Anurati Mathur of Sempre Health talks affordability programs and adherence | AMCP Nexus 2026

Members enrolled in a medication affordability program at UPMC were more likely to stay on their heart medications than similar members who did not enroll, according to Anurati Mathur, co-founder and CEO of Sempre Health. Emergency room (ER) visits also fell, with no significant rise in total cost of care.

Sempre Health works with health plans, pharmacy benefit managers (PBMs), drugmakers and patients to lower out-of-pocket costs. Mathur co-presented “The Last Mile at Point-of-Sale: Why the Pharmacy Counter Decides Everything Policy and Plan Design Set in Motion” at the Academy of Managed Care Pharmacy (AMCP) Nexus 2026 meeting today. The session looked at unfilled prescriptions through three lenses: policy, from John O’Brien, Pharm.D., M.P.H., of the National Pharmaceutical Council; PBM and payer operations, from Michael Einodshofer, R.Ph., M.B.A., of Optum; and member-facing programs, from Mathur.

Why cost matters at the counter

Patients stop filling prescriptions for many reasons, including forgetfulness, side effects, doubts that a drug works and prior authorizations. Mathur said it’s hard to pin down how much each factor drives abandonment, but cost is the simplest to change. Data show abandonment rises as cost rises, she said.

“Sticker shock should really not be a reason that a patient walks away without therapy,” Mathur said.

What the research found

Both studies were run by the health plans’ own teams. The UPMC study focused on antiplatelet and anticoagulant drugs, while the Blue Shield of California study looked across several disease areas. Both found significant gains in adherence, Mathur said.

In the UPMC study, 63% of enrolled members were adherent, compared with 43% of a matched group. ER visits fell 16%. Drug spending rose, as expected when more patients take their medications, but total cost of care did not increase significantly.

Limits to keep in mind

The research was not a randomized controlled trial. The program was offered to all members, and those who enrolled were compared with those who chose not to. The two groups were matched on many traits to help control for bias, Mathur said.