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Ed Gaudette
Foreign.
Welcome to Risk Never Sleeps where we meet and get to know the people delivering patient care and protecting patient safety. I'm your host, Ed Gaudet.
Welcome to the Risk Never Sleeps podcast in which we learn about the people that are on the front lines protecting patient safety and delivering patient care. I'm Ed Gaudette, the host, and I am pleased to be joined by Mariam Paramore. RX Utility.
Mariam Paramore
Correct?
Ed Gaudette
Is that right?
Mariam Paramore
Got it in one.
Ed Gaudette
Damn, I remembered it.
Mariam Paramore
Outstanding. Way to go, Ed.
Ed Gaudette
Cheap drugs.
Mariam Paramore
Well, yes, cheap drugs.
Ed Gaudette
Tell me about the shirt.
Mariam Paramore
Okay, well, so this is an audio, right? So people can't see me. I have on a black T shirt with white letters that say cheap drugs. And on the back it says says I want to turn so you can read it. Okay.
Ed Gaudette
Has your company name, I bet. Oh yeah, we help people get them RX Utility.
Mariam Paramore
Nice. Correct.
Ed Gaudette
Yeah.
Mariam Paramore
So that's the rest of the story.
Ed Gaudette
I love it.
Mariam Paramore
All right, so our company is a consumer prescription affordability platform and our focus and our mission is to save people money on medicine.
Ed Gaudette
That's a great mission.
Mariam Paramore
Yeah. Very simple and very specific to the consumer's out of pocket cost in this industry. There's all kinds of call talk about the cost trends and the broken systems and poor outcomes and all of that is real. But we want to take a slice that's really focused on when it comes to the pharmacy counter and we all go to our wallet, what is it that medication is going to cost. And unfortunately, there's really no way for a consumer to know until they show up to the pharmacy and then they're told.
Ed Gaudette
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
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
Okay. All right. So are you a founder?
Mariam Paramore
I am the founder.
Ed Gaudette
You are. You have a co founder now.
Mariam Paramore
I'm the founder and the CEO and funding the business.
Ed Gaudette
Bootstrap, right?
Mariam Paramore
Bootstrap, Correct.
Ed Gaudette
That's what that means, kids.
Mariam Paramore
That's exactly what that means. Yes, exactly.
Ed Gaudette
Kids. Yeah. That's risky too.
Mariam Paramore
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
Yes.
Mariam Paramore
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
Yeah, I love that. How's it going?
Mariam Paramore
Oh, it's incredible. It's fantastic.
Ed Gaudette
Is this the first company you've done?
Mariam Paramore
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
You have no idea.
Mariam Paramore
Life is a winding kind of road.
Ed Gaudette
Yeah.
Mariam Paramore
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
Yes.
Mariam Paramore
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
From the ground up.
Mariam Paramore
If I didn't say that, would I be on the air anyway?
Ed Gaudette
Of course you would be, but the
Mariam Paramore
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
using cursor or Claude, or we use
Mariam Paramore
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
Yeah. Where do you sit? Do you sit alongside the ehr?
Mariam Paramore
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
Do they want to do that though?
Mariam Paramore
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
Will you ever make that data direct to consumer?
Mariam Paramore
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
I've had experience with that in the
Mariam Paramore
past, just breaking it down. I help you find good drug deals. That's a drug dealer, isn't it?
Ed Gaudette
It is such drug deals.
Mariam Paramore
But basically that AI intelligence can help a consumer navigate best price.
Ed Gaudette
So we manufacturer like manufacturer options or choices or. Yeah, changes to manufacturers.
Mariam Paramore
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
Yeah. Let me tell you what happened to me. So I'm a, I'm on lisinopril which is blood pressure med.
Mariam Paramore
Yeah.
Ed Gaudette
Small dosage.
Mariam Paramore
Yeah.
Ed Gaudette
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
Was it shaped different?
Ed Gaudette
Yes.
Mariam Paramore
Yeah, yeah.
Ed Gaudette
And from a different manufacturer up.
Mariam Paramore
Yeah.
Ed Gaudette
And from a different location.
Mariam Paramore
Was the price different?
Ed Gaudette
I don't care about the price.
Like my father in law had that happen to him and he had a reaction to it.
Mariam Paramore
Yeah.
Ed Gaudette
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
It's not the same thing.
Ed Gaudette
Different fillers, other different things that are in there.
Mariam Paramore
That's right. You're exactly right.
Ed Gaudette
So are you also going to provide that level of transparency to consumers?
Mariam Paramore
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
Yeah.
Mariam Paramore
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
Yes.
Mariam Paramore
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
It would be the same thing. Exactly.
Mariam Paramore
But it's not the same thing.
Ed Gaudette
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
Yeah, yeah.
Ed Gaudette
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
It was a price issue.
Ed Gaudette
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
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
Yeah.
Mariam Paramore
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
Yeah, exactly.
Mariam Paramore
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
Interesting.
