gaudette (3:57)

Yeah, I love that. How's it going?

Mariam Paramore (3:59)

Oh, it's incredible. It's fantastic.

Ed Gaudette (4:02)

Is this the first company you've done?

Mariam Paramore (4:03)

It is not. It is not the first company I've done earlier in my career, let's say midway through my career, I had some just. I don't know, you're not as old as me, but life is a. I might be.

Ed Gaudette (4:13)

You have no idea.

Mariam Paramore (4:14)

Life is a winding kind of road.

Ed Gaudette (4:16)

Yeah.

Mariam Paramore (4:17)

And so I started a consulting business when hipaa, the HIPAA rules came out and I'm quite an expert in that arena. Yeah. 96. It's been a while passed, but in those. So it really didn't start to get adoption until kind of the late 90s. It was around 99ish, I think. I started the business maybe 98, but I left. I was the CEO of a subsidiary of Anthem at the time and I left that to do this consulting really for lifestyle. I had two small children, I was single and I wanted to see if I could design a way to make money in a little bit of different way and it worked. So I ran that, that business for about seven years. But that's quite different. A professional services firm is quite different than a software firm.

Ed Gaudette (4:57)

Yes.

Mariam Paramore (4:58)

Which I've also built and run as part of larger organizations. So this is my first data data company. It's a data/software SaaS business. Right. It's really a DAS business, but I think that sounds dumb, but if it's this data as a service. Yeah. So AI enabled. Yes.

Ed Gaudette (5:16)

From the ground up.

Mariam Paramore (5:17)

If I didn't say that, would I be on the air anyway?

Ed Gaudette (5:21)

Of course you would be, but the

Mariam Paramore (5:22)

truth is that it is AI enabled. So as a programmer, like I used to write COBOL code, I know how to write code and it's astonishing and so much fun to use these tools

Ed Gaudette (5:32)

using cursor or Claude, or we use

Mariam Paramore (5:35)

both OpenAI and Claude so we have those LLMs underneath. And then if you think of it as a data foundation, we have collected, curated and aggregated and organized a whole bunch of data. And there's a lot of crosswalk, different things to make the data make sense. What are the drugs, the NDC codes, all the prices match it all up with the pharmacies and the consumer's coverage. And it's complicated. Yeah, but it's just a bunch of data. But then you need to have some intelligence on top of the data and that's where the AI really comes in. But the AI also is used to actually build the software. You know all about Vibe coding, Azure and everything. You know, even I know how to Vibe code and I hadn't written a line of code in like forever. But it's astonishing the capital efficiency that you can. Oh, it's incredible that you can experience as an entrepreneur with very few human resources and you can create agents, write code for you. And we do. And we have from the very beginning. So now we're getting to the point where we're bringing in sort of decisioning layers. It's not an LLM. I could say that I have a proprietary LLM and lie like the rest of these people here on the floor, you damn liars. But I won't. But we do have a lot of great tooling and we've built it in such a way that because it's a utility, that's the aspiration is to be a tool inside all of these healthcare systems that exist so these prices can be surfaced and consumers can make informed choice. So we do use the latest tech. I'm proud of what we accomplished.

Ed Gaudette (7:06)

Yeah. Where do you sit? Do you sit alongside the ehr?

Mariam Paramore (7:10)

Yeah. Perfect question. So if you think about all the people that are on the floor here at Vive, they face a lot of different parts of the industry. So you have pharmacy facing Tech, you have provider, office and health system facing tech. You also have a lot of digital health and consumer facing tech as well as employer payer facing which includes a PBM side of the world. As you go around that horn. Every part of the healthcare system touches medication, whether it's at the point of prescribe in the provider's office or at the point of dispense at the pharmacy counter. Or it's a benefits navigation tool that's helping you manage your benefits like a transcarent which is a customer of ours or medication adherence which are payer side businesses and member engagement, patient engagement. I could go on and on. So they face all of these endpoints that embedded technology, whether it's an EHR or a pharmacy management system or a member engage system already exist in the world. What it doesn't have is consumer pricing data. So we sit as a business to business utility tool where they can subscribe to our data and then bring our data to the surface through their workflows that people already use. And that's the utility idea. So we're. I think of it as democratizing consumer prices. So you have to aggregate them all and then hook them up.

Ed Gaudette (8:38)

Do they want to do that though?

Mariam Paramore (8:40)

Even those powers that don't necessarily want to do price transparency have been forced in that direction. From the transparency, excuse me, in coverage rules through PBM reform which is now changing the way spread pricing and rebates work and then through just the sheer power of consumerism as a macro trend.

