Serve You Rx, a pharmacy benefit manager, announced a partnership with Waltz Health on Tuesday to leverage its AI-powered specialty pharmacy platform called Waltz Connect.
Milwaukee, Wisconsin-based Serve Your Rx is an independent PBM serving insurance brokers, consultants, third-party administrators and their employer clients. Starting May 1, Serve You Rx’s clients will have access to Waltz Connect, which offers a marketplace where specialty pharmacies compete on quality, clinical outcomes and price.
Waltz Health just launched Waltz Connect in August. When a specialty prescription is submitted for a member, the platform redirects it to the most suitable pharmacy based on the member’s benefit design, price, turnaround time, fulfillment accuracy, member experience and adherence rate. In addition, health plans receive information about the member’s condition, prescription, onboarding, the selected pharmacy’s contact information, expected fulfillment time and the number of refills.
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This compares to the traditional specialty pharmacy model, in which payers often have exclusive relationships with one specialty pharmacy.
“In the end, what we’re really looking to do through this model — using a flexible and tailored benefit solution — is create a better answer than the current traditional model, which is sort of a one way, my way or the highway, single pharmacy dispensing model. … [We’re] flipping the traditional model on its head, creating an open network that’s intelligently routed, using these prescriptions to put them in the right place at the right price,” said Mark Thierer, co-founder and CEO of Waltz Health, in an interview.
Serve You Rx chose Waltz Health as a partner because the two were trying to solve similar problems in the prescription drug space, according to Justin Jasniewski, CEO of Serve You Rx.
“When we heard about this product, it seemed to solve the exact issue that we were attempting to solve just internally, which was, how do we remove conflicts of interest?” Jasniewski said in an interview. “How do we change our pricing model to be something a bit more disruptive and novel and ultimately, provide the best value to our clients, provide the best level of flexibility?”
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Through the partnership, Serve You Rx pays Waltz Health a fee on a per prescription basis to help direct prescriptions to specialty pharmacies, Thierer noted.
The partnership comes as specialty medication prices are skyrocketing. In 2021, specialty drug costs reached $301 billion, a 43% increase from 2016, according to the U.S. Department of Health and Human Services. Specialty drugs also accounted for about half of total drug spending in 2021.
In the future, the companies hope to expand the partnership to additional therapeutic classes, like GLP-1s, Thierer added.
“[We hope to move] into pharmacy and medical management together in a blended way,” he said. “There’s an awful lot that technology can do to streamline this process, and we’d like to take all our tools over time and plug them in with Serve You.”
These aren’t the only companies looking to disrupt the specialty pharmacy space. Another is Free Market Health, which works with insurers like Highmark to match members to the specialty pharmacy that best fits their needs.
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