Waltz Health, a digital health company focused on prescription drugs, launched Waltz Connect on Monday, a new solution aimed at reducing the cost of specialty medications.
Chicago-based Waltz Health was founded in 2021 to serve payers and pharmacies. The company offers a product called Marketplace Search, which allows users to search for any prescription and see the range of prices available at pharmacies. The company also works with health insurance plans to integrate its marketplace solution into pharmacy benefits.
The company's Waltz Connect product supports payers and focuses on specialty medications. When a member submits a prescription for a specialty medication, Waltz Connect redirects the prescription to the most appropriate pharmacy, regardless of the pharmacy's network status with the payer. This routing is based on the member's benefit design and several factors, including price, turnaround time, accuracy of fulfillment, member experience, and adherence rates. These factors can be customized by drug class or specific medication. Health plans also receive information about the member's status, prescription onboarding, contact information for the selected pharmacy, expected turnaround time for fulfillment, and refill frequency.
Additionally, Waltz Connect will have a marketplace with a network of specialty pharmacies that compete on price, service levels and clinical outcomes, said Mark Thieler, co-founder and CEO of Waltz Health.Waltz Health also announced Monday that specialty pharmacy RelianceRx is joining its specialty pharmacy network.
“We see the biggest value driver as Waltz Connect gives payers what they've been craving: unparalleled transparency and unlocks competition from specialty pharmacies,” Thieler said in an interview.
Payers who use Waltz Connect pay a fixed fee to Waltz Health, Thierer added.
“We don't have a spread, we don't charge kickbacks, we don't take a margin from the pharmacies themselves,” he said, “so it's a completely transparent model and we are paid per prescription to roll out these services.”
The launch of Waltz Connect comes at a time of rising specialty drug costs. According to the U.S. Department of Health and Human Services, specialty drug costs will exceed $300 billion in 2021, up 43% since 2016. In 2021, specialty drugs accounted for 50% of total drug spending. Payers are struggling as they often overpay for claims where there are cheaper alternatives. Meanwhile, patients often suffer delays in accessing their life-saving medications. Specialty pharmacies are also struggling as they frequently receive prescriptions they cannot fill, Thieler said.
Waltz Health launched Waltz Connect with these challenges in mind.
“It's an ecosystem that doesn't have a lot of satisfied campers, and that's what we're showcasing today with Waltz Connect,” Thierer said.
Thieler has extensive experience in the pharmacy benefit management (PBM) space, having previously served as CEO of OptumRx, one of the big three PBMs alongside CVS Caremark and Express Scripts. However, he noted that there is room for improvement in the traditional PBM model when it comes to price transparency and patient experience. In the long term, he hopes Waltz Health will become a “fully tech-enabled pharmacy benefit management company” that can replace these larger players.
“The system is built with a fair amount of friction,” Thieler said, “with everything from prior authorization to different approvals to non-adherence to prescriptions and not actually being able to get the medications that doctors prescribe. … In the short term, I think it's likely we'll work with[the big PBMs]but over time, I think we'll be the alternative. It's a new model, and we probably won't be the only ones.”
Photo: cagkansayin, Getty Images