Ed Gaudette (9:00)

Will you ever make that data direct to consumer?

Mariam Paramore (9:04)

Yeah, we think that we met. We have that intelligence layer and the ability to do that through sort of an AI companion. Think of it as yourself there introduced myself to somebody. What do you do? And I said well I'm basically a drug dealer. You could think of it as your friendly drug dealer.

Ed Gaudette (9:17)

I've had experience with that in the

Mariam Paramore (9:19)

past, just breaking it down. I help you find good drug deals. That's a drug dealer, isn't it?

Ed Gaudette (9:26)

It is such drug deals.

Mariam Paramore (9:29)

But basically that AI intelligence can help a consumer navigate best price.

Ed Gaudette (9:34)

So we manufacturer like manufacturer options or choices or. Yeah, changes to manufacturers.

Mariam Paramore (9:42)

That has happened really. Last year was the first year in history that pharmaceutical manufacturers had gone direct to consumers with their pricing. And we saw that in the news around the GLP drugs. And so that's really a sea change that had never been done before. Nobody ever thought that a pharmaceutical manufacturer would sell directly to a consumer without going through a wholesaler or a retailer. But now we're there. So then you started to see them use that channel to promote other non GLP drugs that are direct to consumer. And so you see now price compression happening. All that's a good thing. That's what happens when there's a real marketplace and consumers can see prices price compression happen. We saw that dramatically in GLP drugs. So one of the things that people don't know a lot about with pharma manufacturers is that they have a whole bunch of savings for consumers called copay coupons. And that's part of our solution. It's a catalog. So it's called the copay coupon catalog, brilliantly named. And there are about $30 billion of consumer savings available every year for consumers to use when they pick up a branded drug like an Eliquis as an example, which is a very popular blood thinner, prevent stroke and heart attack. That's a $600 list price drug. It's going to be probably a tier 3 drug. Have a fairly high out of pocket copay. So a copay coupon can bring the consumer's cost down to $0, $5. Just like a manufacturer coupon on Pampers.

Ed Gaudette (11:15)

Yeah. Let me tell you what happened to me. So I'm a, I'm on lisinopril which is blood pressure med.

Mariam Paramore (11:20)

Yeah.

Ed Gaudette (11:21)

Small dosage.

Mariam Paramore (11:22)

Yeah.

Ed Gaudette (11:22)

They changed the manufacturer on me recently. I was heading to Aruba and Jamaica, my meds were coming up and they, I got this new pill and I'm like what the hell is this? Oh, it's the same thing.

Mariam Paramore (11:36)

Was it shaped different?

Ed Gaudette (11:37)

Yes.

Mariam Paramore (11:38)

Yeah, yeah.

Ed Gaudette (11:39)

And from a different manufacturer up.

Mariam Paramore (11:40)

Yeah.

Ed Gaudette (11:41)

And from a different location.

Mariam Paramore (11:42)

Was the price different?

Ed Gaudette (11:44)

I don't care about the price.

Ed Gaudette (11:45)

Like my father in law had that happen to him and he had a reaction to it.

Mariam Paramore (11:49)

Yeah.

Ed Gaudette (11:49)

And they say, oh, it's the same, it's the same thing. It's the same. It's not the same thing.

Mariam Paramore (11:54)

It's not the same thing.

Ed Gaudette (11:54)

Different fillers, other different things that are in there.

Mariam Paramore (11:57)

That's right. You're exactly right.

Ed Gaudette (11:59)

So are you also going to provide that level of transparency to consumers?

Mariam Paramore (12:03)

Interesting. That's a little bit of a bridge too far at the moment. But it's a very important point that you make and I just want to comment on that because there are switching programs that happen that the consumers never know and it's wrong. Yeah. Like what is wrong? A lot of times that happens between a branded drug and a generic. The doctor will prescribe the brand but the pharmacy will fill the generic.

Ed Gaudette (12:23)

Yeah.

Mariam Paramore (12:24)

And there's a certain way to write a drug called dispense as written, where the doctor has to say on the script, dispense as written, meaning do not switch. This and one of the big debates about drug affordability as well. The generics are cheap. Why are you ever using a brand? In our coupon catalog, there are 1200 brands. So 1200 drugs that have coupons, 75% of them do not have a generic equivalent. Okay. And even if they did, it is true that patients can experience adverse side effects when they are switched from a brand to a generic.

Ed Gaudette (12:56)

Yes.

Mariam Paramore (12:57)

Because it may have the same active ingredient. But to your point, the way it's formulated, how it's manufactured is different. It's just different. Or it would be the same thing.

