In July 2025, Dan Reynolds, the editor in chief of Risk & Insurance, caught up with Paul King, President of MyMatrixx by Evernorth. What follows is a transcript of that discussion, edited for length and clarity.

Risk & Insurance^®: Thanks for spending some time with us Paul. What has your experience been like during these first weeks as president of MyMatrixx?

Paul King: It’s been about six weeks in the position. The time has gone by quickly, making the year seem very compressed. Having this interview with Risk & Insurance marks one of my first significant engagements in this new role.

R&I: How relevant are Pharmacy Benefit Managers (PBMs) in today’s health care landscape, and what value do they bring to clients?

PK: PBMs are very relevant today and will continue to increase in relevance going forward. For years PBMs, like MyMatrixx, were focused on managing pharmacy spend when opioids represented 15-20% of that spend. We created and implemented solutions to manage the utilization and control the spend of opioids and their associated medications – and we were successful in those efforts.

As pharmacy treatments have evolved however, the relevance and value provided by PBMs continues to increase. The industry is witnessing a rise in specialty medications and more single-source brands are entering the market. This is driven in part by an FDA drug pipeline that is larger than it was four years ago by at least double-digit percentage points. Even though many of the new drugs are healthcare and disease related and not specific to workers’ compensation − cancer medications being a high percentage of these – we often see that what happens in health care inevitably influences our space as well. So, managing chronic conditions is an opportunity for improved outcomes.

For these medications and all injury-related medications, MyMatrixx is a vital part in making sure they are: Safe, Effective, Accessible, and Affordable.

Paul King, President, MyMatrixx by Evernorth

R&I: What impact will emerging technologies like Artificial Intelligence (AI) and quantum computing have on the pharmaceutical industry, and why are PBMs important in this evolving landscape?

PK: We believe both AI and quantum computing will have an impact on new medication development, testing and approval for the market. Understanding the complexities, safety, effectiveness, accessibility and costs of these medications will enhance the importance of PBMs in managing their dispensing.

AI solutions can help speed up the assessment, design and development processes for new medications. And, based on our conversations with manufacturing experts, the future state of the industry will see the use of quantum computing, which may limit the need for human testing of medications because it can test all variables simultaneously.

While pharmacy manufacturers are using enhanced technology to improve their performance, we too use these advancements to ensure better outcomes and improved processes for all our stakeholders. As an example, at MyMatrixx, we have implemented proprietary algorithms and other technology solutions that help claim adjusters approve medications more accurately and more quickly. This allows patients to receive their medications faster and it streamlines the payment process for the pharmacy and the payer.

R&I: How is technology playing a role in reinforcing medication safety, particularly when evaluating drug combinations and interactions?

PK: When it comes to medication safety, technology is critical but so is a strong clinical team. The MyMatrixx team of caregivers, pharmacists, and researchers are responsible for helping to ensure patient safety. Their insight and expertise combined with technology help to process medications at the patient level. Our proprietary algorithm evaluates what’s happening with a patient’s current injury-related medications and analyzes their previously prescribed medications and their trends. This helps our team evaluate whether a medication is effective, at an optimized dose, and if it positively impacts the injured worker’s return to health and capability.

Well before AI was a buzzword, we developed an algorithm to assign a patient risk score, which is based on four or five key categories and encompasses 31 data elements. The higher the risk score, the less safe the medication regimen. For example, a risk score of 20 indicates an immediate intervention is needed to prevent poor outcomes.

As the score lowers, the concerns shift. A risk score of 15 might not present an immediate safety issue, but it could indicate an opportunity for better dose optimization to improve patient adherence and lead to better claim outcomes.

We’ve been using our algorithm for four or five years now and introducing AI into our solution is helping our tool learn faster and become more robust.

R&I: What results have the algorithm produced for your organization?

PK: When we compare the use of our current algorithm to our previous approach, or when onboarding new clients as a means for a benchmark, the algorithm helps us to identify 10 times more injured workers who would benefit from clinical intervention. When implemented, the interventions typically result in a four- or five-point reduction in a patient’s risk score and that can lead to a corresponding decrease in costs. The algorithm expands our reach to provide positive safety and financial benefits, a faster return to work, and improved capabilities for the injured workers we serve.