Mariam Paramore
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
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
Ready.
Ed Gaudette
Okay. Go back in time. Tell your 20 year old self something. What would it be?
Mariam Paramore
Don't be so insecure.
Ed Gaudette
No, that's good.
Mariam Paramore
Yeah.
Ed Gaudette
Okay.
Mariam Paramore
Yeah. All right. I would tell my 40 year old self that too.
Ed Gaudette
Okay. All right. Riskiest thing you've ever done.
Mariam Paramore
Business or personal?
Ed Gaudette
Either.
Mariam Paramore
This is the riskiest thing I've ever done. In dollars.
Ed Gaudette
Yeah.
Starting your own.
Mariam Paramore
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
Yeah. Well, thank you for sharing that.
Mariam Paramore
Yeah.
Ed Gaudette
You're on an island. You can bring five records with you. What would you bring? Oh man.
Mariam Paramore
So hard. Well, I would have to bring Aerosmith because I've always loved them.
Ed Gaudette
I spun.
Mariam Paramore
You know, I think the whole band. You can.
Ed Gaudette
Okay. Which record? It's your island. You can bring the. You can bring the whole band. Steven Tyler.
Mariam Paramore
Honestly, I should know that I should know to name but I really don't.
Ed Gaudette
You don't need to.
Mariam Paramore
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
Oh yeah.
Mariam Paramore
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
Movies.
Mariam Paramore
Not all that Contemporary. Oh, easy. It's a Wonderful Life.
Ed Gaudette
Great movie.
Okay.
Mariam Paramore
Best movie of all time. Field of Dreams.
Ed Gaudette
Okay. Oh, okay. Certainly you're an optimist.
Mariam Paramore
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
Oh, okay.
Mariam Paramore
And then I kind of run out of steam really fast.
Ed Gaudette
If you weren't doing this job, what would you be doing? What are you most passionate about outside of work?
Mariam Paramore
Politics.
Ed Gaudette
Really?
Mariam Paramore
Oh, yes.
Ed Gaudette
Okay.
Mariam Paramore
Yes.
Ed Gaudette
What about politics?
Mariam Paramore
I believe in equality.
Ed Gaudette
Yeah.
Mariam Paramore
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
We lead the way.
Mariam Paramore
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
Yeah.
Mariam Paramore
So that's why I say my passion is really around equality.
Ed Gaudette
I love that. Hang in there, because the change is going to come.
Mariam Paramore
Change is going to come, as they say. As they say.
Ed Gaudette
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
Thank you.
Ed Gaudette
Making drugs affordable, people. Yeah. What a great mission.
Mariam Paramore
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
I do not.
Mariam Paramore
Yes, you do. Stop it.
Ed Gaudette
CEO, Founder of a company.
Mariam Paramore
I know you are. Did you just do this for fun?
Ed Gaudette
Yeah. Yeah. To kind of give it back to the community.
Mariam Paramore
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
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.
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.
Guest: Miriam Paramore, Founder & CEO of RxUtility
Host: Ed Gaudet
Date: April 28, 2026
In this episode, Ed Gaudet sits down with Miriam Paramore, the founder and CEO of RxUtility, to untangle the confusing world of prescription drug pricing. Together, they explore why it’s so difficult for consumers to know what their out-of-pocket drug costs will be and discuss how technology—especially data aggregation and AI—can help make prescription drugs more affordable and accessible. The conversation weaves practical insights about pharmacy and insurance practices with personal anecdotes, while also touching on risk, entrepreneurship, and Miriam’s personal passions.
On the confusion at the pharmacy counter:
“There’s really no way for a consumer to know until they show up to the pharmacy and then they’re told.” (01:36–01:44)
On building with AI:
“It's astonishing the capital efficiency that you can... experience as an entrepreneur with very few human resources and you can create agents, write code for you. And we do.” (06:15–06:32)
On receiving new, different drugs at the pharmacy:
“They say, ‘Oh, it’s the same, it’s the same thing. It’s the same.’ It’s not the same thing.” (11:54–11:57)
On drug pricing and insurance:
“You still have a copay on a tier one drug... If you paid cash for that exact same drug, $2.18. But no consumer would know that.” (14:40–14:45)
| Segment Topic | Timestamp | |-----------------------------------------|-------------| | Company’s mission and “cheap drugs” | 01:04–01:14 | | Miriam’s health tech background | 01:54–05:16 | | Technology and AI in RxUtility | 05:16–08:38 | | Direct-to-consumer drug sales | 09:04–11:15 | | Ed’s drug switch experience | 11:15–13:09 | | Insurance vs. cash revelations | 14:01–15:14 | | Personal rapid-fire Q&A | 15:14–18:52 |
Memorable Closing Quote:
“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.”
—Miriam Paramore (13:34–14:01)
For more information or to listen to the full episode, visit Censinet.com.
Prepared for listeners seeking deep insight into prescription drug pricing, technology innovation in health tech, and the personal drives behind healthcare entrepreneurship.