Ed Gaudette (13:06)

It would be the same thing. Exactly.

Mariam Paramore (13:07)

But it's not the same thing.

Ed Gaudette (13:09)

And they were. And CVS is telling me that, oh, it's the same thing. And I'm explaining. And so finally, they got frustrated with me because I wouldn't stop, wouldn't accept it.

Mariam Paramore (13:16)

Yeah, yeah.

Ed Gaudette (13:16)

And they said, it's going to be a different price then. So now they were telling me initially that it's because they couldn't get it any longer, but in fact, it was a problem price issue.

Mariam Paramore (13:24)

It was a price issue.

Ed Gaudette (13:25)

And I said, I don't care about the price. They went, oh. But they fought me. I literally. I didn't advocate for myself and really push. And then the best part of is they didn't even charge me.

Mariam Paramore (13:34)

Well, that's good sometime, if you're willing to. But think about that. Think about if you had been less informed or less motivated or didn't feel empowered enough to argue for yourself. This happens routinely, all the time. It does happen all the time. And it's a bad thing if someone had a negative reaction after it was switched, but they needed to go back to the brand, and then they couldn't afford the brand because your health plan dropped it from the formulary and now you're just out in the cold.

Ed Gaudette (14:01)

Yeah.

Mariam Paramore (14:02)

Then you've got, well, what am I going to do now that there are options? So there. It is possible to just pay for drugs with cash.

Ed Gaudette (14:08)

Yeah, exactly.

Mariam Paramore (14:09)

You don't have to use your insurance for a long time. I didn't even really know that. And I'm in the industry. I'm like, well, they're not going to give it to me if I just give them money. Turns out they will. You give them money and give me medicine. They're like, okay. But a lot of times, this is another thing that we really Want to inform consumers about when you take a generic drug and does our tier one on the formulary. They're like the cheapest. Right. You still have a copay on a tier one drug and it's usually 10 bucks, maybe 15, depending on your brand. If you paid cash for that exact same drug, $2 and 18 cents. But no consumer would know that because you just assume if I use my insurance benefit.

Ed Gaudette (14:44)

Interesting.

Mariam Paramore (14:45)

It's just. So now that we're in this direct to consumer world with pharma that you asked about. Now that we're in this switching. Now that we're in. I just need the drug that works for me and my doctor wants me to have that. Please give me access to it. There's some decisioning around should I even use my insurance benefit or should I pay cash? So we do make all those prices available to the consumers. Co pay insured prices as well as all the cash prices and then let the consumer choose. Find the best price.

Ed Gaudette (15:14)

We spent a lot of time on the business. But I want to know about you, Miriam, the person. So rapid fire. Ready?

Mariam Paramore (15:20)

Ready.

Ed Gaudette (15:20)

Okay. Go back in time. Tell your 20 year old self something. What would it be?

Mariam Paramore (15:24)

Don't be so insecure.

Ed Gaudette (15:25)

No, that's good.

Mariam Paramore (15:26)

Yeah.

Ed Gaudette (15:27)

Okay.

Mariam Paramore (15:27)

Yeah. All right. I would tell my 40 year old self that too.

Ed Gaudette (15:31)

Okay. All right. Riskiest thing you've ever done.

Mariam Paramore (15:33)

Business or personal?

Ed Gaudette (15:35)

Either.

Mariam Paramore (15:35)

This is the riskiest thing I've ever done. In dollars.

Ed Gaudette (15:37)

Yeah.

Ed Gaudette (15:38)

Starting your own.

Mariam Paramore (15:39)

Probably the riskiest thing I've ever done personally. There are walkaway points in relationships that are personal that it's just feels hard to see an upside and you just have to do what you know is. Know is right. Yeah. You have to push into it even though it's really risky.

Ed Gaudette (15:52)

Yeah. Well, thank you for sharing that.

Mariam Paramore (15:53)

Yeah.

Ed Gaudette (15:54)

You're on an island. You can bring five records with you. What would you bring? Oh man.

Mariam Paramore (15:59)

So hard. Well, I would have to bring Aerosmith because I've always loved them.

Ed Gaudette (16:02)

I spun.

Mariam Paramore (16:02)

You know, I think the whole band. You can.

Ed Gaudette (16:06)

Okay. Which record? It's your island. You can bring the. You can bring the whole band. Steven Tyler.

Mariam Paramore (16:11)

Honestly, I should know that I should know to name but I really don't.

Ed Gaudette (16:14)

You don't need to.

