Digital health company Waltz Health charts move into payer market

Digital health company Waltz Health is cracking into the payer market by inking its first partnership.

Waltz aims to deploy technology to rethink the way medications are priced, distributed and prescribed. It first rolled out its Marketplace Search tool in retail pharmacies and is now adapting that platform for payers, pharmacy benefit managers and self-insured employers.

Though it didn't name its new health plan partner, Waltz is integrating its technology into its PBM, which serves millions of people across the country, according to the announcement. Thanks to the tool, members will be able to automatically receive the lowest price at the pharmacy counter through either their benefits or a cash-pay option with a discount.

"The product that we built, you can think of as Kayak for prescription drug cards," CEO and co-founder Mark Thierer told Fierce Healthcare in an interview. "The important thing here is we have the integration capability to move it into the tools that these plans use to interface with their members."

The Marketplace Search tool deploys artificial intelligence to sift through "disparate and confusing" data that can include prescription pricing, healthcare services and clinical outcomes from multiple sources, Waltz said. It can then use that information to elevate the most valuable prescription data directly to the member.

Waltz's platform can also be customized to meet the needs of a specific organization, according to the announcement, ensuring members can access the savings they need with a seamless experience.

And the product has clearly resonated with investors, as Waltz Health has secured backing from GV, Define Ventures, Echo Health Ventures, Blue Venture Fund, Byers Capital and Twine Ventures.

Thierer said it's critical to ensure platforms like this are essentially invisible to the member so as to avoid unnecessary confusion. For instance, seniors are the highest utilizers of medication, and making the tool work in the background avoids forcing those patients to start using a complex product. 

"It's got to be seamless, and they don't have to do anything," he said. "It's critically important. I think that's the next generation in the benefits business, for sure."

Thierer is no stranger to the PBM business as the former CEO of Optum Rx, one of three companies that dominate the market. He said it shouldn't come as surprise that there are new entrants, like Waltz, that are looking to shake up the status quo in this sector.

PBMs have taken heat from pharmaceutical manufacturers, lawmakers and patient advocates for the role they may play in rising drug prices. Part of the problem is that there's not much transparency into how the industry functions, and, at the same time, they're raking in quite a bit of cash.

"The reason that new offerings and new disrupters like us makes sense is because the incumbents are protecting their profitability," said Thierer. "The value that they're delivering at the consumer level is not in keeping with the amount of money they're making."

"So this is why I think timing is perfect, you know, to emerge as a new player here," he said.

Ultimately, he said he views Waltz's future as a full-scale PBM, and it's putting the building blocks in place now to reach that goal.

"I think it's very difficult to think you can parachute into this industry and blow up an incumbent that's of scale, and so capable," he said. "So our view is to run alongside that model, and kind of Brick by Brick make incremental improvements."