Anurati Mathur discusses affordability at the counter | AMCP Nexus 2026

Affordability programs work only when the money reaches patients at the pharmacy counter, on every fill and all year, according to Anurati Mathur, co-founder and CEO of Sempre Health. Many tools that health plans and pharmacy benefit managers (PBMs) rely on today fall short of that standard, she said.

Sempre Health is a medication affordability platform that works with health plans, PBMs, drugmakers and patients. Over the past decade, Mathur has helped design and negotiate programs that lower out-of-pocket costs and help patients start and stay on therapy.

She co-presented “The Last Mile at Point-of-Sale: Why the Pharmacy Counter Decides Everything Policy and Plan Design Set in Motion” today at AMCP Nexus 2026 with John O’Brien, Pharm.D., M.P.H., of the National Pharmaceutical Council, and Michael Einodshofer, R.Ph., M.B.A., of Optum. The session examines why prescriptions go unfilled from three angles: policy, the PBM and payer operations that turn policy into formulary and copay decisions, and the programs that meet patients at the pharmacy.

A test for affordability programs

Health plans, PBMs and manufacturers share plenty of common ground, Mathur said. But the programs that work best pass one test: Do the dollars meant for affordability “actually reach the patient consistently on every fill all year?”

Several common tools fail it. Rebates can move a drug to a lower formulary tier with lower cost sharing, but that money doesn’t reach patients directly. Copay accumulator and maximizer programs, which plans use often, keep patients from seeing much of that support consistently through the year. Copay cards help patients who find them, she said, but they aren’t proactively given to patients facing cost barriers.

The signal plans already have

Mathur’s top suggestion for reducing abandonment is to act on reversed claims. A paid claim means a patient left the pharmacy with the drug. A reversed claim means the patient tried to fill a prescription and walked away without it.

“It’s the cleanest, most observable data point that tells us that an abandonment event occurred,” she said. However, pharmacies and payers rarely act on it, and manufacturers may not see that data at all.

In this interview with MHE, Mathur explained why building member outreach and support around that moment could strengthen the affordability programs already in place.