Rivera secures $15M with MK Capital to accelerate innovation in pharmacy benefit payment integrity

Rivera (formerly HealthPlan Data Solutions), the leader in pharmacy payment integrity, today announced a $15 million growth equity investment led by MK Capital, with participation from Tamarind Hill, JobsOhio, and Rev1 Ventures.

Since its founding, Rivera has helped payers recover millions in misplaced pharmacy spend and strengthened oversight for more than eight million covered lives. By uncovering overpayments, resolving contract misalignments, and improving benefit performance, Rivera ensures every pharmacy dollar is used with integrity.

“This investment allows us to accelerate platform innovation, advance our analytics, and expand client capabilities so health plans and employers can maintain true clarity and control over their pharmacy benefit,” said Ron Hamm, Chief Executive Officer of Rivera. “We’re not just analyzing claims — we’re transforming oversight into a living system that continuously drives transparency, accountability, and performance.”

As pharmacy costs continue to rise, health plans and employers need more than reactive audits — they need continuous, independent oversight. Rivera’s technology continuously reviews 100% of pharmacy claims post-adjudication, applying more than 700 proprietary algorithms to detect pricing discrepancies, benefit design gaps, and systemic errors that traditional audits miss. This approach enables payers to identify and recover claim-level errors, reveal hidden inefficiencies, and prevent recurrence, delivering measurable savings and sustained alignment.

“We are thrilled to partner with Rivera at this pivotal time ,” noted Mark Koulogeorge, Managing Partner at MK Capital. “With bipartisan calls for PBM reform and rising prescription drug costs, sophisticated payers recognize they have a responsibility to take back control of their pharmacy benefit. Rivera’s solution pays for itself within months and provides customers the assurance that their members’ pharmacy benefit is being properly administered.”

Hamm added that clients can expect ongoing innovation across Rivera’s platform — including expanded automation, additional oversight algorithms, and workflow enhancements that further strengthen insight, efficiency, and impact across every PBM relationship.