And, as I stated, our current algorithm analyzes 31 data elements to develop the patient risk score. But what happens if we have more data and more elements? If we could integrate data from group health with the workers’ compensation system, we would have a comprehensive foundation to determine a better indicator of risk.

R&I: What tools will help PBMs better serve their customers in the future?

PK: Data, data, and more data. MyMatrixx is working towards a future that combines our experts, tools, and technology to access and analyze more comprehensive data to focus beyond the injury to whole person health. More data will help us understand what else patients are being treated for and that means we can provide better support and recommendations for our clients.

On the commercial health side, they refer to cardiodiabesity (those that suffer from cardiovascular disease, diabetes, or obesity). In workers’ compensation we call these comorbidities, and these conditions have a significant impact on claim outcomes, yet are typically not fully addressed or managed as part of a workers’ compensation claim.

MyMatrixx is working to expand our approach so we can take action on a patient’s complete health profile. For example, we might manage hypertension while simultaneously helping a patient recover from lower back pain. This comprehensive approach could help patients return to work months sooner with lower utilization of ancillary medical services. We’d see a positive return on investment for insurers (and employers) while getting patients back to health and capability.

R&I: What are some additional client needs and challenges that PBMs are addressing?

PK: Well, let me start this answer by saying there’s never a dull moment in this industry.

We’ve already discussed the increasing number of new medications hitting the market and with that comes a need for education and coaching. MyMatrixx has close to 30 pharmacists on staff, and they are dedicated to educating patients, nurses, pharmacists, peer reviewers, and even doctors on the latest drug trends, medication compliance, and medication management.

Supporting and assisting adjusters is another client need. Today their average age of an adjuster is five or six years younger than it was ten years ago. They have a higher turnover rate and a higher learning curve in a complicated industry. Our team is always available for questions, and we provide instant medication information and approval recommendations through our portal, so adjusters can make informed decisions on a claim.

Medication fraud, waste, and abuse is a client concern as it can go unnoticed unless you stop to look for it. Our Enhanced Fraud Waste and Abuse solution uses our proprietary algorithm to identify questionable patterns (clinical and financial) within injured worker, prescriber, and pharmacy data to protect injured workers and client programs from unnecessary costs and unsafe practices.

Then there are the scripts that fall out-of-network – which can be up to 20% of pharmacy transactions. Again, these are the numbers that can be harder to see and track, so clients need a PBM like MyMatrixx with a strong out-of-network and paper bill management program in place to capture these transactions, process them with all the appropriate discounts and edits, and convert them to in network moving forward.

One last critical area is the need to understand and react to the changing legislative and regulatory environment. I believe the last tally I heard is there are approximately 200 pieces of pending legislation that specifically or tangentially relate to pharmacy across all states or at the federal level. Clients need and want to know what the legislative actions mean for their business and claims. Whether it’s a new fee schedule in California, transparency laws in Idaho, or out-of-network physician dispensing in Pennsylvania or Florida. MyMatrixx is on the front lines proactively working with stakeholders, advocating for clients, and informing the industry of what changed and what it means state by state.

R&I: As we wrap this up, what is your strategic vision for MyMatrixx in both the short and long term?

PK: I break my vision into two different buckets. The big bucket is making sure the ecosystem is as efficient as possible – the claim adjuster, the prescriber, the pharmacy, and MyMatrixx all working on behalf of the patient. We need to ensure all stakeholders can operate smoothly while patients get safe, effective access to the medication they need at an affordable rate.

The second part focuses on how we expand our impact. I want to marry pharmacy with physical medicine delivery and consider whole health aspects of comorbidity and disease management. This includes cardiac issues, obesity, behavioral health – all those pieces together to drive better outcomes at the patient level.

Outcomes such as fewer emergency room visits, better medication adherence, fewer doctor visits, lower medication costs and lower risk scores. With this, everyone benefits, the patient, employers, and our clients.

To learn more, visit https://www.mymatrixx.com/.

This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with MyMatrixx by Evernorth. The editorial staff of Risk & Insurance had no role in its preparation.