Serve You Rx, a pharmacy profit supervisor, introduced a partnership with Waltz Well being on Tuesday to leverage its AI-powered specialty pharmacy platform known 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 gives a market the place specialty pharmacies compete on high quality, medical outcomes and value.
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, value, turnaround time, achievement 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 achievement time and the variety of refills.
This compares to the standard specialty pharmacy mannequin, during which payers usually have unique relationships with one specialty pharmacy.
“In the long run, what we’re actually trying to do by means of this mannequin — utilizing a versatile and tailor-made profit resolution — is create a greater reply than the present conventional mannequin, which is kind of a a technique, my method or the freeway, single pharmacy shelling out mannequin. … [We’re] flipping the standard 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 value,” stated Mark Thierer, co-founder and CEO of Waltz Well being, in an interview.
Serve You Rx selected Waltz Well being as a accomplice as a result of the 2 had been making an attempt to unravel 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 unravel the precise problem that we had been trying to unravel simply internally, which was, how can we take away conflicts of curiosity?” Jasniewski stated in an interview. “How do we alter our pricing mannequin to be one thing a bit extra disruptive and novel and finally, present the very best worth to our shoppers, present the very best degree of flexibility?”
By the partnership, Serve You Rx pays Waltz Well being a price on a per prescription foundation to assist direct prescriptions to specialty pharmacies, Thierer famous.
The partnership comes as specialty treatment 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 medication additionally accounted for about half of complete drug spending in 2021.
Sooner or later, the businesses hope to broaden the partnership to further therapeutic lessons, like GLP-1s, Thierer added.
“[We hope to move] into pharmacy and medical administration collectively in a blended method,” he stated. “There’s an terrible lot that expertise can do to streamline this course of, and we’d wish to take all our instruments over time and plug them in with Serve You.”
These aren’t the one firms trying 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.
Photograph: megaflopp, Getty Pictures
