Waltz Well being, a digital well being firm targeted on prescription medication, launched Waltz Join on Monday. The brand new answer goals to scale back the price of specialty medicines.

Chicago-based Waltz Well being, based in 2021, serves payers and pharmacies. It has a product known as Market Search, which permits customers to seek for any prescription and see the vary of costs accessible at their pharmacy. It additionally companions with well being insurers to carry its market options to their pharmacy benefit.

The corporate’s Waltz Join product helps payers and focuses on specialty drugs. When a specialty prescription is submitted for a member, Waltz Join routes it to probably the most acceptable pharmacy, whatever the pharmacy’s community standing with the payer. This routing is predicated on the member’s profit design and a number of other components, together with worth, turnaround time, accuracy of success, member expertise, and compliance charges. These components may be personalized by drug class or particular drugs. Plans additionally obtain details about the member’s situation, prescription onboarding, chosen pharmacy contact data, anticipated turnaround time of success, and variety of refill prescriptions.

Moreover, Waltz Join has a market with a community of specialty pharmacies that compete on worth, service ranges and medical outcomes, mentioned Mark Thierer, co-founder and CEO of Waltz Well being. Waltz Well being additionally introduced Monday that specialty pharmacy Reliance Rx is becoming a member of the specialty pharmacy community.

“A part of what I see as the largest worth driver is that Waltz Join provides payers one thing they've been crying out for, which is unparalleled transparency and it opens up competitors with these specialty pharmacies,” Thierer mentioned in an interview.

Payers who use Waltz Join pay Waltz Well being a flat price, Thierer added.

“We don't have any diversification. We don't take any rebates. We don't take any margin from the pharmacy itself,” he mentioned. “So it is a utterly clear mannequin the place we receives a commission per prescription to implement these companies.”

The launch of Waltz Join comes as specialty drug prices are hovering, to exceed $300 billion in 2021, a 43% improve since 2016, in accordance with the U.S. Division of Well being and Human Companies. In 2021, specialty medicine accounted for 50% of complete drug spending. Payers are struggling as a result of they usually overpay for claims involving cheaper options. In the meantime, sufferers usually face delays in getting lifesaving drugs. Specialty pharmacies are additionally struggling as a result of they usually obtain prescriptions they will’t fill, Thierer mentioned.

With these challenges in thoughts, Waltz Well being launched Waltz Join.

“It's an ecosystem with not many joyful customers, and that's what we're introducing as we speak with Waltz Join,” Thierer mentioned.

Thierer has in depth expertise within the pharmacy profit administration (PBM) house, beforehand serving as CEO of OptumRx, one of many large three PBMs, together with CVS Caremark and Categorical Scripts. Nonetheless, he famous that the normal PBM mannequin wants enchancment on the subject of worth transparency and the affected person expertise. In the long run, he hopes Waltz Well being is usually a “totally technology-driven pharmacy profit supervisor” that may exchange these giant gamers.

“The system is constructed with important friction,” Thierer mentioned. “All the things from prior authorizations to a number of approvals to not adhering to formulary and simply not permitting you to get the drugs that your medical doctors prescribed. … I believe within the brief time period, it's extra seemingly that we'll work with [the big PBMs]. I believe that over time we will probably be another. It is going to be a brand new mannequin, and we are going to most likely not be the one one.”

Photograph: cagkansayin, Getty Pictures