Raechele (Rae) McMahan, MBA, Prescryptive Health

Raechele (Rae) McMahan is the senior vice president of payer solutions at Prescryptive Health, Inc., a pharmacy benefit manager focused on price transparency and access to medications.

For McMahan, though, healthcare was personal long before it was professional.

When she was just 17, McMahan was diagnosed with Hodgkin lymphoma. She credits the obstacles she encountered during that time for inspiring her to pursue a career in healthcare.

“Going through that and not having a prior authorization on file to be able to get a needle biopsy done when you already know that you have a cancer diagnosis is challenging for a 17-year-old, and it’s challenging for a family that is not educated in the healthcare space,” McMahan says.

McMahan went on to earn her bachelor’s in health services administration from the University of Central Florida and an MBA from the University of Phoenix. After she graduated, a family member working in the field encouraged her to change the system rather than just operate within it.

Early in her career, she focused on specialty pharmacy, digging into the clinical and operational mechanics of how high-cost drugs reach patients.

“What I built across Aetna and Prime Therapeutics was not a portfolio of roles,” she explains. “It was a layered understanding of how the same drug moves through radically different incentive structures depending on who is paying, who is distributing and who is making the clinical decisions.”

As she moved from specialty operations into broader benefit leadership roles, her perspective changed.

She began to see, as she puts it, “the whole board”: how rebate economics govern formulary placement, how distribution decisions translate into what patients pay at the counter, and how incentives can routinely diverge from clinical best practice.

She also came to realize that the problems she faced within the system were structural and that structural problems require structural solutions. “That’s why Prescryptive exists — to change some of the underlying platform of the pharmacy ecosystem,” says McMahan.

Prescryptive, which is headquartered in Redmond, Washington, operates with between 150 and 200 employees, serving clients including drug manufacturers, health systems and employers.

“At its heart, Prescryptive is a healthcare technology company,” she says. “Our technology provides the ability for clear, concise and transparent pricing and aims to help patients, beneficiaries and members to be able to access and afford their medication with an understanding of where they can get it.”

McMahan often uses everyday images to explain what she means. It’s easy, she says, to keep applying “Band-Aid on top of a Band-Aid on top of a Band-Aid” without ever asking what’s wrong at the foundation.

At a system level, she contrasts healthcare with other parts of life, explaining that in most areas, consumers expect convenience. New shoes can arrive at the doorstep within hours, and groceries within a day. However, when it comes to something as fundamental as medication, the default is delay and uncertainty.

“The organizations that lead the next era will be those that connect manufacturers, payers, pharmacies and patients more directly, with incentives structured around access as a predictable outcome rather than a variable one,” she says. “The pharmacy benefits model that survives this period is not the one with the most sophisticated rebate optimization. It is the one that can demonstrate it is actually reducing cost and improving access for the people it serves. The market is now demanding that.”

McMahan, 47, currently lives in central Florida with her 10-year-old son, Pierce, who has significant healthcare challenges of his own. At age 4, he was diagnosed with Type 1 diabetes. Once again, McMahan found herself navigating the day-to-day of an unfamiliar disease.

“To not only have an experience as a child, but then to be working within the industry, and then have a child who needs seven prescriptions that cross the pharmacy benefit and the medical benefit, including devices,” she says. “It was challenging for me, and I am in the pharmacy world, and I was able to push for what was needed, but I can’t imagine that same experience for others [who are] not in my shoes.”

Because of her cancer diagnosis and her son’s diabetes diagnosis, McMahan says she spends a lot of time appreciating “the small moments.”

“I have come to realize that life goes by very, very fast, and so in my free time I try to encourage him to do sports and all the things that you would expect a regular kid to do,” she says.

She also loves thrifting, especially when she goes on vacation.

“That tells me about the fabric of the culture and of the community that I’m in, based on the stuff that they’re going to have at the Goodwill store,” she says. “I love the treasure hunt!”

Most of her clothing and home goods, she notes, come from thrift stores. It’s partly about value, partly about avoiding unnecessary consumption, and, like much else in her life, partly about understanding underlying systems and how they work.

If she could go back and tell her younger self anything, she says she would advise keeping it simple: “At the end of the day, everything is going to be OK,” she says. “I think that is the biggest one.”

The second message would be about how to move through an ever-changing world: “Being nimble and grateful and a constant learner are so incredibly important.