Mariam Paramore (16:15)

I just always love them and I just argue with people. They're one of the best rock bands and I would. Jon Batiste.

Ed Gaudette (16:21)

Oh yeah.

Mariam Paramore (16:22)

Absolute brilliant. Maybe. Gosh. That's about it. I'm not. Can you tell? I'm not that big of a music lover.

Ed Gaudette (16:27)

Movies.

Mariam Paramore (16:28)

Not all that Contemporary. Oh, easy. It's a Wonderful Life.

Ed Gaudette (16:32)

Great movie.

Ed Gaudette (16:33)

Okay.

Mariam Paramore (16:33)

Best movie of all time. Field of Dreams.

Ed Gaudette (16:35)

Okay. Oh, okay. Certainly you're an optimist.

Mariam Paramore (16:37)

Fantastic movie. Gosh. That's about it. That's all I can think of. You said it was easy. It's easy to get the top two.

Ed Gaudette (16:46)

Oh, okay.

Mariam Paramore (16:47)

And then I kind of run out of steam really fast.

Ed Gaudette (16:50)

If you weren't doing this job, what would you be doing? What are you most passionate about outside of work?

Mariam Paramore (16:54)

Politics.

Ed Gaudette (16:55)

Really?

Mariam Paramore (16:56)

Oh, yes.

Ed Gaudette (16:56)

Okay.

Mariam Paramore (16:57)

Yes.

Ed Gaudette (16:57)

What about politics?

Mariam Paramore (16:58)

I believe in equality.

Ed Gaudette (17:00)

Yeah.

Mariam Paramore (17:00)

And I believed that our country was going to continue to move towards more and more equality. And I'm. I'm very saddened. As a woman who was born in 1963, I have seen the women's rights revolution and I've lived through the glass ceiling, and gratefully I've broken it. But I know what it feels like to now be told that we're all just DEI hires and what it feels like to be told that you don't get to make decisions about whether you have children or not. And you don't really. You should know your place. I could go, like, on and on, but it's a material backward step in my opinion of equality in our country. And so whether it's gender, race, religion, country of. Or whatever it is, we're supposed to be focused on equality. That's what America is, what we do. We're equal. We're equal rights. And we don't bow to entrenched power structures, and we don't go backwards.

Ed Gaudette (18:03)

We lead the way.

Mariam Paramore (18:03)

We grow together. And so I have not experienced. The only life I've experienced is mine, and I'm a white woman, and I'm very privileged to be an educated white person in the United States of America. I'm very grateful and I love this country. And I'm so sad. And I'm also really angry because we did have to fight hard to be accepted into the workforce and be able to build careers and grow in that way. So I still believe that in our system we can continue to move forward. And I guess we. Maybe we've had fits and starts in our country. You could probably see that. Yeah. But that. But I'm passionate about it. And not so much just women, but it's just that I am a woman. That's what I know.

Ed Gaudette (18:48)

Yeah.

Mariam Paramore (18:48)

So that's why I say my passion is really around equality.

Ed Gaudette (18:52)

I love that. Hang in there, because the change is going to come.

Mariam Paramore (18:54)

Change is going to come, as they say. As they say.

Ed Gaudette (18:57)

Well, it's been a pleasure having you on the show. I really appreciate your time and you as a person and everything you do.

Mariam Paramore (19:03)

Thank you.

Ed Gaudette (19:03)

Making drugs affordable, people. Yeah. What a great mission.

Mariam Paramore (19:07)

Thank you. I'm very committed to it. And you have the best voice. So are you like a. Do you do radio all the time?

Ed Gaudette (19:14)

I do not.

Mariam Paramore (19:14)

Yes, you do. Stop it.

Ed Gaudette (19:15)

CEO, Founder of a company.

Mariam Paramore (19:17)

I know you are. Did you just do this for fun?

Ed Gaudette (19:19)

Yeah. Yeah. To kind of give it back to the community.

Mariam Paramore (19:22)

Well, I appreciate that, too, and you shared that, so thank you for doing that. Thank you for having me today. Thank you.

Ed Gaudette (19:26)

This is Ed Gaudette from the Risk Never Sleeps podcast. If you're on the front lines protecting patient safety and delivering patient care, remember to stay vigilant because Risk never sleeps.

Ed Gaudette (19:41)

Thanks for listening to Risk Never Sleeps. For the show, notes, resources and more information and how to transform the protection of patient safety, Visit us@SenseInet.com that's C E N S I N E T dot com. I'm your host, Ed Gaudette. And until next time, stay vigilant because Risk never sleeps.