New in-workflow capability flags misprocessed pharmacy claims at the point of adjudication, while RIS Rx’s pharmacist-to-pharmacist engagement sees every flagged claim through to correction and recovery
IRVINE, Calif.–(BUSINESS WIRE)–#GTN–RIS Rx, the healthcare technology company delivering real-time GTN Revenue Protection for the world’s leading pharmaceutical manufacturers, today announced that its Affordability, Audit & Assurance (Triple A) solution now monitors pharmacy claims submission in real time, flagging misprocessed pharmacy claims pre-payment, in workflow, at the point of transaction.
Triple A has spent years identifying misprocessed copay claims, electronically reversing them, recouping funds, and most importantly, putting a pharmacist on the phone with the pharmacy that submitted them. The new feature brings that work into the transaction itself, giving manufacturers live visibility into monitoring that was already happening. Detection was never the bottleneck. Follow-through was, and remains, the differentiator.
“This is an extension of work we’ve been doing for years – the real-time integration just adds an additional security blanket to the solution,” said Stephen Hom, Co-founder, EVP and Chief Operating Officer of RIS Rx. “A real-time alert nobody follows-up on is just a faster way to watch money leave the program. Most solutions stop at a pass/fail message to the pharmacy. Our PharmD team picks up the phone, gets the claim corrected, and documents the change in behavior.”
The distinction shows up in the numbers. Triple A has delivered more than $110 million in cumulative cost avoidance for two GLP-1 brands, with tens of thousands of misprocessed claims reversed or reprocessed. Another neurology brand saw monthly copay spend cut in half (roughly $21 million per month) within two months of implementation. And during a one-month pause in monitoring on one program earlier this year, misprocessed claims jumped 51% – a reminder of how quickly pharmacy behavior reverts without continuous engagement.
“Stephen and I are pharmacists. We built Triple A because we watched affordability dollars leak out of programs one mishandled claim at a time. And for a patient, these leaked dollars mean that their copay card runs out far earlier than expected,” said Gerard Rivera, Co-founder and Chief Executive Officer of RIS Rx. “This capability gives our partners a real-time view into work we’ve been doing all along. What it doesn’t change is how the work gets done: pharmacist to pharmacist, claim by claim, until the behavior changes. That has been the model since day one, and it’s why our results look the way they do.”
The real-time capability is available now across all Triple A programs. The solution remains fully vendor-agnostic, bolting onto any existing copay vendor ecosystem under a straightforward data use agreement, with typical implementation measured in weeks, not quarters, with no disruption to patients or established workflows. Manufacturers receive performance report cards quantifying cost recoupment and avoidance.
RIS Rx will take a closer look at the capability – including what full-lifecycle claim monitoring finds that point-in-time flagging misses – during the company’s upcoming Xtalks webinar on August 24, 2026.
About RIS Rx
RIS Rx is a healthcare technology company delivering real-time gross-to-net (GTN) revenue protection for the world’s leading pharmaceutical manufacturers. Through proprietary software, real-time analytics and pharmacist-led expertise, RIS Rx helps clients optimize operations, eliminate leakage and ensure that financial assistance reaches the patients who need it most. The company has protected more than $1 billion in annual revenue for its customers. Founded in 2020 and headquartered in Irvine, California, RIS Rx serves leading pharmaceutical manufacturers across a growing portfolio of drug brands. Learn more at www.RISRx.com.
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