Serve You Rx, a pharmacy profit supervisor, introduced a partnership with Waltz Well being on Tuesday to leverage its AI-powered specialty pharmacy platform referred to as Waltz Join.
Milwaukee, Wisconsin-based Serve Your Rx is an impartial PBM serving insurance coverage brokers, consultants, third-party directors and their employer shoppers. Beginning Could 1, Serve You Rx’s shoppers could have entry to Waltz Join, which affords a market the place specialty pharmacies compete on high quality, scientific outcomes and worth.
Waltz Well being simply launched Waltz Join in August. When a specialty prescription is submitted for a member, the platform redirects it to essentially the most appropriate pharmacy based mostly on the member’s profit design, worth, turnaround time, success accuracy, member expertise and adherence price. As well as, well being plans obtain details about the member’s situation, prescription, onboarding, the chosen pharmacy’s contact data, anticipated success time and the variety of refills.
This compares to the conventional specialty pharmacy mannequin, by which payers typically have unique relationships with one specialty pharmacy.
“Ultimately, what we’re actually seeking to do by way of this mannequin — utilizing a versatile and tailor-made profit resolution — is create a greater reply than the present conventional mannequin, which is type of a a method, my approach or the freeway, single pharmacy meting out mannequin. … [We’re] flipping the normal mannequin on its head, creating an open community that’s intelligently routed, utilizing these prescriptions to place them in the appropriate place on the proper worth,” stated Mark Thierer, co-founder and CEO of Waltz Well being, in an interview.
Serve You Rx selected Waltz Well being as a associate as a result of the 2 had been attempting to resolve related issues within the prescription drug house, in accordance with Justin Jasniewski, CEO of Serve You Rx.
“Once we heard about this product, it appeared to resolve the precise subject that we had been trying to resolve simply internally, which was, how can we take away conflicts of curiosity?” Jasniewski stated in an interview. “How do we modify our pricing mannequin to be one thing a bit extra disruptive and novel and in the end, present one of the best worth to our shoppers, present one of the best degree of flexibility?”
By the partnership, Serve You Rx pays Waltz Well being a payment on a per prescription foundation to assist direct prescriptions to specialty pharmacies, Thierer famous.
The partnership comes as specialty remedy costs are skyrocketing. In 2021, specialty drug prices reached $301 billion, a 43% improve from 2016, in accordance with the U.S. Division of Well being and Human Companies. Specialty medicine additionally accounted for about half of whole drug spending in 2021.
Sooner or later, the businesses hope to broaden the partnership to further therapeutic courses, like GLP-1s, Thierer added.
“[We hope to move] into pharmacy and medical administration collectively in a blended approach,” he stated. “There’s an terrible lot that expertise can do to streamline this course of, and we’d prefer to take all our instruments over time and plug them in with Serve You.”
These aren’t the one corporations seeking to disrupt the specialty pharmacy house. One other is Free Market Well being, which works with insurers like Highmark to match members to the specialty pharmacy that most closely fits their wants.
Picture: megaflopp, Getty Photographs
